Shared Electronic Health Records – Coming at Last to the UK!

Finally, it seems to be really coming!

The following appeared a few days ago in e-Health Insider.

Summary Care Record launched in Bolton

24 Oct 2007

The first 48,500 summaries of patient records have been uploaded to the NHS Spine and out-of-hours staff in the Bolton pilot area will start using them over the next few weeks, Connecting for Health announced today.

Bolton in North-west England was the first primary care trust to take part in the NHS Care Records Service Early Adopter Programme. Final staff training is underway at the town’s out-of-hours service which deals with, on average, over 5,500 calls per month from patients who require access to a GP outside of their own surgery’s opening hours.

Connecting for Health (CfH) estimates that - with the current upload figure - around 900 calls per month could be from patients with NHS Summary Care Records (SCR).

Announcing the milestone in the NHS Summary Care Records programme, CfH said: “The records, which contain key medical information, including current medications, allergies and previous bad reactions to medication, have been uploaded from eight GP practices.

Please continue reading here:

http://www.ehiprimarycare.com/news/item.cfm?ID=3145

The importance of this achievement is not to be underestimated. That it has taken almost a decade shows – as I have often said – just how hard a national shared EHR is to implement!

And, what a battle it has been, however to get this far. Seeing the reports of the first clinical records being sent to the NHS ‘Spine’ made me think back to 1998 and the excitement I felt when I realised the UK Government was actually serious about all this.

The seminal document for me is the document entitled:

Information for Health

An Information Strategy for the Modern NHS 1998-2005

A national strategy for local implementation

The document was written by Frank Burns who was at that time seconded from a major management role in the NHS to a position as Head of IM&T for the NHS, NHS Executive.

You can see from the table of contents – and the title – that Frank really understood Health IT in a way I would suggest simply no one in the present health bureaucracy does in Australia some 10 years later. Parenthetically, he also knew you need a plan!

The main chapter headings were:

1 An information strategy for the modern NHS places the strategy in the context of broader Government policy, and describes the strategic information objectives and targets

2 Supporting patient care sets out how electronic patient and health records will be developed to support the healthcare process

3 Supporting integrated care through NHS-wide standards and infrastructure identifies the national infrastructure that must be in place to support local action

4 Information for improving health and more effective management addresses what must be done to improve the flow and use of information for health improvement, clinical governance, performance management and national service frameworks

5 Meeting public and patients’ needs addresses how the information needs of patients and the general public will be met

6 Making it all happen outlines what needs to happen at national and local levels

7 Implementation programme sets the scene for detailed implementation guidance by discussing resources and local implementation timescales

The full document can be downloaded from here.

Now, almost 10 years later we are seeing all sorts of things flow..partly at least because of the sponsorship of the effort by a rather determined young prime minister who also got it! The forward to the strategy says it all!

Information for Health - Foreword by the Secretary of State for Health

"The challenge for the NHS is to harness the information revolution and use it to benefit patients."

Rt. Hon. Tony Blair,
All Our Tomorrows Conference, Earls Court, London. 2nd July 1998

Following the General Election of 1997 we took over responsibility for the National Health Service and took on the task of modernising it so that it can provide top quality treatment and care in every part of the country. We are determined to ensure that in future the buildings, plant and equipment in the NHS match the excellence of the staff.

Our White Paper The new NHS: Modern • Dependable set out a demanding ten year programme. It is designed to ensure that the NHS provides a universal, prompt, high quality service which is as close to people’s homes as can be achieved safely with current and developing levels of expertise and equipment. Clearly, information technology has a crucial role to play.

Up to now the use of IT in the NHS has not been a success story. Far from it. Lots of money has been wasted. Some important data has not been collected and used. Other data has been collected but not used. There has been too much emphasis on financial data to support an internal market at the expense of IT systems which could directly benefit patients. As a result, clinicians working in the NHS came to see data collection not as a help but as a hindrance to their work.

The Information Strategy we are launching in this report is not intended merely to put that right. It is a radical programme to provide NHS staff with the most modern tools to improve the treatment and care of patients and to be able to narrow inequalities in health by identifying individuals, groups and neighbourhoods whose healthcare needs particular attention. Our new information strategy will help staff do the jobs they came into the NHS to do and to do them better.

Using rapidly developing information technology clinicians will be able to draw on the expertise of others, sometimes over great distances. Test results will be dispatched in a fraction of the time it has taken up to now. Patient’s details will be transmitted between primary care and hospitals rapidly and accurately.

It will be possible to book hospital admissions over the phone at times which suit patients. Analysis of the data will show up any variations in the cost and effectiveness of treatments. Area studies will reveal sources of ill health or inequalities in healthcare.

All this won’t happen overnight. It will involve a lot of work. As with all our proposals for modernising the NHS, it will also involve detailed discussions with staff about what they want the system to provide and how best to provide it. But it has got to be done. A lot of people will have to change the way they work. The NHS can only face the challenges of the new century if it has the most modern information technology and systems in place. Nothing less will do for a service which looks after the health of the nation.

In the immediate future the most important non-clinical priority for the NHS must be to complete the work necessary to cope with the Year 2000 problem and make sure the NHS continues to function and function safely.

The details of this strategy are complex but the overall position is simple. We must grasp the opportunity which new information technology offers to improve both healthcare and health. All NHS organisations will have to play their part in delivering this key component in our programme to modernise and improve the NHS. Senior clinicians and managers throughout the NHS and senior members of professional bodies will have to show leadership and commitment. There are formidable educational, cultural and management challenges to overcome. But they are more than matched by the scale of the benefits the success of this strategy will bring for patients, professionals and the public.

Frank Dobson
Secretary of State for Health

I must say such an introduction to a national e-Health Strategy could almost be written by a new Federal Health Minster in OZ with just the dates changed!

I would guess there is another five years of hard slog before the work started by this initial UK strategy is getting close to being complete – although it should be noted some areas are (e.g. PACS rollout to all English Hospitals) – and it is only then will we really be able to finally evaluate what has been achieved. There are doubtless a huge number of lessons to be learnt at all levels as the major systems are more fully rolled out.

Being an optimist I think a decade from now we will all look back and wonder what all the fuss, pessimism and clinical resistance to change was all about and we will all be wondering what is the best way to get the benefits the UK will be achieving.

These are long journeys. We really need the leadership to start down a path that suits our health system sooner rather than later. I really like the idea of Australia having “A national strategy for local implementation”

David.