BT: leading the way inhealthcare IT

BT is not only the UK’s largest information andcommunications company it is also the largest supplier ofNHS Information and CommunicationsTechnology – withmore than 2,000 staff solely dedicated to NHS projects.

The NHS Care Records Service

As the National Application Service Provider (NASP),BT is creating the national care records databasethat will store electronic patient record summaries –the NHS Care Records Service Spine. Whencompleted it will be one of the largest transactionaldatabases in the world.

BT has put in place the extensive hardware and infrastructurerequirements for the Spine, which will operate across three ofBT’s data centres. In addition, BT is conducting ongoing designreviews of the technical architecture for the care records Spine toensure that the system continues to meet the highest standardsof resilience and availability through the period of growth.Disaster recovery and business continuity services are also beingbuilt to ensure that care records remain accessible, but only toauthorised personnel.

Although the national Connecting for Health programme is currently attracting attention, BT has beenhelping the NHS to transform the way that the thousands of individuals, departments and agenciescommunicate with each other and exchange information for many years.

This has provided BT with invaluable experience of the needs of healthcare providers and thechallenges they face as they enter the digital networked economy. That experience is currently beingapplied to a wide number of projects throughout the NHS, including those that make up the NationalProgramme for IT led by NHS Connecting for Health.

BT’s health specialists are constantly developing and delivering innovative applications while continuingto deliver the key national services that are underpinning the modernisation of the NHS.

Aside from its contracts to deliver component parts of the National Programme for IT, BT is workingwith the NHS to develop specific health and disease management solutions.

The NHS Care Records Spine will integrate fully with systemsfrom Local Service Providers and with appropriate existingsystems in order to support the core services and applications tobe delivered by the national and local programmes. The first ofthese was the Choose and Book Service, which has beenfollowed by the Electronic Transfer of Prescriptions (ETP),launched by BT with selected suppliers to pharmacies and GPpractices.

BT’s work has provided the necessary foundations for thedeployment of the patient record database, which is the nextphase of the Spine programme.

BT is the LSP for London and leads the BT CapitalCare Alliance (CCA) in delivering integrated localpatient record applications and systems to supportmore than 7.2 million potential patients; 150,000-plus staff; 43 hospitals – which include half of theUK’s teaching hospitals; 1660 GP practices; and 13care communities.

The initial focus of the CCA has been to implement primary caresystems in GP practices across the region. The firstimplementations have been successfully completed, and arehosted at BT’s data centres. GPs who previously had obsoletecomputer systems, or even no systems at all, can now makeappointments, manage clinical records and issue prescriptionswith the new service.

The first ‘spine-enabled’ versions of the software have also beeninstalled, enabling access to the Personal Demographic Servicethrough single sign-on smart card authentication. BT has issuedthese cards to more than 3,000 London-based NHS staff as partof the national security system for the NHS Connecting forHealth programme.

London has also seen the successful deployment of core servicesin selected areas: the Picture Archiving and CommunicationsService and Electronic Transfer of Prescriptions. BT hascompleted the first full standalone implementation of the InterimPathology system, and extra functionality, such as Scan andAttach that digitises all patient-related documentation andattaches it to the individual CRS, has also been enabled atcertain sites.

BT and the London cluster lead the way in terms of consultationand engagement with clinical and non-clinical NHS staff. Theirinput has helped shape the local Care Records Service acrossLondon and contributed to a series of best practices for bothclinical and administrative processes. In addition, more than 30practicing clinicians are working for the CCA, averaging morethan 20 years experience each with the NHS.

BT has also established a demonstration suite which provides theopportunity for selected clinicians, SHA and PCT staff to follow afictional patient through all care stages and see how thecomponent parts of the Care Records Service will work together.

BT Capital Care Alliance – the LSP for London

N3

Underpinning NHS Connecting for Health’s NationalProgramme for IT is a new broadband network toconnect all NHS locations in England. It will enabledata to be transferred quickly and easily and supportthe applications and services being provided at bothnational and local level.

BT’s role in the new national network – N3 – is to act asintegrator, and to offer the best value to the NHS through theselection of suppliers. BT will select and manage these telecomsproviders to ensure that the service is delivered and supportedeffectively. However, BT will be applying its extensive networksecurity expertise to N3, including anti-virus services andencryption of patient identifiable information.

By March 2007 N3 will totally replace the existing BT-suppliedprivate NHS communications network, NHSnet.

The network is designed for future expansion, so that over timeall healthcare professionals, including dentists, pharmacists,opticians and social services, will be able to access it.

NHS Direct

BT has worked in partnership with NHS Direct sinceits inception as a telephone health information andadvice service in 1998. With a dedicated accountand service support team NHS Direct are guaranteeda high quality service at all times to support their 24hour, 365 day, a year operation.

With 54 locations across England, BT provides NHS Direct withall of their inbound telephony service, routing and supportthrough the Intelligent Call Management Platform & Network.BT handle more than 7.5 million inbound calls per year for NHSDirect and the ICM routes calls on a geographic and volumebasis depending on NHS Direct’s resource availability andrequirements.

BT also provides, maintains and monitors NHS Direct’s privatedata network and the online link for NHS Direct’s interactiveweb-based service. NHS Direct On-line receives over 1 millionvisitors per month.

All of the technical links for NHS’s Direct’s out-of-hours services,on behalf of primary care trusts, is also provided by BT, coveringover 40% of the English population.

