Evidence submitted by Intellect UK (EPR
67)
Intellect sees the current programme as just
one phase in a long-term multi-decade effort to improve the capabilities
and performance of information systems in healthcare, not for
their own sake but as a vital infrastructure for patient care.
There are two areas in particular where better
information systems can deliver direct benefit to patients, a
joined up approach shared amongst organization and a dynamic cooperation
between different healthcare providers.
Our members experience so far indicates that
shared health and social care systems encourage the generation
and use of good-quality patient records, as they provide workflow
and unite organisations. The key to further adoption is through
integration to core systems in each care setting, and guided external
funding of this may be expected to realise benefits comparable
to those emerging from the spine.
The electronic decision support makes (secondary)
use of data held on the system to enable safer prescribing and
dispensing at the point of care. The open standards are key to
achieving interoperability of information together with flexibility
in the management of ICT assets. NHS Connecting for Health has
been an exemplar of good practice in the UK public sector in developing
open standards and has also demonstrated good practice by engaging
in technical consultation.
As a final point, the lesson learned across
the National Programme is that the phased approaches, with room
for manoeuvre as understanding grows on both sides, deliver better
value in the long run. This should be seen as growing maturity,
not "failure to deliver".
1. INTRODUCTION
This submission has been prepared by Intellect
in response to the press notice issued by the Health Select Committee
on 5 February 2006.
Intellect is the UK trade association for the
IT, telecoms and electronics industries. Its members account for
over 80% of these markets and include blue-chip multinationals
as well as early stage technology companies. These industries
together generate around 10% of UK GDP and 15% of UK trade. Our
membership spans blue chip multi-nationals through to early stage
technology enterprises. Intellect's website is located at www.intellectuk.org
This response focuses primarily on the Information
and Communications Technology (ICT) element of the Electronic
Patient Record programme; this is the area where Intellect members
have most expertise and are most engaged with the programme.
2. REFLECTIONS
ON NPFIT
TO DATE
We see the current programme as just one phase
in a long-term multi-decade effort to improve the capabilities
and performance of information systems in healthcare, not for
their own sake but as a vital infrastructure for patient care.
3. AREAS WHICH
CAN BENEFIT
FROM NPFIT
Two areas in particular where better information
systems can deliver direct benefit to patients are:
— Where several organisations need
to work together to deliver "joined-up" care, for example
to vulnerable elderly people (as well described in the January
2006 White Paper Our Health, Our Care, Our Say).
— With individuals with long term conditions
(such as diabetes), where co-ordination between different healthcare
providers, together with full engagement by patients themselves
and their carers, is a key practical and policy goal.
In both these areas, a flexible, pragmatic approach
to information systems procurement and deployment, meeting needs
of regions with different geography and demographics in different
ways, is preferable to a "one size fits all" approach.
For example, in areas of high population density such as London
and the West Midlands, it is important to take a regional approach
so that services can be integrated across local administrative
boundaries, and to enable efficient sharing of specialist facilities.
In more rural areas, the challenge is rather to enable scarce
and geographically dispersed resources to work together. Neither
just a national shared record, not just local shared records,
will deliver what is needed. Systems need to be both flexible
and integrated, with the National Care Records System playing
its part alongside, and integrated with, local and regional systems.
Policy and practice are moving in this direction, and that is
to be welcomed.
Our members experience so far indicates that
shared health and social care systems encourage the generation
and uses of good-quality patient records, as they provide workflow
and unite organisations. The key to further adoption is through
integration to core systems in each care setting, and guided external
funding of this may be expected to realise benefits comparable
to those emerging from the spine.
4. DRUG RELATED
CLINICAL DECISION
SUPPORT
Electronic decision support makes (secondary)
use of data held on the system to enable safer prescribing and
dispensing at the point of care.
— Electronic active clinical decision
support (eg alerts for allergy, contraindications & precautions)
is wholly dependent on SNOMED CT[53]
encoded clinical data being of high quality and consistently present
on the system.
— It is not yet evident that NCRS[54]
data will be sufficiently robust for clinical decision support.
— Native use of SNOMED CT within clinical
applications would significantly improve data quality and progress
interoperability.
5. OPEN STANDARDS
Open standards are key to achieving interoperability
of information together with flexibility in the management of
ICT assets. NHS Connecting for Health has been an exemplar of
good practice in the UK public sector in developing open standards
(the NPfIT Message Implementation Manual) for systems integration
within its scope of influence, and has also demonstrated good
practice by engaging in technical consultation with the implementation
community during the development of these standards (for example,
through HL7 UK, see http://www.hl7.org.uk).
6. LESSONS LEARNED
FROM NPFIT
As a final point, the original cost figures
and timescales for NPfIT were set "hard" as a policy
measure, before the requirements were fully understood, and this
approach is well known to nearly guarantee timescale and/or cost
overrun on initial figures in complex ICT projects. Phased approaches,
with room for manoeuvre as understanding grows on both sides,
deliver better value in the long run. This lesson is slowly being
learned across the National Programme, and this should be seen
as growing maturity, not "failure to deliver".
Intellect
16 March 2007
53 SNOMED Clinical Terms (SNOMED CT) is a dynamic,
scientifically validated clinical health care terminology and
infrastructure that makes health care knowledge more usable and
accessible. Back
54
NHS Care Record Service. Back
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