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http://www.bcs.org/server.php?show=ConWebDoc.13667 The Go-Between Information for Information Users Issue 88 June 2009 The Go-Between would like to hear from potential contributors. Articles should be on IM&T related matters and around 250-400 words in length. Copy deadline for Issue 89 is 20 July 2009. complete medication order. This information can then be shared among multiple healthcare professionals, allowing reliable access to medicines information without having to hunt down a single paper record. For contributions etc. please write to the Editor (address on back page). ____________________________________________________ ePrescribing systems can also provide various degrees of clinical decision support (CDS), to help prescribers create orders based on full information about the patient and about the medicines in use. For example, a prescriber can be informed about a patient’s allergies, or about potential drug-drug interactions. Similarly, during administration a nurse can have access to decision support, for example access to laboratory tests or additional administration instructions at the time of administration. In This Issue Diary ePrescribing Lessons Learned HC2009 Info Governance Assurance Information Standard News in Brief NHS Evidence Open Source ____________________________________________________ ePrescribing Lessons Learned The number and complexity of medications has grown significantly since the NHS came into being. Electronic prescribing (ePrescribing) systems, where the ordering, administration and supply of medicines is supported by electronic systems, offers opportunities to support decision making (e.g. prescribing choices), patient safety (e.g. checking for contraindications) clinical governance (e.g. a robust audit trail) and enable potential innovations in the use of medicines. A major motivation for introducing ePrescribing systems is to improve the safety of medicines use and reduce the current and unacceptable levels of adverse drug events. There is also the opportunity to redesign aspects of the medicines use process and establish new practices. An ePrescribing system needs to be integrated with other hospital systems such as electronic health records, pathology results or patient administration systems, using data drawn from these systems, and feeding data to them. ePrescribing projects take time to be established and to make all the preparations needed before a system can be put to use – between one and two years. Throughout this period the ePrescribing project team must maintain good two-way communications with stakeholders. ePrescribing will demand changes in work practices, and that this implies a need for an active and open approach to learning how the system can be used to maximum benefit. The ePrescribing team must be open, taking time to listen to concerns of users, their suggestion and enquiries. Continued on page 2 _______________________________________________ NHS Connecting for Health has recently published “Electronic prescribing in hospitals. Challenges and Lessons Learned”. ePrescribing must be understood in the context of the whole medicines use process, not as just about prescribing or exclusively of relevance to prescribers. Nurses use ePrescribing systems to administer medicines, and pharmacists to review orders and manage the supply of medicines. Beyond these central stakeholders – doctors, nurses and pharmacists – are many other healthcare professionals who are potential users of ePrescribing if and when they need to review a patient’s medication. ePrescribing systems are widespread in primary care, and almost all GP prescriptions are electronically generated. In secondary care ePrescribing is, as yet, less widespread though the number of systems is growing. The benefits of ePrescribing for all users and all medicinesrelated tasks start with the generation of a legible and Raising standards. The Information Standard is launched – see page 2. _______________________________________________ Continued from page 1 Don’t underestimate how long procurement and installation of the equipment and software takes, or the potential for this technology – networks, computers, software systems – to fail. The sequence and pace of the roll-out of ePrescribing into clinical areas needs careful consideration. Experience suggests that, once a system is fully tested in a pilot location, roll-out to the rest of the hospital should be as fast as is compatible with safety, so as to minimise the period of time where multiple systems are in use. ePrescribing will change how people work; some tasks may become more rigid, demanding a full compliance with a set of procedures, or constraining options. However, it is also about support for creative use of the data generated, help in prioritisation of work, and the ability to reflect on and review practice. As people start to use an ePrescribing system it will result in various ‘workarounds’ – ways that people discover to get the job done faster or easier. People will, in effect, configure the ePrescribing system to meet their particular needs. These ad hoc developments may be desirable and useful, or may be dangerous. Workarounds will need to be monitored and assessed to understand the needs of users, the demands of safety, and what it is possible to achieve. ePrescribing offers many advantages in medicines related tasks, supporting management and practice development, and in innovation in medicines use processes. More Information: www.connectingforhealth.nhs.uk/eprescribing/challeng