Delivering 21 st Century IT Support for the NHS. National Specification for Integrated Care Records Service. Consultation Draft

Transcription

1 Delivering 21 st Century IT Support for the NHS National Specification for Integrated Care Records Service Consultation Draft Version: 1.22 Date: 26 July 2002 Status: Draft Version /08/02 Page 1

2 CONTENTS Executive summary...4 PART I : OVERVIEW Introduction Context National IT Programme for the NHS Structure of this Document OVERVIEW of Integrated Care Record Service Context IT in the NHS IT Support for the 21 st Century NHS Integrated Care Record Service Benefits...21 PART II : OUTPUT REQUIREMENTS Generic Functions Introduction Patient / Service User Index Diagnosis, Treatment and Care Management Booking and Scheduling Ordering and Results Reporting Prescribing Digital Imaging Access to Knowledge Clinical Governance Operational Service Management User environment Introduction Information capture Information Analysis and Reporting Tools and Reporting Information Governance Specific Requirements Introduction Primary Care Community and Social Care Acute Care Mental Health Pathology National Service Frameworks Introduction Diabetes Delivery Requirements Version /08/02 Page 2

3 7.1 Project Management Implementation Acceptance Testing Training Support arrangements Future Developments Approach To Existing Systems Data Conversion Service Requirements Performance and availability System Resilience Accessibility and Reliability Remote access to information Security Systems Administration Maintenance PART III : STANDARDS Standards Introduction Information Governance Terminology, Classification and Grouping Clinical Communications XML Schema Datasets Service Management E-Government Interoperability Framework Infrastructure in NHS organisations PART IV : NATIONAL SERVICES National Services Overview Infrastructure Services Population Record Services Health Record Infrastructure NHS Direct Care Assessment System Information and Decision Support Services Analytical Services Business Support Services Version /08/02 Page 3

4 Context Executive summary The publication Delivering the NHS Plan (Department of Health, April 2002) develops the vision already set out in the NHS Plan of a service designed around the patient. Patients will be offered more choice of where and when they get treatment. The announcement of the Spending Review settlement for 2002 (HM Treasury, July 2002) included publication of the Public Service Agreement targets for the NHS. The prime objectives for the NHS are to: Improve service standards Improve health and social care outcomes for everyone Improve value for money. IT in the NHS will support that vision and empower both patients and professionals by offering explicit choice, for example with electronic booking of appointments. IT will support the frontline delivery of care and treatment. The national strategic programme for IT in the NHS contains four major deliverables: Delivering the robust infrastructure, including the national approach to authentication, security and confidentiality; Delivering electronic booking of appointments; Delivering electronic transfer of prescriptions; Delivering the integrated care records service. This document provides the specification to take forward the life-long health records service. Purpose The aim is to implement integrated care records services (ICRS) records which are: integrated across all health and social care settings; designed around the patient, and not around individual institutions; therefore able to support the implementation of care pathways as part of National Service Frameworks. The major change proposed is to move away from the concept of a number of separate information systems based primarily around organisational structures to a situation in which professionals are provided access to the one integrated service. The services will include access to records and the functionality needed to support clinical practice. Implementation of these services will lead to a number of important outcomes for: service users, where a modern IT-enabled NHS will directly and visibly impact on how they interact with the care system and on their experience as consumers of care services health and care professionals involved with direct patient and service user care, who will have safe, fast, modern IT to support them routinely in their work managers, researchers and other professionals not involved in direct patient care to have ready access to high quality, confidential, information The requirements for such a service will continue to develop, and there is therefore a need for local flexibility and tools, and for commitment from suppliers to provide enhancements as part of the service. Version /08/02 Page 4

