Friday, June 08, 2012

The UK National Health Service (NHS) Announces A New Information Strategy. Different Horses for Different Courses.

Big news for the UK NHS a few weeks ago.

New NHS information strategy unveiled

21 May 2012   Jon Hoeksma
The new NHS information strategy, published today, urges health and social care services to make full use of online technologies to put patients in control of their health and health records.
The strategy puts a particular emphasis on the creation of portals for patients, health professionals, commissioners and researchers, in a series of moves that health secretary Andrew Lansley says will free up the "power" of information.
A national ‘portal’ will be created as the definitive source of trusted information on health and social care by 2013. The NHS portal will inform patients’ decisions on selecting treatments and providers.
This fits with the central theme of shifting to a presumption of sharing information within and between health and social care providers, and capturing data just once at the point of care.
"These proposals will ensure that the NHS will become easier to understand, easier to access and will drive up standards of care,” said Lansley.
A new commitment is given to make it far easier for the life sciences industry to access anonymised patient records, with the lead role to be provided by the Health and Social Care Information Centre.
An ambition is also outlined to develop integrated health and social care records, and provide patient access, “once technology permits."
The long-awaited strategy, developed after extensive consultation, is titled ‘The power of information of information: Putting us all in control of the health and care information we need.'
The strategy is big on ambition – nothing less than the previously promised 'information revolution' – but only offers a sketchy map of how to get there.
No specific financial commitments are given, other than a brief statement that there will be some funding from capital investment for patients administration systems for hospitals that didn't receive them from NPfIT. (DM Note: Remind You Of Anywhere Else?)
Here is a news report:

Patient access to GP records by 2015

21 May 2012   Rebecca Todd
Providing patients access to their online records by 2015 is one of the few specific commitments in the government’s newly released NHS information strategy.
Many GPs remain unconvinced of the benefits of giving people access to their records, and are concerned that this will create more work for practices when patients ring up to question what they have read online.
However, the strategy predicts just a “modest” time investment by GP practices that will lead to significant increases in productivity that “far outweigh the initial investment."
The government has committed to all patients having secure online access to their GP record by the end of this parliament.
The information strategy says this means that by 2015, all general practices will be expected to provide electronic booking and cancelling of appointments, ordering of repeat prescriptions, electronic communication with the practice and online access to their record to anyone who wants it.
Although more half of GPs in England have systems which can provide electronic access to records, fewer than 1% offer the service.
The uptake for offering transactional services is much higher, with 70% of GPs using a system that offers it - and 30% using the functionality.
More here:
Here is a summary of some reactions.

Power plays

GPs and GP system suppliers are glad to see the NHS information strategy published, but they are concerned about some of its commitments and the lack of detail on how to achieve them. Rebecca Todd reports.
22 May 2012
The strategy makes much of its ‘vision’ for moving the NHS towards a ‘digital first’ service, and giving researchers, commissioners, clinicians and patients the information they need to make informed choices about health and care.
But it sets out little by way of targets or milestones and is virtually silent on what organisations will be put in place to support the vision – or where the money will come from.
Reaction to the strategy has been muted in the GP community, with doctors and suppliers welcoming the commitment to more transactional services for patients, but raising practical questions about giving patients online access to their GP records by 2015.
Commenters have also raised concerns that the strategy is silent on such pressing issues as what will happen to GP IT support and systems as primary care trusts are abolished and GPSoC comes to an end in 2013.
BMA and RCGP joint IT committee chair - Dr Paul Cundy
“[The strategy] is largely fairly sensible. [It talks about] online booking of appointments and prescription requests; but a lot of us are doing that already, so it’s a non-issue.
“There’s no problem with [patients] having access to their records, but there are issues which will have to be sorted out first, not the least of which is knowing it is the patient who is accessing the record.
“Also, it has long been my personal view that the records I hold on my computer systems are not the patient’s records. They are my records, and the patient element is a component of them.
“There’s an enormous danger in letting patients believe that they can edit the tools I use to treat them. Yet the message from politicians is that ‘it’s your record and you can write it’.”
BCS Primary Healthcare Specialist Group chair – Roz Foad
“The call for a reduction in face to face consultations as a means of saving money is something that should only be introduced with patients involved in the implementation.
“Some will welcome the idea of telephone and, no doubt later, video consultations as a way of saving time. But the heaviest users of the NHS - the elderly with chronic conditions - will most likely see this as another reduction in service.
“What GPs have been crying out for since before the National Programme for IT in the NHS is the introduction of an electronic discharge summary direct into their records, in a form which provides the right, relevant, correctly coded information – where is that an actual target in the new strategy? It is flagged up as a good pilot scheme example, but it should be a priority target, not just an ‘encouragement’.
“What I have not found in the strategy generally is the specifics; such as who is responsible for GP IT system commissioning and support after March 2013, which is less than a year away. What is the replacement for the National Information Governance Board? Information governance will be ever more critical, and I see no independent, credible, replacement.
“Indeed, I very concerned about the consent issues around sharing confidential medical records with outside bodies. Obviously, there are great benefits to research organisations, to public health and so on in doing this, but patients must be fully informed about where their data is going, and have the opportunity to opt out if they so wish.”
Chairman of the BMA’s GPs Committee - Dr Laurence Buckman
“There are GP surgeries which have been pioneering online booking and repeat prescriptions for a while now, so we would support the wider implementation of this, as long as it doesn’t impact on patients without IT access who [will need to be able to] continue to book appointments in the usual way.
“However, we would caution against the potential use of email for consultations, because compared to a telephone or face-to-face consultation, it is difficult for GPs to assess someone quickly and safely this way.
“When it comes to patients being able to view their records online, we believe patients should have access to their health records but we’d want to be satisfied that their records would remain secure before this was implemented.”
GP and EHI Primary Care columnist - Dr Neil Paul
“My reaction is: records access by 2015 – do we need that long? The government should be more ambitious. Most of what is in the strategy is doable now.
“And I don’t think it goes far enough. We need better, secure communications with patients rather than email. We need something like the banks have, so we can send messages to patients safely and confidentially.
“We need to be publishing more performance data. For example, hospitals often take months or weeks to let patients know what their CT scan results are, when I know they are reported on the same day. Publishing some of this data would force secondary care to invest in IT more.
“We need to do more than just share data. We need better tools to analyse data and we need open access to clinical systems to allow custom built modules that don't rely on big monopolies to dictate what we can and can't
Lots more reactions here - especially from the GP system vendors:
Here is some Ministerial Comment.

