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British Computer Society
The Care Record Service
and
Information Governance functions
Stephen Elgar
14th March 2006
© National Programme for Information Technology, London, 2004. All rights reserved.
Introduction
• The Care Record Service – what is it?
• Where have we got to in London?
• Information Governance functions / tools that
underpin the Care Record Service
• Experience in use of these tools
• Active Information Governance controversies
© National Programme for Information Technology, London, 2004. All rights reserved.
© National Programme for Information Technology, London, 2004. All rights reserved.
© National Programme for Information Technology, London, 2004. All rights reserved.
The future:
Eldorna Smith
Eldorna (65) has a fall.
Her neighbour
discovers her
in the evening and
calls an ambulance.
© National Programme for Information Technology, London, 2004. All rights reserved.
The ambulance crew uses a
protocol of tests that show a minor
infection could
be making her
unsteady.
They rule out broken bones and
check her electronic health record
with
her for other
potential causes.
© National Programme for Information Technology, London, 2004. All rights reserved.
Eldorna doesn’t want to go to hospital.
The crew consult a
doctor in the A&E via telelink.
The doctor agrees the diagnosis and
sends a prescription electronically that
the local pharmacist will deliver with
clear instructions. It has been
checked against Eldorna’s other
medications.
© National Programme for Information Technology, London, 2004. All rights reserved.
At Eldorna’s request, the crew book an
assessment by the intermediate care
team, who will visit within two hours
and arrange home services.
At her request, they also book a follow
up appointment with her GP at a time
that suits her. They do this online as
the surgery is closed. The GP will get
a prompt if she doesn’t attend.
© National Programme for Information Technology, London, 2004. All rights reserved.
The crew leave Eldorna with
information about her condition on
paper and in her HealthSpace.
Eldorna knows that those involved in
her care will have access to parts of
her electronic record and make notes.
(inspired by Surrey Ambulance Service and Chiltern and S.
Bucks PCT)
© National Programme for Information Technology, London, 2004. All rights reserved.
How Spine will work across
clusters in an emergency
A London resident Tom
visits Blackpool . . . .
Following an accident
Tom visits A&E for
assistance . . . .
A&E Doctor needs
to view Tom’s
Health Record . . .
Transaction & Messaging Spine
PDS
PSIS
Data +ACF
Search performed - Record is found.
Legitimate relationship is formed.
Information is transmitted to A&E Doctor
© National Programme for Information Technology, London, 2004. All rights reserved.
How Spine will work across
clusters in an emergency
A&E Doctor views
Tom’s Health
Record . . .
Carries out
investigations &
treats Tom . . .
Tom’s Information
is Stored in the
Local System
Electronic
Patient
Record sent
via Spine to
the PSIS
Transaction & Messaging Spine
PSIS
Data
Discharge Note generated sent to Spine
Alert generated sent to GP System via Spine
© National Programme for Information Technology, London, 2004. All rights reserved.
How Spine will work across
clusters in an emergency
Tom returns home to
London . .
eTP
GP receives alert & discharge note
Orders nursing care and medication
Transaction & Messaging Spine
Refers Tom to Physiotherapy (Choose and Book)
Refers Tom to Hospital Consultant (Choose and Book)
© National Programme for Information Technology, London, 2004. All rights reserved.
Care Record Service in London
10 year programme (year 3):
• 45 / approx 1500 GP Practices with new systems
• 1/ 30 hospitals (Queen Mary’s Sidcup)
• Choose and Book; 86% GP Practices able to send & 32 Trusts able to
receive (30/185k London / national bookings so far)
• 7/22 PACs (2/8 Radiology in addition)
For 2006/7:
• Single Assessment Process (Older People) – 3 Boroughs / PCTs
• Plan for 7 Hospitals, 5 Mental Health Trusts, 22 PCTs
• PACs – to be completed
• Pilot of Clinical spine
© National Programme for Information Technology, London, 2004. All rights reserved.
Information Governance functions /
tools that underpin the Care Record
Service
© National Programme for Information Technology, London, 2004. All rights reserved.
Patient confidentiality
No surprises: patients see and control
what information is shared – Patient
Guarantee
© National Programme for Information Technology, London, 2004. All rights reserved.
Information Governance functions / tools
Function
Status
Recording patient consent for information
sharing
Nominally live but key function concerns
“Clinical spine” that is not yet live
Patient Access; Health Space – telephone and
web
live for Choose and Book, no dates for later
functionality
Role-based Access Control (RBAC) defines the
functions available to staff
Live – some elements are application- specific
Smartcard authentication – “chip and PIN”
200k Smartcards in England & 25k in London
Legitimate relations for staff to control whose
records can be accessed
Application & Organisation specific at the
moment
Sealed envelopes; patients able to have part of
their information sealed away
Not yet live
Audit trails
Live; Application specific and varied at the
moment
Alerts sent to Trust staff
Application specific and varied at the moment
Psedonymisation; information for reporting
without patient id
Will be live shortly as part of Secondary Use
Service
Large-scale use of Smartcards and Role-based Access Control
Choose and Book – issues with Smartcards:
• Effort of Smartcard distribution and provision of support for use (e.g.
loss / forgetting cards and PINs)
• Locums
• Tension between local developing business process and national
roles (administrative staff being given Clinical roles?)
Queen Mary’s Sidcup Hospital (400 beds with ED) = 1000+ users with
Smartcards
• “for the most part national roles have worked with a proportion of staff
with locally added functions at minimal administrative effort”
• Investigating proportion / effort as part of a review in progress
• HR team run Smartcards administration now
© National Programme for Information Technology, London, 2004. All rights reserved.
Active Information Governance controversies
•
London has a number of stakeholder groups including:
– London Caldicott Guardians
– London Information Group (non-clinical)
– London CFH LMC Group
•
Controversies:
–
–
–
–
–
–
–
–
–
“openness” / who can view & who can edit demographic spine (choose and book application)
Legal basis for information sharing
“openness” / who can view & who can edit Smartcard spine
Sharing of Smartcards
National Insurance number held on Smartcard spine
Identity checks for Smartcards issue (lack of co-ordination with other HR requirements)
Recording on paperwork required to issue Smartcards (National Insurance & Passport number)
Locums and temporary staff
Tension between local developing business process and national roles (administrative staff
being given Clinical roles?)
© National Programme for Information Technology, London, 2004. All rights reserved.
Summary
• Care Record Service is here!
• Information Governance tools are being
implemented incrementally
• Consultation with the Public continues & Publicity
campaign is just starting in Trusts
• Stakeholder groups are gaining an understanding
and are “storming!” – controversies are being
addressed
© National Programme for Information Technology, London, 2004. All rights reserved.
Stephen Elgar NPfIT London Information Governance
Team Leader
[email protected]
07736 706 538
© National Programme for Information Technology, London, 2004. All rights reserved.