News in brief
ISCG strengthens grip on national IT: The Information Services Commissioning Group is to strengthen its role as a national co-ordinator of healthcare IT strategy, reported eHealth Insider. It will publish a national technology strategy in March 2014 and will launch its own website, EHI Live 2013 has been told. Speaking at the NEC in Birmingham, Beverley Bryant, director of strategic systems and technology at NHS England, said all the NHS arms length bodies will feed into the new strategy. NHS England was due to publish its own technology strategy – ‘Unleashing the Power of People’ – next month, but Bryant said the organisation needs more time. It will also publish its strategy around March next year. She said NHS England is taking the lead on the national technology strategy to ensure that “technology does not become a means in itself” and to pull together interests from across health and social care. “It’s really important when creating a technology strategy that everything is grounded in clinical care, what’s best for patients,” she told delegates. Components of the system-wide strategy will include an: identity strategy; consolidated directory of services; architecture for integrated digital care records; security and information governance strategy; and the future funding model for underlying infrastructure.
GP practices ‘need IT overhaul’: According to a report from the Academy of Medical Royal Colleges some GP practices are “stuck in the 1990s” because of outdated technology, reported Health Service Journal (subscription required). In some cases, family doctors are unable to receive emails, which are larger than 5Mb, according to the report. Some medics are forced to send vital patient information by post, courier or sometimes even via the patients themselves. As a result, patient care is poorer and less effective and transferring data in such a way presents greater costs to the NHS, the report states. Elsewhere in the healthcare system, information is often sent out in “incompatible formats”, the report found. The academy is calling for the health service to “radically overhaul” the way it collects and shares data. It said that the structure and content of patient records must be standardised across the whole health service. Terence Stephenson, chairman of the Academy of Medical Royal Colleges, said: “If the NHS is to continually improve patient care and safety it is essential that we bring our IT and communication systems into the 21st century. Computer technology plays a huge part in medicine and is a key way in which we can strengthen the patient experience. Poor systems could disempower staff leaving them fighting to deliver care effectively.” Health secretary Jeremy Hunt said: “It is deeply frustrating to hear stories of elderly dementia patients turning up at A&E with no-one able to access their medical history, or doctors prescribing the wrong drugs because they don’t know what drugs a patient is already on. We need to put this right. That’s why one of my top priorities is helping the NHS meet the challenge of going paperless by 2018. Technology is key to helping our A&E staff meet the massive demand they face as the population increases and ages.”
£20m of tech fund to go on open source: Up to £20m of the ‘Safer Hospitals, Safer Wards: Technology Fund’ will go towards open source development, reported eHealth Insider. Speaking at EHI Live 2013, Beverley Bryant, director of strategic systems and technology at NHS England, said 20 trusts want to pursue an open source electronic patient record system. She said further trusts have also expressed an interest, so a large sum of the first round of the tech fund will go towards supporting that. “We’re going to reward £15m-£20m specifically for trusts to develop an open source option,” she said. Bryant confirmed that she expected a similar amount to be awarded from the second round of the tech fund, due to open shortly. “When we launch tech fund 2, we expect that we will be able to stimulate further demand. We’re going to be ready to launch in December for responses in February,” she confirmed. She explained that NHS England was working with four different organisations and suppliers to put their products on the framework: IMS Maxims; University Hospitals Birmingham NHS Foundation Trust with its in-house PICS e-prescribing system; the US Veterans Association system, VistA, and HP.
NHS England launches index on trusts’ digital capabilities: Variable levels of the use in IT in hospital trusts has seen NHS England announce a rating system that will allow trusts to see how they compare with others over the use of technology, reported Commissioning GP. NHS England and EHI Intelligence hope the launch of the Clinical Digital Maturity Index (CDMI) will show NHS hospitals how investing in, and effectively using, IT can improve patient safety and outcomes, reduce bureaucracy, and deliver efficiencies. The index, free to all NHS organisations, will help them rate their own technical capabilities, such as e-prescribing and e-referral, and identify where progress can be made. The CDMI also delivers on NHS England’s commitment to develop and publish a Clinical Digital Maturity Index in Putting Patients First: The NHS England Business Plan 2013/14 – 2015/16 to drive the move to digital records, prescribing and referrals by March 2015. NHS England has partnered with EHI Intelligence to develop the CDMI, which is based on EHI’s existing tool and uses information obtained directly from NHS Trusts, to provide the learning and information completely free of charge to all NHS organisations, saving the NHS about £1.6m. Beverley Bryant, Director of Strategic Systems and Technology for NHS England, said, “Digital systems drive up the quality and safety of patient care by preventing drugs being prescribed incorrectly and, potentially, lethally because patient notes have been lost. The CDMI is an important first step in realising NHS England’s digital vision, and I hope it will help stimulate discussion between trusts, their peers and partners about what good, better and best look like. We will make this information freely available to all NHS Trusts so they can see where they sit in relation to their peers.”