Ten years to digital first NHS: Earl Howe

Health minister, the Earl Howe, tells eHealth Insider editor Jon Hoeksma that the NHS needs to become ‘digital first’ in the next ten years, and the finally just-published NHS information strategy will help to get it there.
21 May 2012
The seventh Earl Howe is an unlikely revolutionary, yet he hopes his department’s new information strategy - ‘The Power of Information’ - will set in train a far-reaching upheaval in the way healthcare services are delivered.
The parliamentary under secretary of state, who has a background in banking, says the strategy is “deliberately bold and consciously so.”
It is intended to create a culture shift among health professionals and patients that will enable a “digital first” NHS to be built from the ground up over the next decade.
In an exclusive interview with eHealth Insider, the minister said the strategy is framed to set the ambition of a digital health service, which promises to be as transformative as the information revolutions that have re-shaped other sectors.
“Our task is to give a sense to patients and the public of how transformative this technology can be to their own lives.”
The strategy also aims to catalyse action by providing “a series of ideas on how this could be done, and already is in places being achieved.” But it is not intended to prescribe how the health services, or individual organisations, should get there.
Quality underpinned by information
A key theme in the strategy is for the government to step back and create the conditions that will enable quality information, local innovation and best practice to flourish and spread only intervening where necessary. Or as Earl Howe put it: “The role of the centre is to facilitate the process.”
The role of the centre is to set the direction of travel and create the conditions for local innovation, together with core infrastructure “including standards.” Use of the NHS Number and pushing adoption of SNOMED CT are the two mentioned by the strategy.
Heaps more here:
All in all fascinating stuff - and it will be interesting to see how it evolves without specific funding. We all know what happened with the NON-FUNDED National E-Health Strategy in Australia.

1 comment:

B said...

I've just had a quick look at the UK NHS Documents.

a) there is not a single mention of liability.

b) there is a lot of talk about the cost of medical errors, but there is no discussion about how to handle errors in the health information.

Rule number one when automating a human process. Always define how you will handle errors and exceptions and what do do when things go wrong.

When training people how to do things you only need to tell them the correct conditions and procedures. A simple instruction of "if anything unexpected occurs, request help from your supervisor" is sufficient to trap exceptions and errors.

With automated systems you need to define all potential errors and exceptions, otherwise the system will apply the rules incorrectly.

Neither the UK initiative nor the PCEHR have adequately worked out what to do when things go wrong. They haven't even raised it as an issue.

This is a sign of inexperienced, well meaning amateurs. Any experienced information system professional should know about error and exception handling.

Would you trust your health to a system that is expected to work perfectly all the time? One that assumes all health information is perfect and has been interpreted with no uncertainties?

And we can't forget rule number two when automating a human process. When things go wrong in an IT system, they go wrong faster and with greater consequences.

I'll repeat my mantra. Changing and incomplete requirements are the single best predictor of project failure. Neither the UK initiative nor the PCEHR have any requirements for errors and exceptions.