Integrated Care Records Service in London
23 October 2003
David KwoChief Information Officer London ICT Programme
Integrated Care Record Service (ICRS)
• ICRS will provide consistent clinical support and secure patient data across all care settings: – Nationally, a repository of summary
patient information (NHS Spine)– Locally, tools for aiding delivery of
patient-centred care– Both facilitating the secure sharing of
electronic patient records
Integrated Care Record Service – scope and roles
Sample Set of Generic Processes
Range of Care Settings
Flexible Toolkit to Support Range of Data and Viewing Requirements
INTE
GR
ATE
D C
AR
E R
EC
OR
D S
ER
VIC
E
Master Patient Index (eMPI)Order Entry
Results Reporting
E-prescribingE-booking
Integrated Care Pathways
Resource scheduling
Screening
Bed Management
Ambulatory Care Management
Mental Health Act Administration
Clinical Decision Support
Confidentiality
Authentication Domiciliary Care Management
Clinical Noting
Clinical Correspondence/Summary
Management InformationGraphical AnalysisImage Management Casenote and Film Tracking
NHS Spine
Personal DemographicServices
E-booking
Electronic Transferof prescriptions
Common Services
Nationally built by NASPsand locally
implemented by LSPs Locally configured and locally implemented by LSPs
Cardiology Anaesthesiology
Intensive Care
Diabetes Theatres
Radiology
Pathology
MaternityOld Age Psychiatry
Radiotherapy
Child Health Screening
Trauma Rehabilitation
Respite Care
Palliative CareColposcopy
Nephrology
Endoscopy
DTCsACADs
GeneralPractice
AcuteHospital
CommunityNursing
HospitalPsychiatry
Therapies(OT/PT)
CommunityMental Health
DiagnosticDepartmentsHome
TertiaryCare
NHSDirect
PrisonSocialCare Hospices Private
HealthAmbulanceWalk-InCentres
National ICRSLocal ICRS
Integrated Care Record Service – scope and roles
Sample Set of Generic Processes
Range of Care Settings
Flexible Toolkit to Support Range of Data and Viewing Requirements
INTE
GR
ATE
D C
AR
E R
EC
OR
D S
ER
VIC
E
Master Patient Index (eMPI)Order Entry
Results Reporting
E-prescribingE-booking
Integrated Care Pathways
Resource scheduling
Screening
Bed Management
Ambulatory Care Management
Mental Health Act Administration
Clinical Decision Support
Confidentiality
Authentication Domiciliary Care Management
Clinical Noting
Clinical Correspondence/Summary
Management InformationGraphical AnalysisImage Management Casenote and Film Tracking
NHS Spine
Personal DemographicServices
E-booking
Electronic Transferof prescriptions
Common Services
Nationally built by NASPsand locally
implemented by LSPs Locally configured and locally implemented by LSPs
Cardiology Anaesthesiology
Intensive Care
Diabetes Theatres
Radiology
Pathology
MaternityOld Age Psychiatry
Radiotherapy
Child Health Screening
Trauma Rehabilitation
Respite Care
Palliative CareColposcopy
Nephrology
Endoscopy
DTCsACADs
GeneralPractice
AcuteHospital
CommunityNursing
HospitalPsychiatry
Therapies(OT/PT)
CommunityMental Health
DiagnosticDepartmentsHome
TertiaryCare
NHSDirect
PrisonSocialCare Hospices Private
HealthAmbulanceWalk-InCentres
National ICRSLocal ICRS
Timescales
• ICRS phase 1 December 2004• ICRS phase 2 December 2006• E-Booking functional December
2005• Infrastructure full connectivity
March 2005
Transformation
To:Whole continuum systemsClinical Patient’s NHS NumberFew systems/single solution setConsistent version(s) cross clusterPrimary/community/home focusPatient access/common interfaceModern, reliable, planned refresh Deep clinical functionality for allAdherence to standardsRich management information driven from clinical practice with knowledge and clinical decision support common place
Of systems from:Silo or organisation systemsAdministrativeMany patient identifiers1000’s of systems/many suppliersMany versionsAcute focusNo patient access Ageing legacy environmentDeep clinical functionality for fewMany technologies, few standardsLittle mgt info for PCT/SHA, lack of knowledge in general
To:“We make the best use of ICRS to improve care”
Of attitude from:“We use the best systems in our organisation”
London is one offive NPfIT Clusters.Each Cluster is responsible for localimplementation of ICRS.
(NPfIT’s geographic grouping of StrategicHealth Authorities in England)
London has...
• 32 acute trusts• 32 PCTs (1600 GP practices)• 10 mental health trusts• 31 Local Authorities
‘The London Museum of IT’
LSL Health Community
Trusts
Lewisham
Guys & St Thomas
PCTs
iSoft/SCMKing’s
iSoft/SCM SocialServices
Bexley & Greenwich Health Community
Trusts
Greenwich
Queen Elizabeth
McKessonStar
PCTs
Queen Mary’s Sidcup
SocialServices
Bromley Health Community
PCTs TrustsSocial
Services
Bromley
Siemens/Elan
South East London StHA
McKesson/Star
McKesson/Star
North Central London StHABarnet Health Community
PCTs TrustsSocial
Services
Royal Free Hampstead
Camden & Islington Health Community
Trusts
UCLH
Whittington
McKesson/Star
Barnet & Chase Farm
Cerner
(McKesson/Star)
McKesson/Star
PCTsSocial
Services
North Central London StHABarnet Health Community
PCTs TrustsSocial
Services
Royal Free Hampstead
Camden & Islington Health Community
Trusts
UCLH
Whittington
McKesson/Star
Barnet & Chase Farm
Cerner
(McKesson/Star)
McKesson/Star
PCTsSocial
Services
North West London StHA
KCW Health Community
Trusts
St Mary’s
Royal Brompton/Harefield
iSoft/NGate
PCTs
Chelsea & Westminster
IDX SocialServices
EHH Health Community
Trusts
Hammersmith
Ealing
IMS
PCTs
iSoft/ACTWest Middlesex
SocialServices
iSoft/ACT
Brent & Harrow Health Community
PCTs TrustsSocial
Services
North West London
iSoft/ACT/McKesson
Hillingdon Health Community
PCTs TrustsSocial
Services
Hillingdon
iSoft/Torex
iSoft/ACT
North East London StHABarking Health Community
PCTs TrustsSocial
Services
East London & City Health Community
Trusts
Bart’s/London
Homerton
Barking, Havering & R.