Academy calls for standardised records: Electronic patient records must be standardised to support both patient safety and patient access, the Academy of Medical Royal Colleges (AMRC) says in a report on NHS IT. The report calls for “radical changes” to healthcare IT to ensure that patients are treated safely and effectively, arguing that improved electronic records are crucial to delivering both, reported eHealth Insider. Professor John Williams, director of the Royal College of Physicians Health Informatics Unit, said: “The Francis Report and Berwick Review both identified that the NHS has lost its way, and must be reoriented to deliver patient-focused, compassionate, safe care. Central to achieving this is the availability of real-time accurate information that focuses on the patient.” He added: “Today’s NHS information systems are way off the mark. This document sets out how we can realise the technology revolution.” Electronic records systems must focus on the individual patient and not the disease, intervention or service in which they are seen, says AMRC’s report, ‘i-Care: Information Communication and Technology in the NHS’. There is a need for standardised structure and content of records across the NHS as well as standardised views of records for patients. Clinical IT should be kept up to date with upgrading built into contracts. IT system suppliers should focus on developing mobile solutions and publishing their interface specifications to allow apps to be integrated to wider systems.
NHS England to rebrand ‘toxic’ Summary Care Records: Summary Care Records (SCR) may be rebranded due to the ‘toxicity’ around the future of the programme, said NHS England’s director of technology, reported Pulse. The records are to be renamed the ‘partial GP record’ as the NHS moves towards becoming paperless by 2015. The rollout of the SCR programme has been plagued with problems, and the GPC IT lead called for the whole thing to be scrapped earlier this year because only a small proportion of records are being accessed and the current utilisation rate means each viewing to date has effectively cost an estimated £1,200. However speaking at the EHI Live conference in Birmingham this week, NHS England’s director of strategic systems and technology, Beverley Bryant, said that in the ‘fullness of time’ SCRs may become redundant, but in the meantime they would be rebranded. She said: “There has been a lot of toxicity and noise around the future of the SCR. It probably over promised in terms of what it was about. But the reality is that we have seen a better uptake of summary care records by secondary care clinicians, than in any of the five years prior to that. And we’re potentially going to rename it our partial GP record. We think having access for our A&E, 111 and out-of-hours clinicians to that partial GP record, is a really important step to achieving integration.” Other major objectives include updating Choose and Book, re-evaluating the IT operating model for GPs and doing more to develop e-prescribing.
Health 2.0 predicts end of enterprise IT: Desktops and enterprise systems in healthcare will disappear with the rise of mobile technology and cloud-based solutions, the co-chairman of Health 2.0 has said. Speaking at EHI Live 2013, Matthew Holt, who runs the American health conference in Silicon Valley, said that as more patient information is collected and shared electronically, enterprise systems will become less common, reported eHealth Insider. “The desktop is eventually going to die and enterprise systems will go with it, and the cloud will make that easier,” said Holt. He added that healthcare was playing catch-up with other industries when it came to IT, and that it needed to address three issues to get the most out of technology. The first is mobility, in the sense of making sure that users can access information easily, wherever they need it. As an example, Holt said that patient access to records is quite low in the US. However the ‘blue button’ initiative, in which a blue button is added to a page to show patients they can view and download their medical records has spurred interest. “There are about 100m people whose organisations have signed up to the blue button,” he said. “Patient ownership and access to your own data is incredibly important.” The second issue, he said, are trackers. People can already measure their own blood pressure, record their exercise activity, and use scales that are connected to Wi-Fi and other networks. It is not yet clear how healthcare providers can take advantage of this data.