es _______________________________________________ Information Standard The Department of Health (DH) has appointed Capita to manage a new certification scheme – The Information Standard – as part of a drive to ensure that the public and patients have access to good quality information that will help them make confident and informed decisions about their health and social care. The Information Standard, formerly known as the Information Accreditation Scheme, will be launched later this summer. Organisations that apply to join the scheme will be certified against a standard. The certification bodies will be approved by UK Accreditation Service (UKAS), an independent agency that accredits certification bodies. Capita will manage the scheme on a day to day basis. The Information Standard is a new certification scheme for health and social care organisations. Those that meet the criteria of The Information Standard will then be entitled to place a quality mark on their information materials so people searching for health and social care information can easily identify it as coming from a reliable, trustworthy source. The Information Standard looks at processes and, in that respect, is similar to schemes such as ‘Fair Trade’. The organisation’s process for developing information will be assessed rather than individual pieces of information. The assessment will evaluate elements like the organisation’s processes for making sure information produced is consistent with latest clinical evidence or their process for involving information users. This scheme is designed to run independently. A range of organisations such as charities like Terrence Higgins Trust, private companies like BUPA and Boots and organisations from the public sector like local authorities and NHS organisations produce health and social care information. In order to avoid any potential conflicts of interest if, say the scheme were managed by an NHS body, the Information Standard will be operated by an independent organisation whose role is simply to apply The Information Standard in an impartial way. Capita’s responsibilities in this role include; promoting the scheme, providing support to potential members and authorising a number of Certification Bodies to assess and offer certification against the standard. These Certification Bodies are specialists in carrying out such evaluations against standards. The certification bodies themselves will be accredited by the United Kingdom Accreditation Service (UKAS) to confirm that they are competent to provide a certification service for this scheme. Certified information producers will be able to display the Information Standard quality mark. More information: http://www.dh.gov.uk/en/Healthcare/PatientChoice/Bett erInformationChoicesHealth/Informationaccreditation/i ndex.htm _______________________________________________ NHS Evidence On 30 April a new online service was launched – NHS Evidence. It will allow people working across health and social care – including social workers, commissioners, clinicians, academics and researchers – to access a comprehensive range of sources of clinical and non-clinical evidence to help them make informed decisions about treatments and resources. NHS Evidence will help users identify the best evidence by sorting, sifting and prioritising a range of information and awarding an accreditation mark to the most reliable and trustworthy sources of guidance. All information submitted for accreditation will be assessed by an independent advisory committee and guidance producers must show they meet a pre-defined set of criteria indicating that their product has been developed using rigorous processes. NHS Evidence will consolidate information from a wide range of sources through one central portal and topic areas include clinical, commissioning, drugs and technology, public health, social care and education. The new system is built around a powerful search engine (Microsoft FAST), and will allow users to browse evidence using ‘topic trees’, upload and share their own content (such as local service models and policies) and customise the service based on their own preferences, and to receive alerts about new information. NHS Evidence will search external sources of information, and not act as content host. NHS Evidence will cover more than the previous National Library for Health (NLH) remit. It will cover both health and social care and users will include clinical practitioners and commissioners. The portal will be released in a number of stages and will take some years to reach full functionality as the most effective gateway to all health and social care information provided by a broad range of accredited sources. NHS Evidence is starting its own eBulletin – Eyes on Evidence – containing regular features and with a strong emphasis on quality and access to information. NHS Evidence will also provide an enquiry team based around guiding and supporting users on evidence and information searches and use rather than a technical incidence response. As part of the transfer to NHS Evidence, the specialist libraries have changed their names and, as a group, are now called specialist collections. But the Knowledge Management specialist library will not be maintained while a review of all the collections takes place over the summer. Later in the year, a decision will be made over its future. More information: http://www.evidence.nhs.uk/ Contact: [email protected] _______________________________________________ Info Governance Assurance The NHS Chief Executive