JEC System
PCTs
(McKesson/Trak)
(JEC System)
Newham
(JEC System)Social
Services
Waltham Forest
iSoft
MSW Health Community
Trusts
St Helier
St George’s
iSoft/SCM
PCTsIn-House Social
Services
Kingston Health Community
Trusts
Kingston
TorexPCTs Social
Services
Croydon Health Community
PCTs TrustsSocial
Services
Mayday
South West London StHA
McKesson/Star
London aims to...
… provide the world’s leading metropolitan healthcare system
… support London's care services in the modernisation of their culture, skills and processes, enabled by communications infrastructure and technology that ensure citizens and health and social services professionals have fast, safe, and equitable access to information and clinical services, whenever and wherever needed.
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
Results,Quality,
Audit…
Clinical Process
Plan
Action
Review
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
Results,Outcomes,
Audit…
Clinical Process
Plan
Action
Review
HistoricallyClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
HistoricallyClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
1. Fragmented and thin processes and
systems within organisation
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Historically
Hospital GP Community Mental Health Social Care
Clinical Process and Systems Support
PAS PAS PAS
2. At least in acutes, we tend to focus on actions (tests, drugs, etc) rather than what we intended (care plan) and whether
it was worth it (quality/outcome)
HistoricallyClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
3. Thus, we’re not in full control of
our business processes within
health organisations
Historically
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
Clinical Process and Systems Support
PAS PAS PAS
4. And, we have poor processes and control
ACROSS health organisations,
professionals and agencies: this bad for
patients and staff
But nowClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
ICRS
AssessmentCare Planing
DocumentationOrdersResults
PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging
CDSSWorkflow
AuditSec’y Analysis
eHealthTelecareCharging[Clinicals]
But nowClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
ICRS
AssessmentCare Planing
DocumentationOrdersResults
PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging
CDSSWorkflow
AuditSec’y Analysis
eHealthTelecareCharging[Clinicals]
Active Shared Functions: Assessments/SAP
Active Shared Functions: Community Wide Scheduling
Active Shared Functions: Community Wide Pathways
Active Shared Functions: Community Wide Workflow
Active Shared Functions: Community Wide IRT, eCPA
Active Shared Functions: etc.
But nowClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
ICRS
AssessmentCare Planing
DocumentationOrdersResults
PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging
CDSSWorkflow
AuditSec’y Analysis
eHealthTelecareCharging[Clinicals]
Active Shared Functions: Assessments/SAP
Active Shared Functions: Community Wide Scheduling
Active Shared Functions: Community Wide Pathways
Active Shared Functions: Community Wide Workflow
Active Shared Functions: Community Wide IRT, eCPA
Active Shared Functions: etc.
But nowClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
ICRS
AssessmentCare Planing
DocumentationOrdersResults
PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging
CDSSWorkflow
AuditSec’y Analysis
eHealthTelecareCharging[Clinicals]
Interface ICRS with Legacy?
But nowClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
ICRS
AssessmentCare Planing
DocumentationOrdersResults
PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging
CDSSWorkflow
AuditSec’y Analysis
eHealthTelecareCharging[Clinicals]
Separate PMI, user interface, duplicate data; new interfaces,
commercial interests, etc.
Separate PMI, user interface, duplicate data; new interfaces,
commercial interests, etc.
But nowClinical Process and Systems Support
Assess,Plan,
Record,Inform
…
Test/Screen,Treat,
Schedule,Inform
…
ReviewResults,
OutcomesAudit
…
Plan
Action
Review
Hospital GP Community Mental Health Social Care
PAS PAS PAS
ICRS
AssessmentCare Planing
DocumentationOrdersResults
PrescribingTherapiesSchedulePathwaysProtocolsScreeningImaging
CDSSWorkflow
AuditSec’y Analysis
eHealthTelecareCharging[Clinicals]
ICRS Implementation Priorities
• Order communications• Prescribing• Decision support
• Bates & Gawande NEJM June 2003
Implementation Approach
Design
Build & Test
Deploy Standard Product
Best Practice
NSF’s, SAP, CPA
•NICE
•CHAI
•Guidelines
•NELH
•MA
Pan London•Clinical design teams
•Build team
•Best Practice Focus Groups
•Infrastructure
•LSP
TrustTrust
TrustTrust
TrustTrust
TrustTrust
TrustTrust
TrustTrust
TrustTrust
TrustTrust
Local communities•Deployment teams•Benefits realisation•Local B/Case
Clinician-Lead Development
• 360+ different clinical/audit systems• Migrate to ICRS over time• Clinicians to lead spec’n, testing,
prototyping• Local developers certified • Retains innovation and engagement• IPR potential issue• Clinical research potential
Likely clinician response to inaccurate or out-of-date clinical content
CEOCEO
CMO in helicopterCMO in helicopter
Clinical StaffClinical Staff
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