IT AND TELECOMS
The electronic patient record (EPR) held by care organisations remains a founda- tion stone, yet these still have not been widely adopted in some care settings. Consequently we have recommended that all organisations providing care to the NHS should be given notice that they will be ex- pected to be using an EPR in a meaning- ful way within five years. Following review of the US criteria for meaningful use, the NHS should create a set that is appropriate to the UK.
The rigorous enforcement of standards is not an example of heavy-handed govern- ment interference, but a necessary condi- tion to allow a flourishing market of inter- operable solutions.
Critical to its success, the information revolution requires the creation and nur- turing of a viable market for information services, software and transactions to deliver high quality information services to patients, clinicians and organisations. However for this to happen and for IT sup- pliers to invest most effectively, the centre should give very clear signals to what it will be doing and what it will be leaving to others to do.
To rapidly engineer innovative solutions, the market requires a quickly established set of minimum standards and guidelines, built on existing good standards, for infor- mation collection, production, storage and use by the different actors across health and social care, set against a clear vision for the future. We believe this requires a single overarching approvals and/or as- surance body for informatics standards, directed by the Secretary of State for Health, covering health, social care and population health.
In some cases standards must be rigor- ously enforced. For example, we recom- mended that penalties for non-use of NHS Number by all care providers should now be applied. At the same time, we must make sure that ICT supplier accredita- tion schemes keep standards high, but also keep barriers to entry low. The NHS Interoperability ToolKit accreditation is a good recent example that has allowed rapid innovation from ICT suppliers – this should be extended as a ‘kite mark’ for in- teroperability.
The NHS needs to build on the infrastruc- ture of the National Programme for IT, but take rapid steps to reintroduce competi- tion into the NHS supplier market.
We are now at a point where the NHS move to multiple independent care pro-
viders, the focus on care pathways rather than institutions and the pressing need for every NHS organisation to be mak- ing progress simultaneously means that a more dynamic and entrepreneurial sup- plier market is required.
In an environment of monopoly suppli- ers, every new innovation the NHS wants needs to be specified, priced and paid for. We require a competitive environment, where suppliers will build in the function- ality that the market wants to enable them to win the next contract. Additionally the centre will want to maximise the use of legacy investments in information collec- tion, transfer, storage and reporting – vital if the execution of the information strategy is to be affordable.
We recommended that existing NHS pro- curement frameworks should be enhanced so that new vendors can be added to the framework if they demonstrate a product meets the national minimum requirements for information governance, functional- ity, data standards and interoperability, or removed if they are subsequently seen to fall below those standards. Equally, the Government should ensure that frame- works are sufficiently flexible to allow small companies to bid for contracts.
“The implementation of information services and IT needs to be viewed as a necessary supporting infrastructure to the redesign of service, not as an end in itself.”
The NHS and the informatics community needs to win back public and care profes- sional trust through better explanation of the benefits of the information revolution and more care in ensuring that the indi- vidual patient is engaged and activated in their health and wellbeing.
The transformation of care services re- quires an improved relationship between care system and individual patient. We require: patients to become equal part- ners taking control of managing their own health; choice to liberate patients and in- centivise providers; and transparency so the public can hold the NHS to account.
The information strategy must now dis- tinguish between these different purposes in order that they are individually ap- proached with patients (and care profes-
sionals) in the right way to achieve the desired outcomes.
We have recommended, where sharing is appropriate, that there should be a statu- tory obligation on healthcare providers to release information as a minimum stand- ard if contracting with the NHS.
To mitigate the risk that, in the early stages of data release, organisations, clini- cal teams and individuals will be unfairly judged by inappropriate interpretation of data that is not fully explained, we recom- mended that ministers, the Department of Health and commissioners will need to take a mature attitude in responding to data release and be at the forefront of ex- plaining to the public and the media why over-reaction is inappropriate, though this will not be easy.
Many believe that patient groups and oth- ers with trusted relationships could step into new key roles as ‘health intermediar- ies’ and ‘navigators’. But we must recog- nise that this will not happen of its own accord; they will require help overcoming concerns around liability, skill sets and ability to scale to meet market needs.
Technology also has strong potential to engage people in the care system and the NHS should utilise existing technologies that people use on a daily basis, and har- ness fresh and exciting technology to meet patients’ desire for better interactions with health and care systems.
These core themes, the information revo- lution and the awaited information strat- egy will all falter if we fail to invest in our health informatics workforce capacity and capability. A sustainable health informat- ics workforce infrastructure is required to be put in place, spanning health, public health and adult social care, and the pub- lic, private and third sectors.
As a postscript, we would like to thank our members for rising to the challenge of our consultation response, our specialist groups for their contributions, our Strategy & Policy Committee and Health Executive for their oversight and leadership, Clever Together for the provision of innova- tive crowd sourcing services and KPMG for their sponsor- ship and helping to facilitate our open debates.
Justin Whatling
FOR MORE INFORMATION Visit
www.bcs.org
national health executive Mar/Apr 11 | 31
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