has recently written to Chief Executives making it clear that ultimate responsibility for information governance in the NHS rests with the board of each organisation: • • • • • From 2008/9 information governance must be explicitly referenced within each organisation’s statement of internal controls. A board-level Senior Information Risk Owner (SIRO) is required in each organisation and a senior Information Asset Owner should be designated for every separate database or other major information asset. Appropriate information governance training is mandatory for all users of personal data and for all those in key roles. (On-line training is available through NHS CFH). Details of serious untoward incidents involving actual or potential loss of personal data or breach of confidentiality must be published in annual reports and reported to the SHA and to the Information Commissioner. The annual information governance assessment, via the Information Governance Toolkit, will continue with performance assessments submitted on 31 March each year shared with the Care Quality Commission, Audit Commission, Monitor and a new National Information Governance Board. The NHS Operating Framework for 2009/10 requires organisations to achieve level 2 performance against all key requirements identified in the Information Governance Toolkit. Organisations must also sign the Information Governance Statement of Compliance to provide assurance that they are meeting these key requirements and must have robust improvement plans to address any shortfalls against other requirements. Foundation Trusts are subject to the same requirements, set out by Monitor. The contractual arrangements with independent sector NHS providers also contain strengthened information governance requirements. More information: https://www.igt.connectingforhealth.nhs.uk/. _______________________________________________ Open Source On 24 Feb the Government published a new policy on Open Source software. The new policy reflects changes to both the Open Source market and the Government’s approach to IT and sets out ten actions to encourage the use of Open Standards. There are three aspects to the new policy: • Open Source software: the policy includes 10 actions that will actively help make sure the best possible, best value for money software solutions are put forward for tenders, be they Open Source or propriety products. • • Open Standards: the policy contains an explicit reference to Open Standards, ensuring systems are inter-operable and avoiding getting locked into a particular product where possible. Re-use: the Government will look to re-use what it has already bought, with successful solutions being made available across Government. The Government will actively and fairly consider open source solutions alongside proprietary ones in making procurement decisions. Procurement decisions will be made on the basis of best value for money, taking account total lifetime cost of ownership of the solution, including exit and transition costs, whilst ensuring that solutions fulfil minimum and essential requirements. Where there is no significant overall cost difference between open and non-open source products, open source will be selected on the basis of its additional inherent flexibility. The Government will, wherever possible, avoid becoming locked in to proprietary software. In particular it will take exit, rebid and rebuild costs into account in procurement decisions and will require those proposing proprietary software to specify how exit would be achieved. Where non open source products need to be purchased, Government will expect licenses to be available for all public sector use and for licenses already purchased to be transferable within the public sector without further cost or limitation. The Government will, where appropriate, seek pan-government agreements with software suppliers. The Government will use open standards in its procurement specifications and require solutions to comply with open standards. The Government will support the development of open standards and specifications. The Government will look to secure full rights to bespoke software code or customisations of commercial off the shelf products it procures, so as to enable straightforward re-use elsewhere in the public sector. Where appropriate, general purpose software developed for government will be released on an open source basis. Where the public sector already owns a system, design or architecture the Government will expect it to be reused and that commercial arrangements will recognise this. Where new development is proposed, suppliers will be required to warrant that they have not developed or produced something comparable, in whole or in part, for the public sector in the past, or where they have, to show how this is reflected in reduced costs, risks and timescale. More Information: http://www.cabinetoffice.gov.uk/government_it/open_s ource/policy.aspx _______________________________________________ HC2009 At the HC2009 Conference Christine Connelly, Chief Information Officer of the Department of Health set out a number of key proposals in her keynote address. This included opening up the IT market with a procurement process for hospital trusts in the South of England which are not managed by BT. This would use the Additional Supply Capability and Capacity framework which confirmed a number of suppliers in 2007 as able to deliver extra resources for the Programme. The computing marketplace will also be boosted by the provision of a Department of Health toolkit which will