The National Programme for Information Technology

What’s in it and what’s in it for anaesthetists?

SCATA Annual MeetingManchester, 13th November 2003

Prof P.HuttonChairman, Academy of Medical Royal Colleges

How did it all begin?

Where does the programmestart and stop?

Who pays for what?

Who does what?

The landscape of modern medicine

Patients and potential patients

CliniciansManagersPremises

Pace of changeLimitation of resourcesInformation transfer and storage

The scale of the taskThe scale of the taskIn one year:In one year:

617 million prescription items issued617 million prescription items issued

Approximately 300 million consultations in primary Approximately 300 million consultations in primary care care

13 million outpatient consultations13 million outpatient consultations

Over 5.3m people admitted to hospitalOver 5.3m people admitted to hospital

4 million operations4 million operations

NHS already spends £850m on IT each yearNHS already spends £850m on IT each year

What do different stakeholders want?

What do patient’s want?•Good care, advice and choice•Ease of booking•Prompt response•Keeping to time •Efficient transfer of data•Access to information

What do managers want?

To get information on:•Throughput•Cost•Quality•To run a happy hospital

What do clinicians want?To be able to see:•The right patient•In the right place•At the right time•With the right information But, just who is a clinician?

The functional objective

To ensure that whoever is making a health decision has available the right information at the right time

Not forgetting that this might be the patient, a carer or a manager as well as a clinician

Progress in clinical practice Major changes in 25 years

•Greatly improved diagnosis•Agreed management of common conditions•Team working (between specialties and with GPs)•Skill mix and non-medical roles

Consequences of information transfer

•More protocol driven care

•Does a consultant’s work start where protocols end?

Pressures on the demand-supply balance

•Demographics and longevity

•The changing medical workforce

•Public expectations

Why should we be bothered?

All these factors demonstrate that future demand for health care cannot be met by current delivery models

and, not only will teams be more important, the teams will depend on skill-mix and new ways of working

All specialties and all clinical and non-clinical staff will be affected. The public need to be given encouragement to be more self- sufficient

What is the clinical task?

•To keep people healthy

•To treat and manage those who are ill

National and regional issues

The Five NPfIT Clusters (NPfIT’s geographic grouping of Strategic Health Authorities)

3

life

The health information spine (I)

28 weeksgestation

death

clinical events

Unique identifier

3

life

The health information spine (II)

28 weeksgestation

death

Local records

Local records

Local records

Edited

Edited Edited

3

life

The health information spine (III)

28 weeksgestation

death

Asthma

Pregnancy

Diabetes

OutcomeComplications

FrequencyTherapy

DrugsResults

Current objectives and issues•A common ‘front-end’•Use of a unique identifier•Patient consent and personal information •IT infrastructure to support national applications (e.g. images)•Very basic, nationally accessible patient record (the NHS Care Record)•On-line booking & ETP

Tough problems•Unique identifier•Confidentiality•Consent•Access•Content of stored data•Existing records•Power shifts in relationships

Plus points•Makes a future NHS possible •Better use of scarce resources•Decision support for safer care•Increased clarity of purpose•Better access to records•Less frustration and time wasting•Improved patient experience•Valuable information database

Potential downsides•Suspicion of staff•Suspicion of public•Disbelief in success•Local support and maintainance•Loss of clinical autonomy•Power shifts in relationships•Disruptives and malcontents

What will the future look like?

•First point of contact non-medical•Many consultations not face to face•Many more non-medical people delivering care•More explicit that care is based on chance•Protocols used whenever possible•Patient access to records at any time•Less acute receiving sites•Less clinical freedom•Greater cost-effectiveness in decision making•Clear limitation on resources

The relevance to:•anaesthesia, •critical care and •pain

The NASPBetter historical dataGood for pre-operative assessmentGood for accessing resultsClinical support (prescribing and decisions)

The LSPMust provide for the NASP? Additional functionality

•Anaesthetic records

•Data sets

•Critical incident reporting

Where to from here?