Present and Future Scenario of IM&T Development - Assignment Example

22-11-2006. An evaluation of NHS Ayrshire and Arran information management and Technology strategy. A case study By: ------------------------------------ Total no. Of words: 3295. Contents: Executive summary Introduction Present scenario of IM&T development Future plans for IM&T development Conclusions References. Executive Summary The NHS Ayrshire & Arran in Scotland needs to change. Not because it is in crisis as some would have us believe - it is not; but because Scotland's health care needs are changing rapidly and we need to act now to ensure we are ready to meet the future challenges. There could not be a more appropriate time to undertake a review of NHS Ayrshire & Arran present IM&T plan AND its future development. As we set out in this report, in an area as dynamic as health care, change is inevitable. We have an extraordinary opportunity to improve our health and our health service, but that will not be done by complacent defense of the status quo. In developing this Framework for Service Change, we provide a policy context as well as a plan of action. We make a number of detailed recommendations in the Report and these are underpinned by the following key messages. In planning the future of the NHS Ayrshire & Arran We need to: 1. Evaluate the present information tech. & management system of A & A. During evaluation it has to be seen that how NHS Ayrshire & Arran services achieve their mission and what present strategy they ARE applying to fulfill their aims. 2. Discuss at length about the shortcoming or bottlenecks to implement the strategies to achieve the objectives of the implementation of information management and technology. How these shortcomings could be eradicated and finally how we will achieve the required aims/ goals to develop a prudent information tech. & management system, which could fulfill the needs of the NHS Ayrshire & Arran. 3. Analyze the existing strategies and plans and future needs of the NHS Ayrshire & Arran. In future what specific requirements will be needed is to BE analyzed for implementing any strategic information and technological changes. Introduction NHS Ayrshire and Arran is an agency, which is providing health/ services and supporting health improvement initiatives based at Boswell house in Ayr. The Ayrshire and Arran acute hospitals NHS trust services are based on five sites in Ayrshire and Arram i.e. Ayr Hospital, Ayr, Ayrshire central hospital at Irvine, Biggart hospital, prestwick, crosshouse hospital, kilmernock and Health field clinic Ayr. It has been supported by primary care services of 63 general medical practices, 66 general dental practices, 90 community pharmacists, 55 optical outlets plus 5 practices which provides services in nursing residential and day care facilities, 47 health centers and clinics and area services including children's services, school nursing, and professional allied to medicine, mental health and sexual health. Primary care trust also responsible for the delivery of a range of in-patient services across 12 hospital sites, ranging from mental health, frail elderly services, learning disabilities and day care hospital. It is serving the population of 3,67,140. The demographic trends show that though population is decreasing but population of older people increasing, results in growth of aged people. Main aim of the NHS Ayrshire' & Arran is to provide better health services to its population and specifically provide health services to those people who are deprived, results in reducing inequality in availing health services in its service area. Clearly the overall objectives of the services are to: - 1- Introduce a prudent system, which is user friendly. 2- Provide all the required information to the user; it may be public or patient. 3- Develop a system having care records i.e. could be able to integrate the complete system so that once the information is fended, it will provide all the information about patient as well as support the decision making process by clinicians. It could also provide all other interrelated Para medical information as well as reports to patients and the people. 4- Develop a system, which could integrate its aims and objectives as well as services with national, regional and local level. Present scenario of IM&T development Technology is not a panacea. However information and communication technology (ICT)/IMT has the potential, in combination with organizational modernization, to revolutionize the way health care is delivered. Many of the interactions between patients and the health service will be conducted electronically in the future. An Electronic Health Record will be perhaps the single most important development in ICT/IMT aimed at supporting a new model of health care delivery. Patients will increasingly have a complex mix of medical and social problems requiring input from several different services. Care can best be built on the basis of a comprehensive electronic patient record. Current trends indicate that developments in health care policy and administration are progressively more reliant on ICT (Norris 2002a). A leading contemporary international trend in health policy and service development is the notion of integration (Robinson & Steiner 1998; Satinsky 1998). Integration refers to closely coordinated services and the removal of "boundaries" between the different providers and locations involved in health care provision. The emergence of ICT, facilitating electronic patient records and exchange of electronic information, has boosted integration prospects. In theory, ICT facilitates vertical integration through the various "levels" of health care: community to hospital to national agency; and horizontal integration between providers regardless of physical location. However, to achieve integration, some basic ICT and related requirements need to be in place. First is the need for full interoperability: fully networked ICT systems that provide all relevant data at all points in the health system when needed (Landsbergen & Wolken 2001). This requires that all parties involved in health care are computerized and interoperable. Second, a high level of data security to guard against third parties accessing networks, including systems for authentication and authorization, is required. In tandem with this is the need for protection of personal information and privacy. Policies must be developed around collection of, access to and protection of personal information. Once developed, such policies need to be widely disseminated and strictly observed to bolster professional and public trust in ICT systems and information sharing (Smith 2000). Third, there must be coordination of data standards including the type of data collected, the form this is collected in and the way in which electronic information is sent. In health, there are numerous possible combinations of diseases and complaints. When information is shared, it is critical that common definitions are used. At the hospital level, the World Health Organization has promoted the use of ICD-10 (international classification of disease V10), to ensure a common international language. For electronic data exchange, HL7 (health language v7) has become the agreed international standard. Obtaining complete compliance with such standards is a critical challenge for full interoperability (Hovenga & Lloyd 2002). Fourth, ICT system architecture needs to be coordinated. Numerous combinations of computer hardware and software exist. Naturally, without central oversight and coordination, health agencies will make what they deem to be ICT purchases appropriate for their purposes, or will develop their own "in-house" systems. Indeed, numerous competing hospital patient management systems exist in the marketplace, meaning a high likelihood that there will be multiple different systems of data collection, classification and coding, which confound the quest for interoperability. It has been shown that, where system architecture standards are established, this results in a considerable reduction in the purchase and development of incompatible ICT (Jones et al 2000; Kuperman et al 2000). Fifth, integration often demands organizational reengineering (Dunleavy & Margetts 2000; Norris 2002b). Interoperability may be important, but strong relationships, trust, communication and Cooperation among the various parties involved in a health care delivery system is critical to integration. Achieving this can require a considerable effort by the parties involved and often begins with small projects around specific medical conditions such as the management of diabetes. Important to such projects is the involvement of personnel with knowledge of the technical, organizational and clinical implications of information technology. To run NHS Ayrshire and Arran smoothly is to improve its services by providing fully integrated information systems to support staff in the delivery of efficient economic healthcare to patients, provide accurate and timely information to staff and the public on health, provide a secure and confidential environment for clinical and administrative information, provide a flexible and robust IT infrastructure to meet the future needs of the services, provide individual training and organization development to ensure true benefits of IT investment are realized and provide the IT infrastructure and access to assist in clinical research. NHS Aryshire & Arran has identified eight objectives that were strategic across the operational units and inter faced with national objectives. So we have to analyze all the objectives identified by NHS Aryshire and Arran and its current status with the IM &T maturity matrix. The IM&T maturity matrix is a method used to establish a baseline and target. The level referred to are the assessment of where we are in the matrix and where we want to go reach. The first objective is to allocate CHI number, which has been identified by the scathes executive as the proposed unique patient identifier with in the NHS in Scotland. Access to this system of patient identification is held nationally and applications for CHI number from general Medical Practices, trusts and boards are processed centrally. This leads to delay, and creates problem of duplication. Presently 72% GMP in Ayrshire and Arran are involved in the PARTNERS project with common service agency to allow CHI No. held in GPS to be checked against the CHI held centrally. This facilitates patients' identification. Across the organization the patient Administration system (PAS) has been seeded with CHI to a level of 90% of current attendees. In Acute CHI populated with MPI (Master patient index) and in primary care hospitals unique patient identifier (UPI) enables online access to the central national patient database. COMPAS system at Cross house and ACH and manual STAR system in Ayr and Biggart hospital are the systems usually prevalent in NHS Ayrshire & Arran. The current system of Ayr is not able to support level 3. So it has been quite evident that the present system of patient identification is cumbersome and not uniform all over NHS Ayrshire & Arran. Secondly they are not fully compliant with the Data protection Act. The present system is at level-1 position of the matrix, so it needs uniform improvement right now. Our main aim is to generate a unique number for each patient, which could be identified from local, regional to national level. Identification always plays a major role in generating data information about patient, which has the most important role in knowing the patient case history. Level- 4 could be achieved after making considerable changes. Clinical information system is also needs improvement. It can be categorized into primary care, Hospitals and inter action between these two. Primary care is at level-2 and most of the time using GPASS but this program have limitations such as it cannot incorporate laboratory results and for that another program CDSS has to be included but most of the time it cannot be available. Combination of two to be used in a consistent manner is necessary. Presently 65% GMP