Better access to GPs and social care ‘could solve the A&E crisis’: GP surgeries, social care services and NHS walk-in centres must open for longer to take pressure off casualty wards, leading emergency doctors have urged, warning that A&E is being taken to mean “anything and everything” by too many patients, reported The Independent. As a new analysis of official figures revealed that ever more accident and emergency are breaching national targets to see 95% of patients in less than four hours, the College of Emergency Medicine said that “effective alternatives” to A&E needed to be available seven days a week, for 16 hours per day. Outlining 10 key targets for resolving what it called “the emergency crisis”, the College also called for action to resolve a “massive staffing shortage” by making work on casualty wards more attractive with increased incentives for doctors working nights and weekends. The report comes as an analysis of A&E attendance figures by the Health Service Journal found that the average NHS trust was seeing 93.9% of patients in between April and September this year – just below government targets, despite this usually being the time of least pressure on A&E wards. Accident and emergency chiefs say they are preparing for what could “our worst winter yet” on casualty wards.
Whistleblowing laws ‘must change’: Whistleblowing laws in NHS hospitals must change so staff can report their concerns with confidence, a union has said. The comments from Unison come after it emerged that two administrative assistants at a scandal-hit hospital complained that they were ”pressured or bullied” to falsify data relating to cancer patients to make it seem like people were being treated in line with national guidelines, reported Health Service Journal (subscription required). The Care Quality Commission (CQC) noted “inaccuracies” with waiting time data relating to cancer treatments and as a result a number of patients suffered “undue delays” at Colchester Hospital University Foundation Trust. Two administration staff, both Unison members, raised concerns about the issue but were ignored by a series of managers, a union spokeswoman said. They took their plight all the way up to the trust’s chief executive, who did not even respond to their email, she added. After their concerns were “ignored” the pair contacted the health watchdog, the spokeswoman said. The CQC report concluded that even though an internal investigation in 2012 identified concerns, the trust failed to investigate the allegations thoroughly. Christina McAnea, head of health at Unison, said: “Our members took a brave step by reporting to the CQC that they were being bullied and harassed by senior managers to falsify records relating to cancer patients. They raised their concerns repeatedly and in emails to senior managers, right up to the chief executive, but they were ignored.”
BT signs interoperability agreements: Four major healthcare IT companies have signed agreements with each other to offer a new interoperability solution to the NHS, reported eHealth Insider. BT, Harris Corporation, InterSystems, and Healthcare Gateway have signed agreements that will enable BT to offer a managed interoperability solution, based on a cloud-based platform. This will include three elements: a clinical and a patient portal, developed by Harris; and an integration platform, developed by InterSystems. The additional integration with Healthcare Gateway’s Medical Interoperability Gateway will enable information to be shared with the majority of GPs in the UK, since all of the major GP suppliers have signed up to work with it. Ian Dalton, president of BT Global Health, told EHI Live 2013 that interoperability would be an important theme in the future development of healthcare IT. “Providing co-ordinated care to patients across organisations relies on health and social care professionals having the right information at the right time,” he added in a statement. “Because we are connecting IT systems, not replacing them, care can be delivered [this way] at lower cost and improved efficiency.” Dalton added: “We have chosen to work with three, experienced best of breed suppliers that share our desire to help health and social care organisations to overcome the challenges they face in creating a new world of care.”
More s251 stop-gaps put in place: Some patient confidential data will continue to flow to commissioners until the end of the year while the Confidentiality Advisory Group (CAG) considers three new Section 251 exemption requests, reported eHealth Insider (EHI). In April, the CAG granted NHS England a six-month extension to a s251 exemption, previously held by primary care trusts, to allow some identifiable data sets to flow to the newly created clinical commissioning groups and commissioning support units. This exemption expired on 31st October. However, a CAG spokesman told EHI that it has been extended, while new applications are considered. NHS England has submitted additional s251 requests to extend the current arrangements by 12 months. It has also applied for an exemption to cover “additional commissioning purposes”, but has not provided detail of what this would involve. The CAG spokesman said: “The earlier exemption given to NHS England has been extended, and NHS England has made three further applications, which are under consideration. The outcome of these applications will be published in early December in the minutes of the November CAG meeting.” The group does not make final decisions itself, but advises the health secretary. These stop-gap measures are necessary while the NHS adjusts to a new world in which both Dame Fiona Caldicott’s second review of information governance and the government’s response have confirmed that commissioners should not have access to patient confidential data (PCD) for commissioning purposes. Both say such data should only be used for ‘direct patient care’.
