setting standards for edm and delivering a paperless nhs
DESCRIPTION
At the recent EDM Conference (1st October 2014) Professor Martin Severs (Clinical Professional Lead and Caldicott Guardian, HSCIC) discussed: - the Standardisation Committee for Care Information (SCCI) - Electronic Document Management Systems Access the document to read more.TRANSCRIPT
Setting Standards for EDM & delivering a paperless NHS
EDM Conference 1st October 2014
Martin Severs, Clinical Professional Lead and Caldicott Guardian
Presentation
Click to edit master footer style
• HSCIC?
• Standardisation Committee for Care
Information [SCCI]
• Electronic Documents some observations
HSCIC:
Who are they?
Are they part of the NHS?
3
August 2014: Work by MORI on behalf of NHS England
What we do
We set standards that protect
patient’s confidential information, reduce
bureaucracy and improve data quality
We operate essential technology services
that support the health and care system
We collect, analyse and publish
national data and statistical information
that helps inform decision making
We develop the next generation of
national data and information systems
Who we are
What we do
NHS Mail
600,000 registered
users
GP2GP
89% of clinicians
agree it improves
patient experience
The Spine
Contains 80
million records
NHS Choices
Handles 29 million
enquiries a month
Electronic
Prescription
Service
Potential to save the
NHS £179M a year
Informing public
discussion
3,000 news stories
used our statistics
What we do
GP Payments
Service
Calculates and pays
over £7.2 billion
annually
Choose and Book
50 million patients
referrals reached
Statistical
reports
220 statistical
reports published
Screening
Helps to detect over
13,500 invasive
cancers
National Back
Office
Manages accuracy
of 6.3 million
transactions
SCCI
Click to edit master footer style
• Why do you need it? – Each major organisation in the health and social care
system has its own primary legislation
– This legislation often gives specific powers with regard to data
– Health and Social Care Act 2012 gives new powers and duties in the data and information standards arena
Directions; Information standards approval, collections
– Within the ‘combined sovereignty’ structure called the National Information Board all the major organisations within the health and social care system have agreed to work to the common good
One strategy with shared actions; less duplication and overlap; efficient use of resources; less bureaucracy and burden; maximum data asset utilisation;
SCCI
Click to edit master footer style
• Idea to Need stage
– Anyone can have an idea and bring it to the
service
– If it is for data; do we have any of it?
– If it is for a new standard is there already one?
– If it is completely new who is backing it and who
is going to pay for it? [Sponsor, SRO, developer]
– Is it worth considering in the business plan of one
or more H&SCS organisations
SCCI: Idea to Need
Click to edit master footer style
idea
Supported Statement
of Need
SCCI: Requirement stage
Click to edit master footer style
• Requirements submission consists of three documents:
– The Requirements Specification IEEE 830 – 1998 specification is recommended for
consideration.
– The specific health and social care system [H&SC system] requirements Patient safety, implementation, test etc
considerations
– The Outline Business Case
SCCI
Click to edit master footer style
idea
Supported Statement
of Need
Requirement
Business
Plan Business
Case
Process
Outline
Business Case
SCCI: Draft Technical Regulation [DTR]
Click to edit master footer style
• DTR is defined by EC Technical Standards and Regulations Directive 98/34
• There should be up to 17 documented attributes of a Draft Technical Regulation
• Particular points to highlight: – Lawful processing requirements
– Safety case and clinical authority to release
– Implementation plan
– Proposed information standards notice
– Tolerance
– Burden
– Full Business Case
SCCI
Click to edit master footer style
idea
Supported Statement
of Need
Requirement
Business
Plan Business
Case
Process
Outline
Business Case
Draft Technical
Regulation
Full Business Case
SCCI: Technical Regulations
Click to edit master footer style
• Key point of a (full) Technical Regulation is ‘the observance of which is compulsory’
• Technical Regulations come within the scope of the EC Directive 98/34 so the most crucial step is to assess whether a particular instance needs to be notified to the EU. If ‘yes’ then there is consultation and the specification must be capable of modification on the basis of feedback
• Completion of guidance produced by BIS
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/292896/bis-13-1205-technical-standards-directive-98-34-ec-procedure-guidance-for-officials.pdf
Public consultation MUST take place either at DTR or TR stage [s258 H&SCA
2012]
SCCI
Click to edit master footer style
idea
Supported Statement
of Need
Requirement
Business
Plan Business
Case
Process
Outline
Business Case
Draft Technical
Regulation
Full Business Case
Full Technical
Regulation
Full Business Case
SCCI
Click to edit master footer style
• Information Standards – The publication of the Approval Letter by SoS and NHS
England on their web sites AND