using consultation room module in GPASS allowing access to clinical data held by patient electronic notes. There is only one paperless practice in NHS Ayrshire & Arran. Even not all GP practices have been computerized. Community and mental health system is at level-2 and in North Aryshire schizophrenia services assess patients by using FACE. Secondary care has the current situation at level-1. It has been complicated by the presence of two different clinical systems across two main sites and IT Clinical systems procurement exercise is currently underway. At cross-house site level-2 has been achieved and level-3 work has been undertaken only on referral and discharge comply. A no. Of weaknesses have been identified in the current arrangements i.e. no. Of key critical system are no longer relevant and there is a high degree of manual recording, redundancy of information and not easy to retrieve and not always available at the point of care. So there is a need for integrated system with in the hospital also to support care processes. Primary care trust hospitals presently at level-2 using COMPAS system. Clinical information systems for primary and secondary care and inter agency care are at level-1. Current modernization activities will lead to migration to level-2. Electronic results reports provide information about laboratory testing and radiological testing to primary and secondary care. Current development benefits such as reduction in transcription error; reduction in time, test duplications have been observed. Electronic referrals have been increasing presently. Pilot site has been introduced to legible immediate discharge documentation. Single share assessment has been piloted. Staffs training programe are in their final stage. But the current process in paper based. Patient confidentiality is at level-2 and Ayrshire and Arran intranet has been approved as secure communications medium by SEHD. All system development has to comply with appropriate legislation. Presently patients as well as public need information online but currently it has not been available. NHS Scotland staff information provisions has achieved level-2 and primary care trust, Acute hospital trust and the NHS Ayrshire & Arran have slight variations. Information for public health is available for appropriate staff only. Information management and technology management infrastructure is at level-1. It is imperative that the infrastructure supplied by the services of NHS Ayrshire & Arran is not sufficiently flexible and robust. Evaluation of current situation suggests that even level-1 has not been achieved properly. People issues such as resources for training and technical activities are not proper and rated at level-1. There are concerns about sustainability of the existing resources to deliver the services. Apart from clinical system some other systems such as financial, humans' resources, purchase etc. are as important as the clinical system to implement Information management and technology in any system. Currently Ayrshire & Arran upgraded their financial system at par with the direction of the national services reviews. Acute Hospital trust is implementing PWA Empower, phase-1 to mange their HR information system, but needs to improve and integrate it with national services. Purchasing system do not use electronic procurement system across all user departments and integration with stock control a new system is being implemented which will provide integration with trust financial system. Future plans for IM&T development To develop and formulate a through plan to implement effective information and management technology we have to sort out the problems faced by patients, public and health care staff so that the whole system could deliver effective health care. The technology is needed to deliver the information to the right person at the right time and the processes such as training and support services to make it happen. The basic purpose of the use of information management and technology is much more than the deployment of computer technology. It conveys the message of electronics in support of health and stimulates thought and discussion about the broad range of issues and opportunities that technology offers in health care setting to both health care professionals and patients. "IM&T in health care includes the development, application and implementation of technology to improve effectiveness in healthcare. It includes the use of telemedicine and clinical systems used for diagnosis and care pathways. We also apply the term to the policies and protocols the assured the confidentiality and security of sensitive data. Most of all it includes those aspects that support major change of working practice training, support and organizational development"(Chisholm, M., 2003). The future strategy for the information Management and technology in NHS Ayrshire and Arran will be as follows: "To develop an integrated system to facilitate more reliance on CHI and interaction with national CHI. Now adoption of unique CHI to identify unique patient is the basic requirement. All the patient administration system must depend on CHI and all GP will be using PARTNERS system for patient registration. In future all the system must use CHI. By practicing above system patient has to be identified properly and his/her healthcare records and previous history if any could be identified and synchronized properly. To address these challenges, the hospitals are being similarly linked, there should be planning and initial work on a new technical platform for the National Community Health index number system. This will be known as SCI index. We must also consider developing and making available and NHS board SCI index system and function that not only links to national SCI index but is also purpose designed to serve local identification requirements. Clinical information system for primary care has to be developed through IM &T. It should be developed as all G.P. practices will be paperless and 100% contacts for national priority conditions must be coded by