News

NHS informatics review: integrated information systems key to Darzi's reforms

10 July 2008

The NHS Informatics Review Report, published today, highlights the need for integrated information systems across all care settings, to support patients, the public and staff.

The Review has developed a three-pronged approach to developing information systems:

delivering better, safer care through supplying information to support care processes and sharing information across organisational boundaries, including social, independent and voluntary sectors;
empowering staff by giving the means to assess of quality and effectiveness of care through better research planning and management; and
empowering patients, service users, carers and the public by providing better information on services, online access to records, and involvement in decision making.

The Review has identified a wide-ranging lack of informatics skills in both the NHS and independent sector needed "to plan and implement change programmes in all their stages, from effective integrated planning, through technical deployment, business change and on to benefits realisation". There was a particular shortage of staff skilled in information governance, which includes data security.

There will be a drive to develop the necessary leadership and capability in the informatics workforce and also to improve the informatics capability of the general and management workforce.

Consultations with stakeholders in preparing the Review showed a desire for "a full review of the process involved in putting new systems and services in place, including its effectiveness."

The Review acknowledges that while there have been significant successes in the National Program for IT, particularly in the NHS network, N3, and PACS, there have been problems with delivery of the 'strategic' systems being developed by the Local Service Providers.

It recognises the need for interim solutions so that "patient information can be made available across different IT systems, different care providers and different care settings ahead of strategic systems’ delivery". The Review recognises that there will be differing local requirements because of specific local healthcare needs and existing systems in place, and that effective alternative systems can be rolled out as interim solutions.

The Review says that "we will investigate options with the supplier community to gain NHS access to appropriate interim solutions for the short term".

Stakeholder consultations identified five key elements of functionality that would make systems acceptable for secondary care users:

a patient administration system (PAS) with integration with other systems and sophisticated reporting;
order communications and diagnostics reporting (including all pathology and radiology tests and tests ordered in primary care);
letters with coding (discharge summaries, clinic and A&E letters);
scheduling (for beds, tests, theatres etc.);
eprescribing (including ‘To Take Out’ (TTO) medicines).

Local informatics plans are to identify the 'roadmap' to achieve these five elements in the systems available in their regions. The three LSP areas in England will develop their local roadmaps with the Strategic Health Authorities.

'Non-strategic' systems (ie outside the scope of current national contracts for IT systems) that have been shown to be effective in use in NHS organisations, both from the LSPs and other suppliers should be available for use by NHS organisations "provided that they are able to confirm a roadmap to converge with the strategic solutions within the timescales of the national contracts". It will be up to SHAs and PCTs to decide on the adoption of interim solutions.

With the NHS Next Stage Review focussing on quality there is a need for systems that can provide the necessary data regarding patient safety, patient experience and clinical outcomes, for professional use and to inform the public. There is no national set of clinical outcome and quality measures to provide this foundation for the measurement of quality, therefore "clinically credible" outcome and quality measures will be developed.

To provide quality of staff — through education, training and access to knowledge and information — there will be an NHS staff portal, called mystaffspace, to provide a one-stop-shop for key information sources. There will also be a 'professional' portfolio, as an extension to mystaffspace, to provide information about professional outcomes, development and knowledge for clinicians.

A critical aspect of achieving quality of service is reporting measurement data from multiple systems and sources, including health records, finance and workforce. To reduce the resources needed, data will be collected automatically as a by-product of operational systems.

There are large areas where standard definitions do not exist, such as community, mental health and adult social care, so these will be developed to enable the measurement of quality.

Information and resources for the public will be developed through NHS Choices and HealthSpace, though the role of NHS Direct is not clear. Information on services will include secondary, primary and community care, and "in time" social care. The aim for HealthSpace is to enable patients not just to view their healthcare records, but to contribute to them and manage their health better, especially for chronic conditions such as diabetes and heart disease.

The Review says that many of the recommendations can be implemented within existing "resources, programmes and governance arrangements". It says local organisations "must take greater responsibility for implementation" with leadership from both management and clinicians.

New requirements that will need further funding and resources are:

information for patients and the public;
improved reporting for staff;
extending the scope of NHS Care Records Service to meet the needs of patient pathways and to allow information exchange with social care and voluntary sector organisations, such as hospices;
national work on standards development, implementation and training.

An implementation programme has been established to deliver the Review recommendations and maintain momentum generated by its preparation — up to end of March 2009. A further report, the Health Informatics Review Implementation Report, describing progress and next steps in more detail will be published in the autumn.

Reference

1. Department of Health. The Health Informatics Review Report. 10 July 2008. www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_086073