Emergency department clinicians lead IT project to streamline patient journey: Epsom and St Helier University Hospitals NHS Trust is developing an electronic whiteboard for its emergency department and implementing a clinical portal to give healthcare professionals a comprehensive, real-time view of relevant information about the patients they are treating, reported Building Better Healthcare. Clinicians at the trust are working closely with Harris Healthcare to develop and customise an interactive whiteboard to provide an overview of patient information at a glance. The system will enable healthcare professionals to track patients more clearly and efficiently from admission to discharge, provide information from underlying systems including temporary information, and capture information at the point of care. Additionally, the clinical portal will ensure that all relevant information about a patient is brought together in one place without the need to spend time searching between multiple systems for relevant medical information. Dr Amir Hassan, emergency medicine consultant at Epsom and St Helier University Hospitals NHS Trust, who has been heavily involved with the solution’s development, said: “Emergency departments are under significant pressure to treat patients, many of whom are in a critical condition, as quickly and effectively as possible. The whiteboard and clinical portal will allow us to work effectively by integrating the systems that we already have into one single view, therefore streamlining the clinician’s workflow and ensuring the best possible care for the patient.”
Increase in hospital admissions: The number of hospital admissions rose again last year, with the total level being nearly a third higher than that recorded a decade ago, data reveals. Health and Social Care Information Centre figures show hospital admissions rose from 11.4 million in 2002-03 to 15.1 million in 2012-13 – a 32.7% increase. Last year saw a 0.8% rise, reported Health Service Journal (subscription required). There has been a disproportionate increase in admissions of people aged over 75, with the total rising from 2.6 million in 2002-03 to 4.2 million in 2012-13 – a 61% rise. However, the average length of stay for this age group decreased from 15.9 to 9.8 days over the same period. Overall, the average length of stay for all admissions has decreased from 7.9 days in 2002-03 to 5.2 days in 2012-13. Diagnostic testing and rehabilitation made up the largest share of treatment for admissions last year at 11.8% of the total, followed by lower digestive tract work at 8.9% and other bones and joints, excluding the skull and spine, at 8%. Emergency admissions rose by 34.9%, from 3.9 million in 2002-03 to 5.3 million in 2012-13 – a 1.8% increase on the previous number. Information centre chair Kingsley Manning said: “Today’s report shows the rise in hospital admissions continues, and when looking at admission trends over the last five years hospitals in England are now dealing with more people than ever. Hospital episode statistics data provides a rich and detailed insight into secondary care. Our report shows how much the figures vary across different illnesses, injuries and treatment procedures.”
Health care analytics company increases staff: Wayne Parslow, Mike Smith and Helen Parslow have been appointed to the leadership team of MedeAnalytics, a leading provider of healthcare performance management and business intelligence solutions, reported ProHealthServiceZone. They will be responsible for continuing to extend the success of the company in the evolving analytics market across UK healthcare including within Clinical Commissioning Groups, Commissioning Support Units, acute and social care, while expanding the company’s footprint across existing and emerging markets in EMEA. Wayne Parslow, who has more than 29 years experience in IT, has been appointed general manager for Europe, Middle East and Africa (EMEA) and Mike Smith has joined as chief technology officer. Meanwhile Helen Parslow, who has over 22 years experience of developing US software companies into the EMEA market has joined the company as director of marketing and business development for EMEA. They are well known for raising the profile of new technologies within the NHS and across Europe – through previously held positions at clinical portal and integration provider Carefx, which was acquired by Harris Healthcare and, previously, Imprivata. Their appointment is testament to the strategic importance MedeAnalytics places on international growth and for demonstrating the power of its solutions and the difference they can make to healthcare delivery.
Opinion
Five ways to enable transparency in the NHS
In the Guardian this week, Tim Kelsey, national director for patients and information for NHS England, explains that data sharing between professionals and patients is the precondition for a modern healthcare system.
