raising the roof national patient records analysis service (npras)

PRIMIS Third National Conference Tuesday 1 April 2003Birmingham


RAISING THE ROOF

National Patient RecordsAnalysis Service

(NPRAS)

Gwyn ThomasNHS Information Authority


CHALLENGES TO HEALTHCARE

Growing Complexity- medical

- organisationa

l

Knowledge, Process and outcome management

Inconsistent Quality,

Confusion

Changing expectation

Patient-focused service

Dissatisfaction

Diverse, more efficient provision of care

Increasing demand

Insufficientcapacity


FUTURE PATIENTS*

• Better Informed• More personally accountable• Less uniform in attitude

and will expect …….

• Waiting within reason• Safe, effective equitable service• Hotel Services• An integrated, joined up system

*McKinsey 2002


EXPERIENCING HEALTHCARE

• Patient experience – Confidential journey along a care pathway

• Provider / user experience– Standard Tools to do their job

• Organisation experience– Effective & efficient management


• Health Provider – Where Care is given

• Health Network – Where Specific Care is Integrated

• Health System– Where Overall Integrity is Secured

Values

Clinical standards

Workforce / networks

Information

MAKING THE SYSTEM WORK – NATIONALLY


Providing National Information Services for the NHS

Supporting Local Communities

Implementing National Strategy

Supporting Health Networks

INTEGRATING THE HEALTHCARE SYSTEM– THE ROLE OF THE INFORMATION AUTHORITY


DELIVERING 21ST CENTURY IT VISION

support the delivery of care and services designed around each patient’s choice, quickly, conveniently and seamlessly

support staff through electronic communications, better knowledge management and support, faster access to essential information (notes, test results) and routine access to specialised expertise

improve the management of services by providing good quality data to support NSFs, clinical governance and management information


ICRS - Linking Up Health Communities

InformationGovernance

Analysis

InformationReporting

InformationCapture

UserEnvironment

User Tools

HealthCommunity

Pat

ho

log

y

Men

tal H

ealt

h

Acu

te C

are

So

cial

Car

e

Pri

mar

y /

Co

mm

un

ity Specific Functions

CHD

Older People

Mental Health

Diabetes

Cancer

NSFs

Service User IndexDiagnosis and Care

Booking and SchedulingOrdering & Reporting

PrescribingDigital Imaging

Knowledge Management

Generic Functions

AnalyticalServices

NHS DirectCAS

PopulationRecord

HRIReference

Files

Application Services

Nhs uk NeLHDecisionSupport

Information Services

Infrastructure Services

Network SecurityAccessControl

DirectoryE-maileStaff

RecordFinance

National Infrastructure

NHSINFORMATION AUTHORITY

“THE NATIONAL SERVICE PROVIDER”

THE NATIONAL

PROGRAMME


INFORMATION SERVICES OF THE NATIONAL HEALTH SYSTEM

Four Elements

• CONTEXT – Health Services Providers– common descriptions and details of services and providers

within the health system, their configurations and locations

• INTENT – Standards for Health Services– Using clinical knowledge and adopting standards of care across

the health system e.g. National electronic Library for Health

• ACTIONS – Personal Health Management– electronic records, e-bookings, referrals, investigations, and

prescriptions

• OUTCOMES – Measuring Performance of Health Services– consistent support of the clinical audit of individual care

Where can I go?

What will they (we) do?

What did they (we) decide?

Did it do any good?


NATIONAL INFORMATION SERVICES – REALISATION (1)

1. Health Service

Providers

3. Performance

of health services

2. Personal health

management

4. Standards for health services

National Health System Interface

NHAIS

NeLH NHS directory

NSTS

NWCS

nhs.uk

HRI

Where can I go?

What will they do?

What did they decide?

Did it do any good?


PAT & OSCAR

CLIN. GOV. TOOLKIT

ELDERLY CARE NSF TOOLKIT

HEALTHCHECK TOOLKIT

MENTAL HEALTH

CAPACITY PLANNING

PRIMIS

NWCS REPROCUREMENT

NCASP

CCAD

NATIONALPATIENT

RECORDSANALYSISSERVICE

MIGRATION

NATIONAL INFORMATION SERVICES – REALISATION (2)


NATIONAL CLEARING SYSTEM

NATIONAL PATIENT RECORD ANALYSIS SERVICE

CHANGING PRACTICEEDUCATION & TRAINING

LOCAL CARE RECORD SYSTEMS

WEB BASED ANALYTICAL TOOLKITS

NATIONAL ANALYTICAL SERVICES


NATIONAL PATIENT RECORD ANALYSIS SERVICE – Potential benefits

• Easier access to nationally consistent analyses on patient activity

• Greater sharing of information to allow comparative analysis

• More cohesive views of patients receiving healthcare services wherever it occurs

• Capability to undertake key national analyses once only• Improved availability of aggregated patient activity

across the whole healthcare system• Improved record linkage for audit across the whole care

pathway• Opportunity to provide a coherent framework for existing

disparate systems


ICRS Local / National – Patient RecordAnalysis Services

• Identifiable records for Individual persons• Immediate access• Dynamic, up to date

• Frequent abstracts• Focus on classes of persons • Time series• Short time intervals• Prospective indicators

• Focus on classes of patients• Actual compared with expected (inputs, outcomes)• Ongoing• Indicators

• Focus on classes of patients• Service and pop. based • Forecasting• Periodic

Operational /Direct Care

Audit / Performance review

Tactical Strategic /Planning

Examples of characteristics of requirements

Business Requirements


Demand management within local health systems• Emergency (e.g. winter pressures)• Elective

PCTsTrustsProvider partners (LA SS etc.)

