Touchstone , HL7 and Connecting for Health (NPfIT)

In 1998, the UK ’s National Health Service (NHS) unveiled its strategy, through the document Information for Health, to have IT play a major role in delivering better services and ensuring that its patients get the best possible care.

The proposed outcomes of the strategy to modernise the NHS IT Systems are to provide:

• lifelong electronic health records for every person in the United Kingdom

• NHS clinicians with 24 hour on-line access to patient records and information about best clinical practice

• an information highway that would cater for the sharing of information to facilitate the seamless care for patients through GPs, hospitals and community services

• online access to information and care through on-line information services and telemedicine by members of the public

• health planners and managers with the information they need to use NHS resources effectively.
  

In order to accelerate and gain more control over the various aspects of the delivery of the IT systems to the NHS, as well as its implementation, the Department of Health introduced the National Programme for IT (NPfIT). The programme is to be rolled out in four phases over a period of eight years, having started in April 2002, to December 2010.

The scope and date range of each phase are:

Phase 0: April 2002 – March 2003
This would include the determination of specifications and standards that would be used by the information systems, supplying 100% of the Consultants with a personal computer and working with other government and non government organisations to ensure the smooth takeoff of the programme.

Phase 1: April 2003 – December 2005
This phase would see the building of a secure high speed Internet access for staff of the NHS, the start of online booking and electronic prescription services, and NHS Care Records Service (NHS CRS).

The NHS CRS would provide electronic health records (EHRs) for all the patients within the NHS and would consists information from every aspect the patient’s care – the family physician, acute hospital admissions, nursing plans and more. The information would be made to anyone who needs to make decisions about the patient’s care, including the patient.

The phase would also see the introduction of procedures, services and structures to oversee the quality of information within the NHS available to staff, patients and the general public.

Phase 2: January 2006 – December 2007
This phase would see the see the NHS CRS link to all local health providers’ electronic patient records (EPRs) systems. The electronic prescription and online booking services should have been completed and these, with digital images, would be integrated into EPRs along with standards that would facilitate the electronic exchange of records across the NHS.

This phase would also see the introduction of Telemedicine services in all General Practices and Telemonitoring services in 20% of emergency response vehicles and homes that require it. In addition, there would also be the introduction of a Patient/Citizen portal that is accessible via the Internet, Digital TVs and wireless devices.

Phase 3: January 2008 – December 2010
The final phase would see Telemonitoring services across 100% of all emergency response vehicles and homes that require it as well as the completion of the NHS Care Record. The NHS Care Record Service would also now consist of electronic Social Care records.

When the National Programme when it runs it course, it should have delivered the following:

• An underpinning Information and Communication Technology (ICT) structure that provide secure and high speed communications between it users, as well as underpin the necessary infrastructure to provide telemedicine services.

• The National Booking Service for online booking for all patient appointments.

• The National Prescription Service for electronic prescriptions with full clinical and patient support.

• The NHS Care Records Service (NHS CRS) which would also manage both the National Booking Service and the National Prescription Service
  

Other deliverables expected from NPfIT are

• an NHS e-mail and directory service that would be managed centrally

• Picture archiving and Communications systems (PACS) for digital images

• IT support for the management of General Medical Services Payments.

It is also hoped that the programme would also bring about an improvement in the quality of information available to staff of the NHS by providing easy access to evidence-based materials and the setting up of a health informatics portal that would be provide e-learning materials.

The procurement strategy so far has been to selectively outsource major components of the National Programme. Components that would deliver services nationally, such as the National Booking Service, would be managed by the National Application Service Provider (NASP).

While services that have a more local impact would be managed by the five Local Service Providers (LSPs) and would have to meet the standards and requirements set at the national level. The Local Service Providers cater for the following areas of England :

• London
• North East
• North West and West Midlands
• South
• East

Evaluation of the success of the NPfIT, as with many healthcare IT projects, would be difficult and it does not help that government led IT projects in the NHS have a history of notable project failures.

The factors that affect the success of IT projects are wide and varied but results have shown that those most there were considered successful were thoroughly tested prior to implementation and enjoyed high levels of both end user and senior management commitment.

When the NPfIT announced that it would be handing out contracts for major components for the programme, it also released a list of guidelines and criteria that prospective bidders would have to meet in order to not only win the contract. One of the terms of the contract is that the suppliers would only be paid when the system was delivered and was successfully implemented as well.

This meant that the supplier stood a chance of losing a sizeable amount of money if these and other terms of the contract were not met. Thus suppliers would have to thoroughly test the components they have been contracted to handle in order to get paid.

In terms of commitment of the stakeholders, few can doubt that of Richard Grainger, who heads the programme and other senior members of the Department of Health entrusted to oversee the project. Also NHS IT managers have revealed they have begun preparations to start implementing deliverables from the programme.

The end users fall into two groups – the healthcare providers and the general public. The success of the project could hinge on any one of these groups. For the project to enjoy any kind of commitment from these groups, they would to be involved in most or all stages of project. So far, their involvement has not been great.

In June 2003, Medix UK carried out an online survey amongst 1115 GPs and it found that while most felt that individual consultations with practicing consultants was necessary, few knew much about the NPfIT or had had adequate consultations about it.

Another factor which might also affect the success of the NPfIT would be resources and expertise needed to bring about a change in the organizational culture, staff and patient empowerment and clinical working practices. This level of expertise can probably be best got from IT professionals who have a good understanding of the healthcare sector, the kind of expertise expected from health informaticians.

In the Spring of 2005, the National Program for IT (NPfIT) changed its name to Connecting for Health (CfH).

Touchstone Systems Ltd provides consultancy services to both Connecting for Health, and some of the Local Service Providers (LSP) that have been appointed by them.

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