IT Innovations in NHS - Case Study Example

IT Innovations in NHS Introduction Life expectancy of people in every country is ascending along with the advent of modern medical technology, and advancement in treatment procedures. Healthcare providers are always put to test in their day-to-day activity for finding fast and precise approaches to improve their service with the help of modern machinery. Finding a solution is not easy, and building an information system that provides high quality, error free, timely, and secure information is a major hurdle for a very large and complex organisation like NHS. Increasing the ability of physicians, nurses, clinical technicians, and others to readily access and using the right information about their patient is essential to deliver quality health care. Quality healthcare relies on right information at the right time and using it to make the right decision. The ability of patients to obtain information to better manage their condition and to communicate with the health system could also improve the efficiency and quality of care. Most patients receive care from many unrelated providers and the new integrated delivery system with IT support will reduce medication error, dosage error, and treatment costs. Whether the initiative to improve health care services through IT aided innovations are successful in providing healthcare professional’s access to patient information-- safely, securely and easily, whenever and wherever it is needed –is the main purpose of this study. Background Increasing health expectancy and emergence of new diseases are posing challenge to every healthcare provider. How to provide cheap, fast, and accurate healthcare to all the needy is a great question in front of every health care providers. Information technology (IT) has great potential to improve the quality, safety, and efficiency of the health care by opening new ways for health care providers, and patients to readily access and use relevant information. IT allows healthcare providers to collect, store, retrieve, and transfer information electronically. Though complex financial implications are involved at the initial stages, considering its vast potential, both private and public sectors have engaged in number of efforts to promote IT’s use within and across health care settings. Relevance of IT in Healthcare Major technologies of IT integrated in healthcare are Electronic Health Record (HER), Computerized provider order entry (CPOE), Picturing and communications system (PACS), Bar coding, Radio frequency identification (RFID), and Automated dispensing machines (ADMS). These systems function in a coordinated manner and helps in interoperability, meaning electronic communication among organizations so that the data in one IT system can be incorporated into another. By entering varied information to computers, such as orders of physicians and other providers, details of drugs prescribed, findings of x-ray or other images and clinical reports, consultations and transfers will minimize handwriting or other communication errors. In the clinical perspective IT could be applied in computerized provider order entry for drugs, lab tests, procedures: electronic health record; clinical decision support systems; picture archiving and communications systems for film-less imaging; and electronic monitoring of patients in intensive care units. Obtaining correct patient information is also a basic requirement for helping the healthcare providers to provide precise treatment at the right time. From experience they have realized that IT aided healthcare delivery system will go a long way in tackling the issue. According to Pedler, Networking has been identified as a “prominent recent trend in public policy which operates within statutory and institutional frameworks to generate new directions and agree service delivery arrangements.” This concept has been frequently been applied to the health services to the NHS, to hospitals, to primary care groups, and to effective health promotion.” (2001). Vision of NHS and IT innovations in Healthcare The vision of NHS for the future is to have a more modern, efficient, patient-led health service and to give patients more choice and control over their own health care. To attain this objective many changes have been brought through various agencies of the Department of Health and one such agency is NHS Connecting for Health. As such, Government already have experimented with various IT Projects and strategies, such as Hospital Information Support System (HISS) and Information for Health Strategy (HIS), for the past twenty years, which have shown multiple outcomes. Consequent to Wanless Report (2002) more financial allocation helped to finance new IT Systems for the NHS and launching of National Programme for IT (NPfIT), which “aims to give healthcare professionals access to patient information: safely; securely and easily; whenever and wherever it is needed.” (Fresh approach to Health care as technology leads the way. 2004). NPfIT is aimed to achieve the goal through many approaches, such as Picture Archiving and Communication Systems (PACS), Electronic transmission of prescription (EPS), National Network (N3) with particular emphasis to creating NHS Care Records Service (NHS CRS). Accurate information is very important to help patients to choose and receive the right care at the right time. Hence, NHS Connecting for Health is engaged in services to link GPs, community services, and hospitals to maintain the national critical business system via new computer systems and services. It aims to improve the safety and quality of patient care by providing healthcare staff faster, and easier access to reliable information about patients, to help in their treatment. Safety and quality of patient care depends on the efficiency of health care staff as well. The work load on healthcare personal, particularly GPs and nurses could be assessed from the government Statistics for 2003-04. It shows that NHS dealt with 325 million consultations by GPs or nurses in the community and over 649 million prescription items were dispensed in the community. (NHS: Statistics). According to “A Safer Place for Patients” of the National Audit Office Session 2005-2006 report, the most common patient safety incidents in hospitals after patient injury (due to falls) related to medication errors, record documentation error, and communication failure.” (Background and introduction. 