Surveillance• Incidence of “adverse events”• Incidence of communicable diseases

PCTsTrustsNPSA CHI?PHLS

Resource deployment and allocation• Across care teams and service areas

PCTs,TrustsProvider Partners






Audit of clinical / care services• Quality• Effectiveness and outcomes• Risk management

NHS wide – CHI > CHAIClinical / care networks and partnershipsIndividual organisationsClinical / care teams

Service performance improvement, monitoring and review

• Monitor and review achievement of national and local objectives and targets for access, effective-ness, outcomes, efficiency and quality

• Early identification of performance problems

• Development of responses and plans

StHAsClinical / care networks and partnershipsPCTs Trusts

Commissioning• Development and monitoring of SLAs

PCTsTrusts, Commissioning partners






Service Planning• Population based needs assessment• Capacity planning, service reviews• Planning and development of networks• Health contribution to overall regeneration planning • Development of LDPs

NHS Wide GroupsStHAs and clusters of PCTs, Trusts and partnersLocal care communities – strategic partnerships

Surveillance• Prevalence and incidence of diseases and problems

NHS wideRegionalLocal communities

Strategic resource allocation• Across populations

DoHPCTs

Research• Public health / epidemiology• Medical (e.g. treatment / care outcomes)

NHS Wide / LocalNHS OrganisationsAcademic researchers






NPRAS Characteristics and Objectives

• Characteristics of the Service– Comprehensive– Responsive– Easily accessible– Cost effective and

value for money– Secure– Accurate– Timely– Relevant and fit for

purpose– Flexible

• Investment Objectives– Improve user access to data

to meet business needs– Secure consistency in data

available– Improve coverage and

quality of data– Improve security of data– Prevent duplicate

abstraction– Enable greater public

involvement in decision making

– Enable users to improve services


•Mapping & reference services•Data management•Access through consistent user interface•Aggregated data•Data extracts for indicator construction•Extended data to include aggregate & population data

•Standard analysis & reporting•Analysis tools & models

NPRASPreferred Option


NPRAS – Trials

• Understand the practical implementation issues of using electronic records for secondary analysis

• Sharing models & options for delivering NPRAS type functionality using electronic records as the data source

• Demonstrate how to link local records systems with national systems (e.g. NWCS) for analytical information


NPRAS – Trials• Bradford -

– consolidation of disparate GP systems – analysis of primary care data

• Cornwall - – community wide management & clinical analysis – developing electronic links for data analysis (Cornwall

wide & national flows)

• Dorset - consolidating PCT & GP systems for – clinical governance (CHD) – management information (prescribing vs dispensing)


NPRAS – Trials• Hampshire & IoW -

– analytical information from various hospital based systems, NHS Direct, Ambulance, Social Services to support clinical governance

• Walsall - – supporting NSFs and clinical governance using

primary and secondary care data

• Wirral -– using Trust systems and electronic records across

hospital systems for analysis


Key messages from NPRAS Trials

• Issues needing to be resolved at national level– National information standards which are enforced– Pseudonymisation protocols– Information sharing protocols with non-NHS

organisations– Primary Care ‘Dataset’ based upon new GP contract– ‘Push’ model is more effective & efficient than ‘pull’

for a service as complex as healthcare analysis– Provide for accredited analytical software tools or

procure single supplier for analytical software tools– Rationalise & ensure consistent core requirements

across NSFs


• Issues needing to be resolved at local level– clinician involvement & buy-in– data quality & integrity to develop ‘trusted’

information– continual training & education for local staff

(users/data suppliers)– adherence to national standards even if different

from current practice– active use of the information to support

decision-making processes– investment in systems and people



• Other issues needing to be resolved– Relationship between local analytical services

(systems & people) & NPRAS– Ensuring that funding is available to support local

requirements to use NPRAS as well as national level funding

– Being clear about the relationship between current systems/services with similar functionality with NPRAS (e.g. OSCAR, NCASP, Dr Foster), and identifying migration & implementation timetables

– Start with data that already exists, link it, use it and improve it



NATIONAL CLEARING SYSTEMNWCS – ‘Mk 2’

Current Assets& ICRSLOCAL CARE RECORD SYSTEMS

NATIONAL ANALYTICAL SERVICESNHSIA

WEB BASED ANALYTICAL TOOLKITS NHSIA/SUPPLIERPARTNERSHIPS

CHANGING PRACTICE

EDUCATION & TRAINING NHSIA/NHSPARTNERSHIPS

MAKING IT HAPPEN …


RAISING THE ROOF

National Patient RecordsAnalysis Service

(NPRAS)

Gwyn ThomasNHS Information Authority

raising the roof national patient records analysis service (npras)

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