Since NHS Direct became a Special Health Authority in April2004, BT continues to develop services for NHS Direct - as ittransforms from a network to a regional operating structure.Further investment into NHS Direct’s information andcommunications technologies is enabling them to continuouslyimprove their services to patients.

Working with BT, NHS Direct is able to realise the benefits ofbeing an NHS service that is rooted locally with healthcommunities but nationally connected for maximum efficiencyand effectiveness.

NHS Numbers for Babies

More than one and a half million babies have nowbeen issued with their unique NHS number withinhours of birth thanks to the NHS Numbers for Babies(NN4B) system introduced by BT in 2002. The NHSnumber helps establish accurate records of aninfant’s health and is a key element in anymodernised health service.

The system has already transformed the way that new births arerecorded, cutting delays and potential mix-ups over medicalrecords. Once a child is born, the midwife will enter the time,date and location of birth into the system, which then respondswith the NHS number.

An electronic copy of the birth notification, containing essentialinformation on the baby, its mother and GP, is also sentautomatically to the relevant Child Health department, and fedinto the Child Health systems.

Babies are now also benefiting from an addition to the NN4Bservice. An online link between the BT service and the NewbornHearing Screening Service helps to ensure that no babies missthe vital new hearing tests that are available in the first fewhours after they are born.

The data collected by NN4B immediately after birth forms thebasis of all individual care records that are stored on the centraldepository, and is a key element of the NHS Connecting forHealth Programme.

QMAS

BT has designed and built the Quality Managementand Analysis System (QMAS) to enable the NHS tomonitor GPs’ achievements against its Quality andOutcomes Framework (QOF).

The QOF is designed to reward GPs for improving patientservices, and provides a template for practices to record howthey care for patients with common chronic conditions.

BT has designed QMAS to collect, analyse and report on theachievements of GP practices in England against the QOFstandards. The system collates information from two separatesources to provide the fullest possible picture: clinical datacomes directly from practice systems and non-clinical data isentered by the practice via the QMAS web application.

The application is accessed through a standard web browser andallows GPs and other users to estimate their target achievement,or ‘aspiration’, against the QOF and monitor their attainments.An ‘aspiration management’ tool allows PCTs to govern, agreeand approve GP’s achievements for payment. A sophisticatedreporting function enables SHAs and PCTs to see appropriatelevels of reports.

National Cancer Research Network

BT has created an electronic remote data capture(eRDC) system that will support the National CancerResearch Network (NCRN) and the clinical trial units(CTUs) it works with.

The eRDC is a vital tool in the search for clinical excellencewithin oncology. It replaces the existing paper-intensivemethods of recording information from the 10 to 15 visits tohospital that the typical patient makes during the course of theirtreatment. Rather than forms being filled out in triplicate,gathered into worksheets and posted to the CTUs, data can nowbe entered onto the system once, and seamlessly transferred tothe trial unit.

The eRDC provides uniformity of data, greater accuracy ofinformation and improved efficiency, making analysis of resultsquicker and more straightforward. The end goal is to reduce thetime to market for treatments, making a significant contributionto the government’s targets on cancer care.

The system leverages BT’s detailed understanding of the needsand objectives of the NCRN and its experience in deliveringadvanced and effective systems to healthcare providers. Thenext stage is to trial the system at two CTUs and then roll it outnationally in 2006/7.

BT Carecall

BT Carecall enables the NHS to help patients withtype 2 diabetes more effectively. BT has developedspecialist triage software in conjunction with SalfordRoyal Hospitals NHS Trust that provides the basis forpatients to be remotely monitored via a BT contactcentre.

The contact centre is staffed by a Diabetes Specialist Nurse(DSN) and three telecarers, who proactively call patients in theirhomes to discuss their blood glucose levels and informationabout their general health and well being. The telecarers willthen offer information about the disease and advice aboutmanagement, diet and lifestyle. If needed, patients can then bereferred to the DSN and follow up calls are arranged. Telecarerscan refer electronically to a DSN for in-depth advice ormedication adjustment.

BT Carecall will integrate with both local patient records and theevolving NHS Care Records Service, and offers the ability tobook consultation sessions electronically at a time convenient tothe patient.

By using BT Carecall the NHS can generate additional capacityto support this chronic condition through the more efficient useof specialist diabetes staff. In the longer term the increase inpatient self-management and awareness will lead to a reductionin the number of diabetes-related complications.

The service has been successfully trialled in Salford, and can bereplicated throughout the NHS to support GPs in meeting theirnew QOF targets.

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Converged Networks

BT is helping Primary Care Trusts across the countryto consolidate their communications networks andconverge voice and data traffic. By replacing themultitude of separate networks that typically existedwithin a single PCT with a single Community ofInterest Network (COIN), BT has enabled a numberof trusts to rationalise their communications systemsacross their multiple sites – and generate significantcost efficiencies as a result.

BT has called on its own extensive networking experience todeliver COINs that are built on converged networks. These allowtraditional voice services to be combined with data traffic. Thishas enabled PCTs to centralise and unify the delivery of clinicalsystems to GP practices: applications and services are accessedover the network, rather than having separate versions installedin each location.

The converged networks also support greater efficiencies inremote and mobile working. Health visitors and communitynurses, for example, can access patient records on the move,rather than making repeat visits to their base to pick up details.

BT has implemented more than 20 COINs across the North Westof England, one of the largest being for Stockport PCT covering85 separate sites. BT will also be deploying a county-wide COINfor all PCTs in Essex.

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