5 ICRS incorporates the Information for Health concepts of both the organisation-specific Electronic Patient Records and also the cradle-to-grave Electronic Health Record. The framework for ICRS is illustrated in the diagram overleaf. Part II Local Services StHA1 StHA2 4. User Environment Information Capture Information Reporting Analysis User Tools Information Governance StHA Specific Functions Primary / Community Social Care Acute Care Mental Health Pathology 3. Generic Functions Clinical Governance Knowledge Management Digital Imaging Prescribing Ordering and Reporting Booking and Scheduling Diagnosis and Care Service User Index 6. NSFs Diabetes Mental Health Older People Cancer CHD Part III Standards Part IV National Services Analytical Services Network NHS Direct CAS Population Record Application Services Security Access Control Reference HRI Nhs.uk NeLH Files Directory Infrastructure Services Decision Support Information Services estaff Record Finance Approach One of important features of the strategic programme for IT in the NHS is the shift to more corporate, national approaches. For the purposes of health records, this means: there will be a national approach to procurement and implementation; the resulting services will need to conform to national standards; the resulting services must interoperate with emerging national services such as the Electronic Staff Record and the Health Records Infrastructure. Conformance to national standards and use of national services is critical to enabling access to health records across the whole country, in support of emerging needs around National Service Frameworks and emergency care. User Requirements Part II describes the requirements for the integrated care record service. These requirements are structured so as to highlight the need for integration across health care sectors, and to highlight the need for flexibility and future development. At this stage, suppliers are asked to provide high level responses, to give more scope for innovative solutions, although it should be noted that more detailed requirements will be built into schedules as part of the resulting contracts. There is a core set of generic functions, to operate across the whole health community. These include the patient / service user index, diagnosis, treatment and care management, booking Version /08/02 Page 5

6 and scheduling, ordering and results reporting, prescribing, digital imaging, access to knowledge (developing into decision support), clinical governance and operational service management. It is important that such services are provided within a common user environment that enables the capture of information, the reporting and analysis of such information, and the provision of flexibility and user tools to support local development. It is vital that the services are based around a robust frame of Information Governance, addressing security, confidentiality and data quality issues. There will remain some specific requirements, which relate to functions or data items relevant to a particular context of care. Specific requirements are provided here for primary care, community and social care, acute care, mental health and also for pathology. Key to the NHS Plan is the work on specific delivery areas, particularly around those where National Service Frameworks are being developed. It is critical, however, that the information services to support NSFs are seen as part of the integrated whole, and not as a separate silo for a given condition type. This version of the specification includes the example for diabetes, where the requirements to support the care of patients is described with reference to the generic functions in the earlier sections. Future versions of this specification will include similar sub-sections for areas such as Coronary Heath Disease, Mental Health, Older People and Cancer. One of the reasons for ICRS being described as a service rather than as a system is because the facilities will be critical to the running of the modern NHS. Fast, reliable and efficient access is absolutely fundamental. The specification therefore describes both the delivery requirements and the service requirements for ICRS. The delivery requirements include the project management, implementation, training and support arrangements. The service requirements section includes details about performance and availability, system resilience, accessibility and reliability and security. One of the features of the modern NHS, and for services designed around the patient, will be the need to support access to information from a wide range of locations and through a wide range of media. Standards Part III provides an overview of national standards, indicating the direction of travel for the whole range of standards, and highlighting the need for suppliers to commit to implementation and migration activities to support the uptake and use of these standards. Standards are critical to enabling the exchange of information, both locally and nationally. In the context of this specification, there is a wide range of standard to be considered. The following sub-sections are included here: Information governance - including confidentiality, security and data quality Terminology and Classification - SNOMED CT, ICD-10, OPCS-4, etc. Clinical Communications - HL7 version 3, DICOM and ENV XML Schemas Datasets Training and Service Management Technical - mainly e-government Interoperability Framework (e-gif) standards Infrastructure in NHS organisations. Version /08/02 Page 6

7 National Services Part IV describes the range of national services which will be implemented and supported by the NHS Information Authority. Local solutions will need to integrate with these services, and conformance to published interfaces will be a mandatory requirement. These services cover three main areas: infrastructure services, application services and information services. Relevant examples of each are given below: infrastructure services: includes the core networking facilities, security and confidentiality services and core services such as and directory; application services: includes operational areas such as the Health Records Infrastructure, NHS Strategic Tracing Service and NHS Direct Clinical Assessment System, together with the more analytical services such as the NHS Wide Clearing Service. A range of business support services is also being implemented, including the Electronic Staff Record Service; information services: includes the National electronic Library for Health, nhs.uk and the development of support for e-learning and the NHSU. Consultation We are anxious that as full a consultation as possible takes place with NHS IT directors and staff, clinical and GP leads on IT and NHS IT industry and suppliers around both ICRS and national standards and specification. Comments on the Integrated Care Record Services should be directed to the National IT Programme Office by 31 st August npso@nhsia.nhs.uk. We welcome comments on the following issues: is the vision for ICRS consistent with the overall objectives for the NHS? what phasing of ICRS functions is required in order to create a long-term basis for growth, whilst meeting specific targets and objectives in the shorter-term? are there any major gaps in the specification which need to be filled? is the level of detail sufficient for the procurement of such services? are the standards and national services appropriate to support implementation of the local services? Version /08/02 Page 7