2007) These statements clearly indicate grave situation prevalent in healthcare delivery system due to lack of coordination between concerned agencies and shortcomings in dissemination of patient records. The best choice to counter the situation is with IT aided innovations. NHS initiative for introduction of medical informatics To have a choice and right care at the right time to a patient depends on the accurate information available to health care providers. It is seen that rapid advancements in information technology, where Internet and World Wide Web act as both conceptual model and practical enabler of networking, promotes innovation, sharing, and exchange of knowledge and information. “Healthcare Informatics is the intersection of patient care information technology, which encompasses all aspects of patient care data generated, collected, retained, transmitted and manipulated for patients, health car providers, researchers and players.” (Hebda et al 2004). There are various forms of electronic communication and ways to use it more effectively. Delivery of clinical, medical, and pharmaceutical information via computer reduces time consuming job of manually scoring and preparing hand written reports and eliminates the complex logistics of distributing, storing and tracking relevant papers. Earlier Systems under NHS restricted efficient transfer of information between departments and different healthcare trusts as well as numerous records (paper and computer documents), often created for the same patient, lead to inaccuracy and lack of consistency in patient data. These problems encountered by the agencies of health care delivery prompted the government to charter new methods and approaches to the system. With this in view in 2000 Derek Wanless was assigned to “examine the technological, demographic, and medical trends over the next two decades that may affect the health service in the UK as a whole, and to identify key factors which will determine the financial and other resources required for NHS to provide high quality service.” (Wright 2002). The Report stressed the need of increased financial allocation and overhauling of NHS with the creation of electronic patient records in all Primary care trusts (PCTs) and NHS trusts. Considering the volume of paper work, clumsiness in records management, and its transfer National Programme for IT (NPfIT) was launched to link many different systems and create an electronic NHS Care Record for every patient. Each patient’s electronic record under NHS CRS is securely accessible to caregivers as well patients. By providing safe and secure transfer of information through NHS, the National Programme for Information Technology (NPfIT) took a major step towards providing seamless care for patients through Nurse Practitioners, hospitals and community health service. Infrastructure under NHS Effort to improve efficiency and effectiveness of clinicians and other NHS staff are achieved through creating infrastructure like: NHS Care Records Service (NHS CRS) -- shares patient’s records across the NHS with their consent, making it easier and faster for GPs and other primary care staff to choose and book hospital appointments for patients; Picture Archiving and Communications System (PACS) --enables medical images such as x-ray and scans to be stored and viewed electronically; Electronic Transmission of Prescriptions (ETP or EPS)—facilitates drug information input electronically which can be transferred between prescriber, pharmacist, and reimbursement agency; and National Network (N3) --replaces former private NHS communications network (NHSNet.) Functioning of these agencies is monitored through a Project Board. The composition of project board is very complex and involves GP, Senior Consultant, HR Director, SHA Representative, Director of Modernisation, Director of IT, and Project Manager under the supervision of a Chief executive. The active involvement and monitoring at different levels is viewed as a successful tool to implement the vision of NHS, through IT innovations in healthcare. Benefits of NHS Care Record Service (NHS CRS) NHS Care Records Services (NHS CRS) is introduced to improve the safety and quality of patient care and to give health care staff faster easier access to reliable information about a patient to help with their treatment, including in an emergency. Care providers have to maintain records of the treatment they provided and have to be shared among other healthcare professionals in the NHS. Cumbersome paper work and transferring this information from one place to other is time consuming and may even lead to loss of records on the way. With digitized NHS Care Record Service (NHS CRS) complete and accurate information be shared safely across all appropriate healthcare professionals and critically ill patients, who would have to go to a hospital without previous records and un-accompanied by their family members, do not have to repeatedly narrate their case to healthcare providers. NHS CRS assists GPs to view updated patient records and ensure accurate and speedy patient information. Patients will be able to see a summary of their own health records through a secure internet site and feel confident that best possible health care is being received. A Public Information Programme, through local Primary Care Trust or GP surgery, informs registered patients the status of Summary Care Record and their intention of using NHS CRS and gives chance to express options available to the patient. A Summary Care Record contains basic information such as, date of birth; details of allergies, current prescriptions, test results and x-rays, and bad reactions to medicines and subsequent information for proposed plan or reminders for patient care are added to it, which is accessible to client’s review. In addition a Detailed Records is linked medical records containing more details than Summary Care Records which help the organisations which work together locally to share it between different parts of the local NHS such as GP surgery and hospital. Maintaining confidentiality of records To protect confidentiality name and other identifying details are removed the record will be available to people providing health care anywhere in England. An individual could access his summary care record by visiting. “www.nhs.uk/healthspace” and only those treating a patient in their local area will have access to detailed records. (The NHS Care Records Service). All health records are private and personal and NHS CRS applies strongest national and international security measures for handling individual information. “Caldicott