“Sir Bruce Keogh is a hero of our time. A decade ago, he campaigned for the publication of comparative data on surgical outcomes. In the years since British heart surgeons first published their data, their results have dramatically improved: survival rates for many procedures have increased by a third; 1,000 patients live each year when they might previously have died.
“Transparency saves lives yet, unlike heart surgery, it is not mainstream in our health and care services. Last year, I took a vision to the EHI Live conference to make transparency the operating principle of the new NHS. Data sharing between professionals, patients and citizens is the precondition for a modern, sustainable public service.
“This is the call to action in the NHS. We are the pioneers of a knowledge revolution – a data-led transformation in outcomes for patients.
Kelsey concludes by detailing five core offers which will support the ‘knowledge revolution’:
“1. Transform the availability and quality of clinical data
2. Share hospital data
3. Transform patient and public insight resources for local health and care communities
4. Empower real control for patients and the public, where they wish it
5. Success depends on making transparency a social movement in health and care.”
Virtual reality: observations from the Nuffield Trust study of Virtual Wards
An interesting blog from Dr Martin Bardsley at the Nuffield Trust, who comments on some reserved conclusions in a report looking at three early examples of Virtual Wards.
The key driver for Virtual Wards, Bardsley explains: “was the need to reduce emergency admission through better preventive management of patients who are at risk of hospital admission”.
The report, Bardsley concludes “…did not find a reduction in emergency admissions – though there were perhaps signs of lower elective admissions and outpatient attendances.
“Our findings however have to be tempered by the fact that during the course of the study we did find that in one site, the largest, the model of care had changed away from the Virtual Ward and reverted to something that was much closer to usual community care.
“So even though we did the work, we are still cautious about saying that Virtual Wards either do or do not work, and are actively trying to re-evaluate one of the sites at the moment – subject to having a clear path through the current jungle of information governance.”
Innovation is the lifeblood of the health service
In this weeks’ Health Service Journal (subscription required), Nick Golding, news editor, explains how it is often the case that in the most difficult conditions, the best ideas are born and the greatest creativity flourishes and that this is certainly true in the NHS.
“An unprecedented black cloud is lingering over the health service in the shape of the predicted £30bn financial black hole which it faces by 2020. It is only through innovation in areas including methods of patient care, technology, structural reform, patient engagement and organisational change that the NHS can adapt to the challenges it faces.
“As HSJ’s team of expert judges compiled our list of 50 top innovators, the level of innovation and creativity in the health service shone through.
“We sought to identify people who have taken innovative approaches that make a tangible difference to patients, healthcare colleagues, the healthcare system or wider society.
“The list also contains a mix of innovators who have long track records of driving change and those whose ideas have the potential to effect great change.
“Judges declared any conflicts of interests and, on one or two instances, stepped outside the room when their own attributes were discussed.
“All were impressed by the diversity and breadth of the NHS’ talent pool, something which should hold it in good stead as it seeks to respond to the challenges ahead.
“Innovation is the lifeblood of the NHS. It is right that our great innovators are recognised.”
This week the Kings Fund has put together a selection of articles and consultation responses following the publication of Robert Francis’s final report on the failings at Mid Staffordshire NHS Foundation Trust and the subsequent Keogh and Berwick reports. The Care Quality Commission – the independent regulator of health and adult social care in England – has made changes to the way it works and started a new approach to inspection.
Preparing for the Francis report: how to assure quality in the NHS
It is widely expected that regulators will come in for further criticism in the autumn when the Public Inquiry into the serious failures of care at Mid Staffordshire NHS Foundation Trust reports. The Francis Inquiry’s Chair, Robert Francis QC, is likely to propose far-reaching changes at all levels of the system, including to the external organisations that regulate quality. In this paper The King’s Fund set out their views on how the system of quality assurance, including regulation, needs to evolve, the principles on which it should be built and how it should operate.
The Care Quality Commission (CQC) has been under extremely intense national scrutiny recently. The Kings Fund set out their response to their consultation: A New Start.
Highland Marketing blog
In this week’s blog Kimberley Robinson reflects on her time at EHI Live 2013.