8 Part I : Overview Version /08/02 Page 8

9 1. INTRODUCTION 1.1 Context April 2002 brought three key developments for the NHS: increased investment in the NHS from the 2002 Budget more investment to fund a catch-up period leading to health spending of 9.4% of GDP by 2008 the publication of Delivering the NHS Plan that sets out how the new model for the NHS and extra investment will bring improved services to patients the final Wanless report on securing the future health service Together they mark a watershed in both the funding and future of the NHS and the role of IT in securing the most from increased investment, driving forward reform and delivering prompt, convenient and high quality health and social services Delivering the NHS Plan develops the vision already set out in The NHS Plan of a service designed around the patient. Patients will be offered more choice of where and when they get treatment IT in the NHS will support that vision and empower both patients and professionals by offering explicit choice, for example with information about access to and performance of services. By the end of December 2005 every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their GPs to choose the hospital and consultant that best meets their needs. This will be supported by electronic booking systems. By the end of December 2005 the first generation of electronic records will also be available. IT will support the frontline delivery of care and treatment, though it will be 2008 before the full array of clinical applications and functionality from electronic records are available in all PCTs and Trusts Delivering the NHS Plan also clearly states that a greater share of the new funding will be provided for training, capital infrastructure and modernised IT to ensure that the large extra investment the NHS is now getting is translated into reform and capacity growth. This will take the form of a step change in capital spending, higher investment in information and communication technologies and the training and enabling of health professionals The Wanless report has several key recommendations for IT in the NHS including a doubling of IT spending that is protected to ensure it is not diverted for other purposes, stringent national standards for data and IT that are set by the centre and better management of IT implementation. It states, without a major advance in the effective use of ICT, the health service will find it increasingly difficult to deliver the efficient, high quality service which the public will demand. This is a major priority which will have a crucial impact on the health service over future years. 1.2 National IT Programme for the NHS The national strategic implementation programme Delivering 21st Century IT : Support for the NHS - is concerned with major developments in the deployment and use of Information Technology (IT) in the NHS. It aims to support the delivery of the NHS Plan through the use of modern information technologies to: support the patient and the delivery of services designed around the patient, quickly, conveniently and seamlessly; Version /08/02 Page 9

10 support staff in the delivery of integrated care, through effective electronic communications, better learning and knowledge management, cut the time to find essential information (notes, test results) and make specialised expertise more accessible; improve management and delivery of services by providing good quality data to support NSFs, clinical audit, governance and management information The national strategic implementation programme focuses initially on the NHS but developments in Social Care will be taken forward in parallel so that services can be integrated as and when local communities are ready The major change proposed is to move away from the concept of a number of separate information systems based primarily around organisational structures and with which health and social care professionals interact, to a situation in which professionals are provided with access to an Integrated Care Records Service (ICRS). This service will include access to records, the functionality needed to support clinical practice and supporting services training and helpdesk. ICRS incorporates the Information for Health concepts of both the organisation-specific Electronic Patient Records and also the cradle-to-grave Electronic Health Record The strategic programme and new approach is summarised by the following diagram. Figure 1 National Strategic Programme National direction and performance management of IT - manage funding, procurement process, application portfolio - assist introduction of new working practices - capture & re-use experience / knowledge Partner with egov & IT industry to deliver compliant, open systems & clinical applications - National, regional, local, phased approach - EPR standard system specification first priority Provide Prescriptions Service Provide Bookings Service Build Integrated Care Record Service Create foundation services for NHS IT architecture - authentication, consent & confidentiality Accelerate connecting the NHS with secure broadband Build national data and data-interchange standards based on open XML technology At the very heart of the strategic programme for IT are four major national deliverables: the infrastructure, prescriptions service, bookings service and care records. This document provides the specification to take forward the pillar relating to the integrated Version /08/02 Page 10

