NHS England - 2 viewpoints on supporting clinical informatics in the 'new' NHS landscape. Professor Jonathan Kay, Clinical informatics director, NHS England

Transcript

1. CCIO Leaders Network CCIO Summer School 4-5 July
2. NHS England - viewpoints on supporting clinical informatics in the ‘new’ NHS landscape Prof Jonathan Kay Clinical Informatics Director, NHS England Anne Cooper National Lead for Nursing, NHS England
3. Supporting clinical informatics in the 'new' NHS landscape Prof Jonathan Kay Clinical Informatics Director NHS England jonathan.kay@ndcls.ox.ac.uk
4. Two recent experiences • Junior doctors‟ access to the „net at work • Clinical safety and “health software”
5. Junior doctors‟ access to the „net at work • My assumptions • The survey
6. Unofficial NHS Staff WiFi Survey 2013 • online survey of WiFi availability for frontline NHS staff run by NHS Hack Day community o with support from HANDIHealth, Tactix4, and openGPSoC • 650 responses so far, survey is still live at: o http://bawmedical.co.uk/lime/index.php/481147/lang-en
7. Headline: just 23% have NHS free WiFi The rest are either denied access (even when WiFi networks do exist) or are having to pay for it.
8. "It would mean we could demonstrate ebooks, Pubmed information on ward rounds, BNF and much, much more. Clinicians would get the information they need at the time they need it." "It is frustrating that although 'agile working' is the Trust's agenda, staff are unable to access the Wi-Fi. This is made worse by the ban on memory sticks so that staff without Trust email access are unable to transfer their work to their own machines. Free web email services are blocked." "I do clinics in the community where we have no computer access at all, let alone WiFi." "Staff do not have any wifi access across the trust but there is access available exclusively for medical students. The library service purchased a small number of iPads to loan (for meetings, grand rounds, study etc. ) but the IM&T department has blocked this trial. Unfortunately, I do not foresee an imminent change in trust stance on wifi access."
9. But there is hope... "I am lucky to have free access to fast wifi provided free to all staff at my Trust. It is rated Number 3 in the worlds top centres of excellence and the wifi is a major contributor to that - we all use it for patient databases, checking eBNF, journals, NICE, specilist guidance etc etc etc It is invaluable and a major contribution to outstanding care. It is secure and run well by our superb in house IT team. All our iPhones and laptops were connected by IT at Induction day. They are the best IT Department I have ever come across and as a result of that, we have some incredibly well set up and supported electronic systems for tests, scans, results, admitting, letters etc - utterly incredible facilities"
10. Clinical safety and “health software”
11. First NHS Standards for Clinical Risk Management In 2009, two standards were issued by ISB: •DSCN 14/2009 (Manufacture)* o Set clinical risk management requirements for suppliers of health software. o Defined a simple framework of documentation (evidence) to be produced by suppliers. • DSCN 18/2009 (Deployment and Use)** o Specified a framework within which patient safety hazards associated with the deployment and implementation of new health software can be managed. o Required suppliers to provide suitable information to support Health Organisations analysis.
12. Implementation Review • In 2011 an implementation review of DSCN 18/2009 was undertaken. • This involved the issue of a short questionnaire to health organisations via the 10 Strategic Health Authorities. • The objectives of the questionnaire were: o to provide evidence to the ISB that DSCNs 14/2009 and 18/2009 were being implemented and should remain as part of the ISB library o to provide proof that the profile of clinical safety within the NHS had been raised • A detailed report was issued which presented the results of the review and a number of recommendations.
13. Highlight Findings • 99 organisations responded (28% of the health organisations identified) • 72% of responding health organisations had either not start or had just started to implement DSCN 18/2009. Only one health organisation considered itself to be fully compliant with the standard. • The timescales to implement DSCN 18/2009, where provided, varied from a matter of months through to 2012/13. • 33 of the health organisations that responded planned to develop health IT systems in-house. A further 10 organisations responded "Don't know" to this question. • 60% of these health organisations consider that the in-house systems would fall under DSCN 14/2009. 35% were unsure. • 75% of responding health organisations had a CSO. Of which 55% had attended the Accredited Clinician Training.
14. What did I learn from those? • I don‟t know enough about what‟s happening • We need to treat staff better • We may have a problem doing simple things well
15. CCIO issues • Founders look after themselves (yourselves) • Need to extend To younger colleagues To other professions Professionalisation • Influencing our own organisations To do simple things well To do difficult things well
16. How does computerisation help? • Reduces unit cost of processes • Increases safety But… • Ignorance of unit costs of processes • Passive approach to safety management
17. NHS England
18. NHS Mandate • Every year, the Secretary of State must publish a mandate to ensure… accordance with the Health and Social Care Act • The current Mandate sets 24 objectives and the following 5 priority areas identified by Government:
19. Priority areas in the mandate • Improving standards of care and not just treatment, especially for older people and at the end of people‟s lives • The diagnosis, treatment and care of people with dementia • Supporting people with multiple long-term physical and mental health condition particularly by embracing opportunities created by technology, and delivering a service that values mental and physical health equally • Preventing premature deaths from the biggest killers • Furthering economic growth, including supporting people with health conditions to remain in or find work
20. NHS England issues • How does a commissioning body influence anything? Mandatory elements in contracts Funding projects National Local Transfer of good practice Galley of examples Awards “Do once and share” Influence by… influence
21. NHS England: Big projects • Informatics-led, eg Technology Challenge Fund Digital Primary Care care.data GP Systems of Choice • Informatics-supported Urgent Care Review Every clinical project Every performance standard
22. NHS Reorganisation • Informatics in primary care • Informatics in secondary care Rôle of CCGs, CSUs • Informatics in specialist care • Informatics in social care • NHS England Regional and Area Teams • HSCIC • Public Health England • Medical Education England • Department of Health
23. Things that (some other people think) are barriers • Luddite clinicians • Poor information systems Legacy New • Cost of change and new systems • Split of primary and secondary care • Burden of data collection • Capacity of NHS ICT staff • Capacity in clinical informatics • Capacity in project management
24. Opportunities • CCIOs, but more and more effective • Young practitioners • Everyday technology