Information Management - Case Study Example

Order 257180 Information Management December 02, 2008 (1508) Information Management Report for the Board of Directors of the National Health Service The National Health Service UK (NHS) is the biggest publicly funded health organisation in Europe with the mission of providing good healthcare for all. It is a growing organisation employing more than 1.5 million people providing free healthcare to 60 million UK residents. Nearly half of the employees are clinically qualified personnel like doctors and nurses. More than 6 million people on an average avail of NHS service each day. The annual budgetary grant, 437 million in 1948, has gone up to 90 billion (10 times) for the year 2007-08 which sums up to a contribution of approximately 1,500 for every person covered in the UK. NHS funding derived directly from national taxation has won worldwide recognition as one of the most reasonable and least costly way of public healthcare funding. While the NHS services are run separately in Wales, Scotland and Northern Ireland by their respective administrations, the overall supervision in England is done by the country's 10 Strategic Health Authorities (SHAs) that in turn are controlled by the Department of Health (source: www.nhs.uk). Measuring performance efficiency of a healthcare system is difficult and the same applies to NHS also. However, the broad indicators like the declining infant mortality rate and the increasing life expectancy in the UK point to significant contribution by the NHS to the nation's healthcare. The NHS does not charge its patients except for some specialised services for optical and dental treatments and for some prescriptions. The patient is treated irrespective of the country of the UK he or she is resident of. The patient is not hassled with procedural matters. 2 One of the major information management issues being faced by the NHS is timely implementation of its National Programme for IT which is one of the world's largest IT projects. The rising cost far exceeding the original budget of 2.3 billion for the project and delayed implementation are seriously impeding full-scale launch of the initiatives at the NHS. The initiatives include controlled use of sensitive medical data and management of patient information security. For improving and integrating quality healthcare services, available medical information and data are needed to be recorded and made available in a proper way to the healthcare professionals. The present information management programmes of the NHS are drawing criticisms on the issues of too rigid a control of the sensitive medical data and inadequacy of patient information security. Computerization of the complete records of the NHS patients is another issue to be fully resolved. Another important information management issue involves lending assistance to the patient to select location for treatment by the "Choose and Book" programme under National Programme for IT. The facility is yet to be made available at all locations even after expiry of the various deadlines causing considerable cost overrun. Quality of delivery of service and care for the patients and the planning for such delivery require setting up of a strong information management system maintaining record of health information and data that the health professionals of the NHS can extract, interpret and apply. This recorded information and data of the patients treated by the organisation remain the best sources of guidelines for the future healthcare requirements. The NHS professionals need to access this record online for updating their information base to provide the best healthcare. Understanding of the healthcare process under different settings like hospitals and public health services can be facilitated by a sound information management system. 3 Intertwined with information management is the information governance, a set of standards with professional and legal obligations that the NHS is obliged to follow to ensure complete and accurate maintenance of records maintaining their confidentiality and security. Known as the NHS Care Record Guarantee (2007), it is the commitment of the organisation to promote the health and wellbeing of its patients without compromising their rights. The information recorded under Care has to be clearly interpretable by other organisations under the NHS and reliable to them. Protection of sensitive information collected from the clients through a secured information management system that does not leave any room for breach of the patients' trust and confidence continues to remain a pertinent issue before the NHS. Besides, data protection along with clinical audit helps to develop a practice based on evidence that in turn enables the organisation to measure its performance. Towards responsible information governance in the NHS, existing and new issues that are to be addressed are secured transmission of personal data and identification and reportage of data losses, if any, in the process of such transfer. Prevention of failure in patient data handling in an organisation like the NHS which remains under public scrutiny demands putting in place minimum security standards covering the entire gamut of data security. The primary objective of the NHS information management programme is to ensure access to information across the length and breadth of the organisation in an integrated manner, a kind of centralised approach with the goal of sharing of information within the NHS network. The massive scale of the task requires coordination by all health sectors through developing a communication platform to facilitate such coordination. Developing a national standard of information management with local implementation is being tried by the NHS and its action 4 plans for 2007-08 and 2008-09 have acknowledged this agenda (source: www.dh.gov.uk/DH_063267). The electronically recorded medical data on the patient can be effectively used as information resources to take care of the various issues facing the NHS discussed above and improve its performance with regard to public healthcare in the following ways (source: NHS Care Record Guaranteee/www.connectingforhealth.nhs.uk): i. As a basis for health decisions made by healthcare professionals as well as the patients by providing up-to-date personal information irrespective of the location ii. Monitor the quality of the healthcare, e.g. Clinical Audit iii. Keep track of NHS spending iv. Probe any complaints regarding healthcare v. Guide healthcare professionals in their research vi. Provide copy of the record to client on demand vii. Allow other organisations providing care selective access to the information recorded with the NHS viii. Allow only authorised people to access the record ix. Confidential treatment of healthcare information with the intention to improve service/support research x. Keeping track of everyone accessing the record xi. Building and using data warehouse for "strategic workforce planning and monitoring purposes" (Local IM&T Plans for 2008/09: www.dh.gov.uk). 5 The action plan for developing the information management policy of the NHS is to identify the required resources for adequate control over all types of records. This overall control is needed for making the health information and data accessible to all the parties concerned to use them effectively for healthcare improvement. Starting from information generation, the action plan should also address information monitoring till it is archived and ultimately disposed of as per the Records Management Code of Practice of the NHS. Thus it includes the processes of information creation, storage, retention, disposal and last but not the least, training the staff adequately on information management issues. The various sources to rely upon for such information management will be, apart from the paper and electronic records, microfilm, audio/video tapes, x-rays and other images (Source: Surrey NHS Policy Number IG 12, March 2008). The mechanism for maintaining information security and preventing unauthorised use by controlling access will be an integral and in-built part of this exercise. To summarize, the information management policy and practices will cover the following areas: a. making inventory of all records and defining their retention period; b. continuous monitoring of records to prevent breach of compliance with legal/statutory requirements; c. identifying information required to be archived permanently; d. reviewing stored information at periodic intervals to assess their continued relevance; e. developing the appropriate technical setup for creation, review, storage and disposal of electronic information; f. information security management. "Information management for any organisation is vital for success, but in the NHS it can be literally life saving" (Day 2007). This reflects the challenges before the NHS to develop a health record system with accurate, trustworthy and dependable information. 6 The future healthcare policy of the NHS will have to be built around Electronic Health Information Management System to achieve a proactive healthcare system anywhere accessible and free from storage problems. In this system, each patient's Community Health Index (CHI) number will throw up updated e-health information for using and sharing in a secured electronic environment without compromising on confidentiality. There is a need for sustained investment and timely implementation to achieve this goal. Executive Summary: This Report for the Board of Directors of the National Health Service starts with a brief description of the NHS as an organisation. It then goes on to dwell upon information management issues related to the NHS healthcare services highlighting the need for sensitive data management, timely implementation of changes to avoid cost overrun, data access, patient information security, information governance, maintenance of data/information and developing a national standard for health information management. The action plan for addressing and resolving these issues through a proactive electronic health information management system has been recommended with due investments but without delay. References http://www.nhs.uk http://www.dh.gov.uk NHS Care Record Guarantee available at http://www.connectingforhealth.nhs.uk Local IM&T Plans for 2008/09 available at http://www.dh.gov.uk Surrey NHS Policy Number IG 12, March 2008 Day, K., 2007, Information Management In IT Projects in the NHS, University of Kent. Read More