11 care record service; this document will be used to support the procurement and implementation activities This document is being published with a summary of the procurement strategy and will be followed in September 2002 by the full procurement strategy document and next version on ICRS following this initial consultation. At this stage, it describes the overall vision for integrated care records, and should be read in this context. 1.3 Structure of this Document The specification comprises the following: PART I OVERVIEW 1. Overview of Requirement 2. Vision of Integrated Care Records Service PART II OUTPUT REQUIREMENTS 3. Generic Functions 4. Specific Requirements 5. User Environment 6. Delivery Requirements 7. Service Requirements PART III STANDARDS 8. Standards PART IV - NATIONAL SERVICES 9. National Services A number of source documents have been used in the development of this specification, including the Output Specifications from the South West EPR, London Mental Health, London Primary, Community and Social Care Records and the Academy of Colleges Clinical specification. Additional material has also been used from the Primary Care Information Board, the Pathology Modernisation Project and those involved in the development of the Diabetes Information Strategy This document is a draft and will continue to be developed. There are a number of known gaps (eg support for other NSF areas) and work will be commissioned to address these. Following this round of consultation, formal version control will be exercised by the NHS Information Authority on the specification from September The specification has been deliberately pitched at a high level at this stage. Within the requirements section, a range of functions has been described. At the end of each subsection, there are boxes with numbered questions for suppliers to complete. These questions are intentionally broad, in order to give suppliers more scope to describe their proposed solutions. Version /08/02 Page 11

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13 2. OVERVIEW OF INTEGRATED CARE RECORD SERVICE 2.1 Context The NHS Plan has set out the vision of a service designed around the patient. This section describes what this means both for the health service and, more specifically for the IT needed to support it The announcement of the Spending Review 2002 (July 2002) set out the Public Service Agreement targets for the NHS. The prime objectives for the National Health Service are to: Improve service standards; Improve health and social care outcomes for everyone; Improve value for money The full set of agreed targets are shown overleaf in Table Delivering the NHS Plan set an agenda for achieving the necessary reform, to include: expanding capacity; incentives for performance; choices for patients; plurality and diversity; strengthened devolution; health and social care; and strengthened accountability Delivery plans are being developed for each of the priority areas of work for the Department of Health and the NHS. These are underpinned by four requirements that are common to all: Values; Networks; Standards; Information The exploitation of information and communications technology to support care processes is a critical component of delivering the NHS Plan and the development of new patient focused services. Increasingly, care professionals should be able to rely on information systems and technology to support them in undertaking specific care activities with individual patients or service users; and in the operational management of those care services However, it is vital that such plans for information address the needs of the whole health family. Any attempt to create a solution for just one issue (eg one NSF area) or organisation would compromise the working of the NHS system. We need to cover the full care continuum and for the NHS that will include acute, community and primary care trusts, Foundation trusts and GP practices. The specification described in this document therefore intends to capture the overall requirements for all health and social care users. Version /08/02 Page 13

14 Table 1 Public Service Agreement (PSA) Targets for the Department of Health (Spending Review 2002) Aim: Transform the health and social care system so that it produces faster, fairer services that deliver better health and tackle health inequalities. Objective 1: Improve service standards 1. Reduce the maximum wait for an outpatient appointment to 3 months and the maximum wait for inpatient treatment to 6 months by the end of 2005, and achieve progressive further cuts with the aim of reducing the maximum inpatient and day case waiting time to 3 months by Reduce to four hours the maximum wait in A&E from arrival to admission, transfer or discharge, by the end of 2004; and reduce the proportion waiting over one hour. 3. Guarantee access to a primary care professional within 24 hours and to a primary care doctor within 48 hours from Ensure that by the end of 2005 every hospital appointment will be booked for the convenience of the patient, making it easier for patients and their GPs to choose the hospital and consultant that best meets their needs 5. Enhance accountability to patients and the public and secure sustained national improvements in patient experience as measured by independently validated surveys. Objective 2: Improve health and social care outcomes for everyone 6. Reduce substantially the mortality rates from the major killer diseases by 2010: from heart disease by at least 40 % in people under 75; from cancer by at least 20 % in people under Improve life outcomes of adults and children with mental health problems through year on year improvements in access to crisis and CAMHS services, and reduce the mortality rate from suicide and undetermined injury by at least 20 % by Improve the quality of life and independence of older people so that they can live at home wherever possible, by increasing by March 2006 the number of those supported intensively to live at home to 30% of the total being supported by social services at home or in residential care. 9. Improve life chances for children, including by: Improving the level of education, training and employment outcomes for care leavers aged 19, so that levels for this group are at least 75% of those achieved by all young people in the same area, and at least 15% of children in care attain five good GCSEs by 2004; (The Government will review this target in the light of a Social Exclusion Unit study on improving the educational attainment of children in care) narrowing the gap between the proportions of children in care and their peers who are cautioned or convicted; and reducing the under-18 conception rate by 50% by Increase the participation of problem drug users in drug treatment programmes by 55 % by 2004 and by 100 % by 2008, and increase year on year the proportion of users successfully sustaining or completing treatment programmes. 11. By 2010 reduce inequalities in health outcomes by 10% as measured by infant mortality and life expectancy at birth. Objective 3: Improve value for money 12. Value for money in the NHS and personal social services will improve by at least 2% per annum, with annual improvements of 1% in both cost efficiency and service effectiveness Version /08/02 Page 14