– The distribution of that letter by a HSCIC managed notification service AND
– The publication of the Approved Information Standard and its associated implementation guidance and support materials via the HSCIC
• Collections – The publication of the Approval Letter by HSCIC on their
web site AND
– The distribution of that letter by a HSCIC managed notification service AND
– The publication of the Approved Collection and its associated implementation guidance and support materials via the HSCIC
SCCI
Click to edit master footer style
idea
Supported Statement
of Need
Requirement
Business
Plan Business
Case
Process
Strategic Case
Draft Technical
Regulation
Outline Business Case
Full Technical
Regulation
Full Business Case
Approved
Information
Standard Small
change
Large change HSCIC
required
collection
Click to edit master footer style
• Electronic Document Management
Systems:
Some perspectives
Electronic Document Management [EDM]
Click to edit master footer style
• EDM versus Electronic Record Management Systems
• ISO 15489 (paragraph 7.2) gives the general characteristics of a record as: – ‘ a record should correctly reflect what was communicated
or decided or what action was taken. It should be able to support the needs of the business to which it relates and be used for accountability purposes’.
• One of the principal properties of an electronic document (as opposed to an electronic record) is that it can readily be edited. Preventing this from happening to records where it should not and auditing where it has apparently happened are vital issues.
• My focus is on ERMS as opposed to EDMS
ERMS: Core requirements1
Click to edit master footer style
• Build and maintain a classification scheme, against which folders are classified
• Manage folders, parts and records, and their metadata
• Declare an electronic document as a corporate record, and to maintain its integrity as an authentic representation of a business action or decision
• Search for and retrieve records
• Consistently manage the retention and disposition of whole folders and records,
ERMS: Core requirements1
Click to edit master footer style
• Retaining what should be kept and disposing
of what should not, whether by
• Transfer to another organisation or
destruction
• Control access to folders and records, and to
maintain an auditable track of actions taken
on them
• Provide manageable, usable and robust
mechanisms to carry out core functions.
ERMS: additional health & care requirements
Click to edit master footer style
• Authentication and encryption – facilities enable integration with standard digital signature and certification
technologies, particularly where this is related to transactional records received in this way.
• Document management – facilities enable an integrated document and records management system to be
offered, so that the whole document and record lifecycle can be managed, from the creation, drafting and formalisation of documents to the declaration, management and disposal of records.
• Hybrid and Physical folder management – enables legacy paper records to be managed alongside electronic records; and
for an integrated approach to continuing paper records in the form of hybrid folders.
• Content management – Professional records structure
• Casework and workflow
• Image management and document scanning
• Preparing records for transfer – Transition communications handover, discharge, referral etc
ERMS Metadata
Click to edit master footer style
• supporting record retrieval;
• supporting the wide range of records management processes in the Functional
• requirements;
• establishing the provenance of the record – (ISO 15489 describes this as ‘the context in which the record was created,
received and used should be apparent in the record, including the business process of which the transaction is part, the date and time of the transaction and the participants in the transaction)’;
• showing whether the record’s integrity is intact (e.g. it has not been subject to changes after being fixed as [or ‘declared’] a final record);
• ‘demonstrating that the links between documents, held separately but combining to make up a record, are present’;
• demonstrating that the relationships between separate records are present;
• providing essential information to support interoperability / sustainability of the record between platforms and across time and technological platforms5.
Definition of metadata given in ISO 15489 runs: ‘data describing
context, content and structure of records and their management through time’.
History: Have we moved?
Click to edit master footer style
The Tunbridge Report
1965
• Standardised records
• Primary & secondary
• Standardisation of
documents
• Recommended the NHS
number
• Recommended “data
processing and the use of
electronic forms of
mechanisation”
• Recommended standard
discharge summaries and
education for doctors!
Academy of Medical Royal Colleges &HSCIC
Click to edit master footer style
• Standards for the clinical structure and
content of patient records
• 2013
Good information is an important part of making sure people stay healthy and get the best care
The Power of Information, Department of Health