allow new products to be developed locally, accredited centrally and linked to existing deployments of information systems such as Cerner and Lorenzo. It is envisaged that work on this toolkit - a pioneering initiative to take advantage of the latest technological developments - will be complete by March 2010. She also spoke of the slow progress in implementing electronic information systems in the acute sector. Greater pace needs to be injected into these implementations. If significant progress is not achieved by the end of November 2009, a new plan for delivering informatics to healthcare will be adopted. “The potential for informatics to improve the quality of services for patients is enormous, and I want to ensure that what we are doing is in the best interests of patients, as well as the system”. In moving forward the objective of the National Programme for IT is purely aimed at improving patient care. The challenge is that the NHS and healthcare is complex but don’t forget that the UK was the first G8 country to fully implement a digital x-ray system (PACS). Martin Bellamy, Head of NHS Connecting for Health and Director of Programme & Service Delivery, Department of Health gave a review of benefits and the opportunities for supporting the delivery of safer better care. Some statistics to illustrate the benefits include: • 1 million prescriptions are now dispensed via the Electronic Prescription Service. • Choose & Book had its busiest day on 27 April 2009 with 35,000 bookings being made on a single day. In moving forward he spoke of the need to remove barriers between customers and suppliers, to create true team working and to improve communications. He also spoke of the importance of management ownership, leadership from the top of an organisation and the importance of learning from others and sharing lessons learnt. More information: http://www.hcshowcase.org _______________________________________________ News in Brief NHS Data Model & Dictionary The NHS Data Model and Dictionary Service is running training courses on the NHS Data Model and NHS Data Dictionary in Leeds on 24 and 25 June 2009. Participants will: • Understand how to navigate the NHS Data Model and Dictionary • Read the NHS Data Model • Use the NHS Data Model and Dictionary to resolve data definition queries. See: http://etdevents.connectingforhealth.nhs.uk/all/2342 NHS Mail Guidance and Training New guidance and training material has been made available to support NHS Mail users: The NHSmail user guide. Information includes policy and procedure, case studies and advice on utilising the full capabilities of the service, such as setting up automated SMS patient appointment reminders. See: http://www.nhs.net/ under 'Guidance' pages. Online training course (for users of NHSmail) See http://www.microsoft.com/nhs/nhsmail. NHSmail mini guides (hard copy). Available from http://www.connectingforhealth.nhs.uk/systemsandservices /nhsmail/training/loa_nhs_mail_pdf_april09.pdf. Real-time Patient Feedback A recently published report analyses and looks at the use of real time patient feedback for improving health and social care. The development of new technology is providing innovative and enabling ways in which the human services can be more person-centred, responsive and improve the quality of care. However, there is a danger that technological solutions will become a proxy for human contact. Highest on the list of complaints from patients about their care is how they are treated by people, with lack of respect and dignity cited as key issues. Embedded in a lack of respect or dignity is the lack of relatedness. Real-time patient feedback through technological solutions has limitations, not least because it can only gather responses to ‘what’ questions. The ‘why’ and ‘how’ questions require face-to-face methods to drill down and understand the experience of the person. Technology has an important part to play, but its introduction needs to be thought through carefully. For the copy of the report see: http://www.espace.connectingforhealth.nhs.uk/fileproxy/30 24. IM&T Investment Survey The seventh full national survey on IM&T investment within the NHS was launched in April to be returned by July. The survey collects detailed information on how local IM&T budgets are spent on staff, services and equipment; both revenue and capital expenditure and capture spend for 2008/09 (actual) and 2009/10 (planned). Full results and analysis from the 2009 survey are expected to be made available later this year. Info Governance Reporting The reporting cycle for the Information Governance Toolkit have changed from 1 April 2009. On line reporting through the Toolkit • Baseline Performance - 31st July 2009 • Performance Update - 31st October 2009 • Final Submission - 31st March 2010 See: https://www.igt.connectingforhealth.nhs.uk/. ___________________________________________________ Diary 24 & 25 Jun 09 NHS Data Model and NHS Data Dictionary course, Leeds (//etdevents.connectingforhealth.nhs.uk/all/2342) 29 Jun – 01 Jul 09 BCS Primary Health Computing Specialist Group Summer Conference 2009, Warwickshire (www.phcsg.org) 02 Jul 09 Improving Care in the Capital, NHS London Programme for IT Clinical Conference, London WC2A (http://events.london.nhs.uk/all/1752) ___________________________________________________________ Address for correspondence: The Go-Between, c/o David Green, Director of IM&T, SW London & St George’s Mental Health NHS Trust, Springfield University Hospital, Tooting, LONDON SW17 7DJ 020 8772 5602 [email protected] London & South East