15 2.2 IT in the NHS Historically, the NHS has not used or developed IT as a strategic asset in delivering and managing healthcare. While there have been good, usually local, IT initiatives sponsored by enthusiastic visionaries, these have been outweighed by the overall lack of funding and development priority given to IT at all levels In 1998, the NHS recognised that IT had a major role to play in healthcare, and Information for Health (IfH) defined the strategic approach for the use of IT. Since the advent of IfH, there have been improvements in the level of IT funding and in the uses that are made at local, regional and national levels. However, there remain a number of critical barriers to the effective use of IT as a strategic tool in the delivery of healthcare by the NHS, including: small amounts of protected IT funding that has had low priority for many Trusts leading to very low levels of investment; lack of a national mandate and direction and lack of a cohesive, nationally-led IT architecture for data and system standards that allow information and processes to follow the patient s journey through the NHS seamlessly; the need to improve co-ordination of IT resources and procurements to increase the pace of implementations and provide fast, better value for money IT projects; low levels of secure, high-bandwidth connectivity for NHS staff, backed by means of authenticating users to access sensitive patient information The publication of the NHS Plan in 2000, and the work that has since been underway to implement the Plan, has brought about a key change in the attitudes and structures and overall philosophy in the planning and delivery of care services The fundamental premise is that the NHS is moving towards care services which offer people fast and convenient care delivered to a consistently high standard with services available when people require them, tailored to their individual needs The key principle is that there are care services designed around the needs of patients and service users and not based on NHS institutions This means that the information systems which directly support patients and service users, support professionals in providing care, and support those involved in planning and running the NHS, also need to be designed and delivered based on the needs of the patients and service users, not the institutions This represents a shift from the current situation, where systems are generally run along institutional lines and therefore only deal with a portion of an individual patients interactions with the NHS they deal with sections of the total patient journey The vision for information and IT is therefore to connect delivery of the NHS Plan and the modernisation of care services with the capabilities of modern information technologies to enable that modernisation process to be more effectively delivered. 2.3 IT Support for the 21 st Century NHS It is possible to identify a number of key themes which the Government intends should be reflected in the future including: 1 The NHS Plan Version /08/02 Page 15

16 The use of integrated care pathways will integrate care for patients, health care professionals, and between health care organisations and care settings; Co-ordination and collaboration in the planning of integrated services across NHS organisations, local authorities and other agencies and the allocation of resources for groups of patients and service users; Informed patients, service users, carers and local populations, who are able to participate in decisions on the care that they should receive; Accessible services, which are responsive to the changing expectations of patients and service users; Evidence based care that is effective in achieving outcomes; Patient safety through quality-assured services that are regularly monitored and reviewed and guarantee equity in care across the care communities; Efficient services that are benchmarked both locally and on a national basis Figure 1 illustrates at a high level the range of services which need to be supported and the normal settings within which those services are delivered. Figure 1 Range of services to be supported Integrated Programme of Care for a Population, Patient or Client Group Primary and Community Care Secondary Care Tertiary and specialist care Social Care Prevention Promotion Screening and surveillance Investigation / Assessment / Diagnosis Treatment/Care Inputs Rehabilitation Maintenance / Respite / Palliative Care Care Continuum Based on this context it is clear that the service must support the provision of all of the components of care that an individual patient or service user requires. These are not confined to a single care setting, or provided by an individual organisation or group of care professionals In an NHS designed around the patient we need to recognise that patients have an increasingly sophisticated relationship with care services, and that their relationships are with multiple institutions and across a continuum of care. It is useful to consider care required by individuals in terms of the care continuum, which extend over time and across care settings, care professionals and organisations. Version /08/02 Page 16

