Download The Go-Between Issue 88 June 2009 Information for Information Users

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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
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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