GPs. LHCS provides interactive access to collated information from practices. Community and mental health system must complete clinical records as per EPR and 100% coded clinical data entered for national priority conditions to CSBS standards. In future multidisciplinary assessment and care plans for individuals should be made available, as part of local EPR. Secondary care hospitals should develop in future the electronic prescribing and administration, multi disciplinary integrated care pathways and digital x-rays/PACS (Picture Archiving Computer System). Clinical information systems for primary secondary care and interagency care must target 100% clinical communication to be exchanged electronically and inter agency information exchange available to support shared care for care/client groups. Patient confidentiality must be taken care of in future also. It should be developed for BS7799 national security standards. Electronic encrypted clinical communications extended by use of digital certificated technology. Providing information to patient and public about health system and their well being and facilities is that most important strategy for IM & T. NHS Ayrshire & Arran website must be developed in a way that it could provide all the required information and other communication channels such as Digital TV and allow video conferencing with clinical staff and service mangers. In developing information management and technology system, ultimately provide on line support clinical decisions information about health services facilitate planning and analysis as well as epidemiological studies. So availability of all the information needed for study as well as reports to be made online and ultimately develops a data pool of research studies. IM &T infrastructure has to be developed to sustain and keeping in view the development of health system in future. It should be properly documented and meet definite standards. HR strategy should be formulated and messaging standards in support of national programme will be adopted. Networks connected PCs are established in all staff area to improve, access and support personal staff. All the agreed information management processes should be in place for future. Risk management, disaster recovery and contingency planning should be in place for all key information systems. Support level should be such that it meets operational needs of round the clock working. In future the IM &T system must link with external resources such as professional inter and interagency collaborations and redesign programme, which will be fully supported by IM &T staff. So in future IM&T strategies has to be implemented in almost all the area of NHS Ayrshire and Arran to improve the health care system. Conclusion Integrated care records will bring together important information from all sources about each patient available to authorized health care professional to support their day to day work manage care of their patients and to support clinical governance and accreditation requirements. The integrated care record requires that a common set of information support systems are, as appropriate, available in all care setting to support the clinical care process and to summarized in integrated care record. These include a) patient administration for patients and outpatients b) appointment scheduling system c) Accident and emergency department support systems d) Laboratory and radiology support systems e) online ordering of tests f) online access to laboratory test results g) online instant access to clinical images such as x-rays and ultrasound across Scotland h) Primary care and shared communication with other parts of NHS I) electronic prescribing systems integrated with other clinical information systems j) community pharmacy system linked to other NHS practitioners (e-pharmacy) k) specialist clinical support system. The key aim is that information must flow as part of many and various journeys through the NHS the patient can take. Integrated care records are therefore about integration of information at three key levels i.e. Local GP/Specialty electronic patient records such as GP system or A&E system or a diabetic or cancer record linked if appropriate to the local integrated care record, Local integrated care record, information system holding test results, clinical letters and summarizes of care contributions. These may be assembled through specialty electronic records to give clinician a view across all specialty systems, which have current information about the patient to be achieved in the SCI store repository. National integrated care record have in SCI store information repository and holding copies of information from the national systems such as immunization as well as summaries of information from the local integrated care record and lastly a category of records and information shared between the caring agencies under agreed protocol e.g. for care of the elderly or children. Electronic records and use of information management and technology contributed in general Medical practice and has advanced significantly and consequently gives us reassurance that our ambition for integrated care records across all NHS Ayrshire and Arran as well as NHS Scotland can be realized. Finally implementing the IM&T strategy in all areas of healthcare services in NHS Ayrshire and Arran must integrate us to national services and facilities which ultimately results in improved and efficient health care practices in Scotland in general and at NHS Ayrshire and Arran in particular. 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" A national framework for service change in NHS in Scotland", accessed from < http://www.show.scot.nhs.uk/sehd/national framework > on 21-11-2006. 13. < http://www.ebxml.org/casestudies> Accessed on 21-11-2006. 14. Commission for Health Improvement. Performance ratings: overall summary of results 2002-3. < www.chi.nhs.uk/Ratings >Accessed 21-11 2006. 15. Source: Malcolm Chisholm, Minister for Health and Community Care, speech at ECCI Conference, Friday 28th February 2003. Read More