17 2.3.5 For example, the care of a particular condition such as a stroke may involve: an initial urgent call to an Out of Hours Service; emergency patient transport services and an emergency admission to an acute hospital; rehabilitation in a step-down intermediate care facility following acute treatment; a further rehabilitation and support package of care, involving home care support and attendance at day centres; carer support and education for carer and patient This care continuum will comprise care services provided by several organisations within a care community, including social services and the independent sector. This requirement, as demonstrated by the NSFs, requires care inputs from a wide range of care professionals, in different settings including the patient s home The care professionals, who are directly involved in planning and providing care to the patient throughout the continuum, require access to the records relating to the patient and associated systems support functionality at all locations at which care is planned or provided. The electronic record systems within care communities must support these care processes, which span care settings and organisations The record service is required to support patient care in a number of situations: Routine single episode of care (may involve more than one visit); Emergency and unscheduled care; To support care pathways such as the National Service Frameworks; To provide aggregated clinical data for research, clinical audit, public health and management of the NHS. What we are seeking to achieve with ICRS is summarised in Table 2 overleaf. Version /08/02 Page 17

18 Table 2 What we want from an Integrated Care Records Service For patients, a modern IT-enabled NHS will directly and visibly impact on how they interact with the care system and on their experience as consumers of care services to: 1. feel confident that information about them and their history of care is accurate and easily accessible to any other professional involved with their care and with a need to know, except where the patient has expressed a view to the contrary 2. be reassured that their professionals have access to information about the latest care knowledge and practice 3. be reassured that the information that they provide at any healthcare encounter is kept secure 4. be able to look at their records and have the ability to amend or add information (taking into account the legal implications) 5. be able to understand their care process through use of patient-friendly care pathway views 6. be offered the opportunity to exercise choice over date, time and place of future encounters with care services 7. be offered choice over where to pick up prescriptions 8. be able to use a range of technologies PC s, phones, digital TV to interact with care services and at times that are convenient to them 9. have access to evidence of the quality of care provided to them or by local providers 10. be able to understand their records and to derive beneficial advice and support from them 11. provide links to patient communities and support groups For professionals involved with direct patient and service user care, to have safe, fast, modern IT systems to support them routinely in their work and to: 1. have ready access to information about their patients when they want it, from wherever they want it (including peripatetic staff), and structured in a format they want 2. have ready access to the knowledge, clinical tools and related services they need to support their clinical decision making process 3. be able to use high quality information in support of the implementation of audit, peer review, clinical effectiveness and other aspects of Clinical Governance 4. be able to rely on the fact that they will be notified about responses to service requests which could be referrals or test requests - or lack of response within an appropriate time period 5. be assured that their records and communications with patients and colleagues are secure and conformant with agreed information sharing protocols 6. be able to participate in lifelong learning through access to education, training and development services For managers, researchers and other professionals not involved in direct patient care for example epidemiologists to: 1. have ready access to aggregated and anonymised information to support research, planning and management of care services. 2. be able to use high quality information in support of the implementation of clinical governance and improvement of public health 3. be able to participate in lifelong learning through access to education, training and development services Version /08/02 Page 18

19 2.4 Integrated Care Record Service This requirements document outlines the information and systems support requirements associated with the high quality care of patients and other service users by health and social care professionals. The ICRS is the: Integrated, operating across the care continuum, Care, covering both health and social care, Record, single record based around the patient, Service, to reflect a need to address not only the functionality required of the information systems but also the nature of the supporting services which will be required to effectively support professionals in the delivery of the care process The purpose of ICRS is to support the provision of high quality care across the whole health community, linked to national services and conformant to national standards. ICRS should therefore be looking to support a seamless continuum of care for an individual patient or service user across all care settings within a care community (and across care communities) The components of ICRS are illustrated in Figure 2 below. This reflects the core requirements for record services at local level, supported by a range of national services and national standards. Figure 2 ICRS Components Part II Local Services StHA1 StHA2 4. User Environment Information Capture Information Reporting Analysis User Tools Information Governance StHA Specific Functions Primary / Community Social Care Acute Care Mental Health Pathology 3. Generic Functions Clinical Governance Knowledge Management Digital Imaging Prescribing Ordering and Reporting Booking and Scheduling Diagnosis and Care Service User Index 6. NSFs Diabetes Mental Health Older People Cancer CHD Part III Standards Part IV National Services Analytical Services Network NHS Direct CAS Population Record Application Services Security Access Control Reference HRI Nhs.uk NeLH Files Directory Infrastructure Services Decision Support Information Services estaff Record Finance Version /08/02 Page 19

