Select Committee on Health Written Evidence


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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