Guardians” are responsible for caring patient confidentiality, and rights to privacy and other details are given in “The Care Record Guarantee: our guarantee for NHS Care Records in England.” (Are my records safe? 2007). In the words of Dr. Liaqut Natha “any doctor who, outside the GP practice, comes in a emergency, comes to see the patient in the middle of the night they would have an up to date and accurate summary of the patient record in front of them without having to ask,… the elderly person who may not may not know or not even be in a position to answer these questions, would have a head start and so therefore they would be able to treat the patient in an improved way” highlights the benefits available to doctors as well as patients with introduction of electronic Care Records Service for fast healthcare delivery. (Beswick 2007). Thus, NHS CRS is safe and fast systems that benefit patients and health care providers. Problems encountered and solution There may be problems such as, technical problem with HealthSpace account, records may not be available with it, incorrect address details, delay in information to complete HealthSpace registration problems, loss of secure Login Card and the like encountered by individuals. Contacting HealthSpace helpdesk over net or by calling 0845 3 665 665 and local GP will be able to assist in such situation and help the consumers. (HealthSpace troubleshooting). Though the NHS CRS may look very brilliant we should not forget the concerns expressed by the members of Ethics Advisory Group, which is reproduced in following words. “It should be acknowledged that we do not yet have a full specification of what will be neither provided, nor how best to control access and maintain confidentiality whilst achieving high quality delivery of care. More clarity is needed about the practicality of data sharing with private and voluntary providers contracted to provide care on behalf of NHS, including issues around security outside NHS IT system, and protecting confidentiality where many staff will not be under the same obligations of confidentiality as NHS staff.” (Public information campaign materials. 2004). There are also deep concerns about the confidentiality of medical records—including genetic information-- being breached by government or other third parties from the electronic data. Individual consent is a fundamental human right, and they generally detest government agencies or private group accessing their medical information without their permission. Data protection Act, 1998 defines legal basis for the handling of information and protection of personal data, overseen by the Office of the Information Commission (DPR). The key principles of this Act are: 1) Data may only be used for the specific purpose for which it was collected; 2) it must not be disclosed or transmitted to other parties without consent of the individual concerned and adequate protection; 3) individuals have right to ascertain whether any information is held about him or her, to have a copy of that information, and option for correction or erasure of data, with certain exceptions; and 4) All entities that process personal information must register with the Information Commissioner, and employ adequate technical and organisational security measures. Paper-based health, education and social work records, which were created before 24 October 1998, are subject to slightly different provisions in the Act. (Section IV:30 and 31 (iii)). The provisions under Section 7, 8, and 9 of Data protection Act 1998 guarantees individual freedom to access his personal data, maintain confidentiality, and recommend any modifications. (Right of data subjects and others. 2007). Conclusion We should not forget that though networking is able to connect all health practitioners and patients within the system human error and system breakdown may hamper the intended outcome. “Any technology, when improperly implemented, presents risk to the information it holds, but these risks can and are mitigated through thorough and appropriate configuration.” (Security of IT system. 2007). Adequate legal and technical measures under the programme, such as: the protection of individual data to safeguard their individual freedom of right to consent and secrecy; training of healthcare providers in electronic data collection, safeguard, and dissemination of information; and exposure of beneficiaries to the positive side of IT assisted activities will go a long way in the success of the programme. With the concerted effort of healthcare providers and agencies involved in healthcare delivery National Programme for IT (NPfIT) will reduce cost and time spent for its effective implementation, and lead to complete transformation of NHS. The constant auditing effort of NHS to achieve maximum impact of the programme is reflected from the recent move to transfer “accountability for the delivery of National Programme for IT to Strategic Health Authorities (SHAs) from 1st April 2007 as part of NPfIT Local Ownership Programme (NLOP).” (Programmes for IT. 2007). It shows that the aim “to give healthcare professionals access to patient information safely, securely and easily, whenever and wherever it is needed” will be achieved through IT aided innovations evolved by NHS. Bibliography Are my records safe? (2007). [online]. NHS connecting for health. Last accessed 27 November 2007 at: http://www.nhscarerecords.nhs.uk/patients/your-confidentiality Background and Introduction. (2007). 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PEDLER, Mike (2001). Issues in health development. Networked organizations-an overview. [online]. NHS. Last accessed 22 November 2007 at: http://www.nice.org.uk/nicemedia/documents/networked_orgs_30_10_01.doc Programmes for IT. (2007). [online]. NHS Connecting for Health. Last accessed 22 November 2007 at: http://www.connectingforhealth.nhs.uk/itprogrammes Public information campaign materials. (2004). Response from CRDB ethics advisory group. Agenda Item 7. Last accessed 27 November 2007 at: http://www.connectingforhealth.nhs.uk/crdb/boardpapers/eag_publicinfo_291104.pdf?searchterm=learning+disability+and+NHS+CRS Right of data subjects and others. (2007). Unlocking the potential of public sector information. [online]. Office of Public Section Information. Last accessed 22 November 2007 at: http://www.opsi.gov.uk/Acts/acts1998/ukpga_19980029_en_3#pt2-l1g7 Security of IT system. (2007). [online]. NHS Connecting for Health. 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