20 2.4.4 The requirements set out in the document are intentionally generic. They are also largely independent of organisational structures. They have been identified by considering: firstly, patients and service users and the problems and conditions for which they require care; and secondly the care processes and associated activities involved in assessing individuals care needs, planning this care and providing it The intention of this requirement is to describe the vision of integrated care record services for the NHS. This vision is seeking to implement shared care support services across all sectors of the NHS primary, community, mental health, social care, acute and specialist care. However, the more specific requirements will undoubtedly change over time, for instance as new patterns of care emerge, and it is therefore vital that this requirement specification is not seen as an end in itself Unlike traditional systems requirements documents, the scope of the requirement has not been constrained by focusing on a range of settings in which this care is provided. While important from the perspective of the professional providing care, this constraint is essentially artificial in terms of the care processes as seen by individual service users or patients. This builds upon the Information for Health concepts of both the organisation-specific Electronic Patient Records and also the cradle-to-grave Electronic Health Record, extending them to meet the needs of a patient-centred NHS It is also intended that the requirement should support all care professionals. Different care disciplines may require different detailed content within components of patient and service user records, and may make lesser or greater use of certain systems functionality. However, there is a generic requirement for all care professionals directly involved in planning and providing care to individual patient and service users to have access to comprehensive shared records relating to these patient and service users In addition they should have access to the records and services that they need at any location at which care is planned or provided This access to records and services always need to be on a need to know basis and should be subject to controls and authentication which reflect the requirements of the Data Protection Act and the NHS codes of practice for protecting patient confidentiality The document considers the support required for the direct care of service users or patients a health 2 records service. Information relating to patients and service users required to support audit, service performance management and planning and various accountability and management processes should be derived by abstraction from the service user records supporting direct care and not through separate data collection systems. Figure 3 illustrates the relationship between information used to support care delivery and the planning and management of care services. 2 In this context health is taken in the broad definition, covering both health and social care Version /08/02 Page 20

21 Figure 3 Service Elements Care Processes to be supported Logical Integrated Electronic Record Systems Patient / Service User Information Personal details Admin details Problems Conditions Needs assessment Investigations / Tests Care Plan Care provided Outcomes Reviews Financial Assessments and Contributions Application Functionality Access Capture Process / Analyse Assemble Exchange For example: Booking / referral Scheduling Allocation Prescribing Prompts / Alerts Orders / Notifications Other Information Available Resources For example: Care Professionals Voluntary support Secondary care Drugs Protocols / Pathways Eligibility Criteria Welfare Benefits Service user charges Access Control, Security and Confidentiality Safeguards 2.5 Benefits This section identifies the primary areas of benefit to be gained through the procurement and implementation of Integrated Care Record Services (ICRS) as identified within this document. Individual care communities will attach different priorities to the benefits to be achieved and may wish to amend and extend the benefits illustrated in the tables below Potential providers of such services should be required to comment on the extent to which their proposals may be expected to deliver these benefits and indicate any further areas of benefit, which the care community should investigate. Version /08/02 Page 21

22 Table 3 Benefits to Service Users and Carers Benefit Area Access to advice, information and care services Flexible and responsive service bookings Quality of care processes Examples of the types of benefit Service users and carers have improved access to details of services that they may access to meet their needs, in a format and language that they understand Service users also have improved access to advice on the prevention of problems, the care or treatment of the problems that they are experiencing; and the expected outcomes of care. Service users and their carers are able to access this information in a wide range of locations and circumstances, and care professionals are able to respond quickly to requests for information and advice; and make this available in an appropriate form. All relevant aspects of the patient / professional clinical encounter can be captured and accessed. The shared record enables all those involved in the treatment of a patient to have access to relevant information The ability to access information where required, and to share the electronic record rather than relying on the availability of the paper notes, will save time and effort, leading to faster coding and faster documentation Patients will know that professionals treating them are effectively and accurately sharing information about their condition with each other. The public will be more assured that the information systems support a more consistent approach to healthcare delivery in line with best practice Improved booking and scheduling facilities, and the faster provision of results will reduce wasted time, and hence enable greater throughput. Making appointments at a convenient time for the patient will greatly reduce the number of failed appointments (Do Not Attends) Improved booking facilities, and the ability to group together or block-book sets of appointments and associated tests will be quicker, much more efficient and will improve patient convenience More flexible booking arrangements will make it easier for patients to choose times convenient to them. The integration of patient details will ensure that conflicting dates are not set up. A person centred approach is adopted in which information about an individual s problems is given once, irrespective of the number of professionals and agencies subsequently involved in the delivery of services. There are reductions in the elapsed times for the completion of processes and between services being requested and provided. Service users receive clear and timely information on the progress of requests for services that have been made on their behalf, assessments that are being undertaken and reviews of their care plans. Service users may have a single care professional responsible for co-ordinating the assessment of their needs and their subsequent care plans. Users and carers views and perspectives are actively considered and reflected in resulting care plans. Users and carers able to be more involved in the care process Version /08/02 Page 22

23 Benefit Area Examples of the types of benefit Service users complaints concerning care services provided are considered and where appropriate acted upon in reviewing their care. Service users receive clear and timely information on care plans to be provided, any financial contributions that they will be expected to Effectiveness and outcomes of care More appropriate prescribing with computer support. Better co-ordination of discharge facilities. Privacy, security and confidentiality make etc. Service user s problems are fully assessed and a care plan developed as appropriate, which reflects evidence of best clinical and care practice. Care professionals are prompted to ensure this takes place. Service users at risk are clearly identified and preventative actions or early care provided is provided. Service users previous care experiences are used to ensure inappropriate care is avoided in the future (allergies, reactions etc.). The risks associated with treatment or care is minimised through care professionals having access to evidence of possible complications or interactions; and by identifying where key care actions have not been completed. Service users care plans have clear goals and objectives, which are expressed in terms of the expected outcomes that should be achieved. The achievement of these outcomes is monitored and exceptions identified and acted upon. Care professionals with appropriate skills and experience are involved in care. The use of expert prescribing systems and reduction of duplicate data entry will reduce time spent by clinical staff. Electronic information on drugs will be available to clinical staff. Automatic generation of lists of patients on medication will reduce manual checking and speed the administration process. This will be enabled through real time patient location, faster processes of ordering and the more effective scheduling of support departments (e.g. social workers, patient transport) Service users are assured that identifiable information is secure and confidential and that their consent for its use for different purposes, by different care professionals is obtained and complied with. Version /08/02 Page 23

24 Table 4 Benefits to Care Professionals and Staff Benefit Area More effective use of clinical staff time. Time and workload management Access to evidence and knowledge Support for implementing and monitoring National Service Frameworks. Reductions in litigation risk through better documentation. Better co-ordination of discharge arrangements. Examples of the types of benefit The timely provision of information for clinicians will enable time to be spent more effectively. It will not be necessary to waste time searching for test results, and scheduling facilities will enable forward planning of workload. Support for the use of protocols will reduce the time spent on ordering Reduce care professional time involved in recording information already maintained by other care professionals and agencies. Reduce the number of forms to be completed to request services, resources etc. The ability to access information where required, and to share the electronic record rather than relying on the availability of the paper notes, will save time and effort, leading to faster coding and faster documentation Reduce care professional time involved in locating service user paper-based case notes, and enable automated searching to identify documents / information required. This should include documents and parts of documents, digital images and audio recordings. Enable quicker communications between care professionals relating to the care of individual service users Reduce the time taken for communicating information when transferring responsibility for care (eg handover between shifts) Enable quicker response to requests Reduce time spent completing expenses returns. Improved support for team managers and care professionals in managing their caseloads and scheduling activities. Support continuing professional development and clinical / care practice improvements by enabling evidence to be reflected in standards and procedures and used directly to inform care decisions. Supporting information strategies will be included within each NSF. These will be designed to support the approved care pathways and will provide for the collection of relevant data. Access will be provided to supporting reference information and best evidence through the National Electronic Library for Health. The use of agreed care pathways will highlight required activities to clinical staff and will record action taken. Support for the implementation of clinical governance arrangements to assure the quality of care provided. Patients will know that professionals are treating them in accordance with agreed best practice protocols The information captured will support audit and evaluation processes. Order entry facilities will also provide warnings and alerts. The full audit trail within the system, with all information attributed and time and date stamped, will ensure complete documentation for each patient. The more effective scheduling of support arrangements such as patient transport, social workers and community staff will facilitate more prompt discharge. To Take Home prescribing can be processed quicker to ensure TTHs are ready for when the patient is Version /08/02 Page 24