NHS Informatics Review says trusts need 'interim' systems

Tags: ASCC CfH Informatics PAS Spine Strategic

10 Jul 2008

NHS trusts are to get support, and in some cases may get national funding, to select and install “interim” systems as a result of the NHS Informatics Review.

The change in emphasis comes in response to delays of four years or more in the strategic, detailed electronic record systems at the heart of the National Programme for IT in the NHS.

The review, which was led by the Department of Health’s interim chief information officer, Matthew Swindells, before his departure to the private sector, says that good information and good information systems are essential for the delivery of Lord Darzi’s Next Stage Review of the NHS.

It reaffirms the goal of the national programme to deliver integrated care records systems, but acknowledges the impact on trusts of lengthy delays in the delivery of strategic systems from local service providers.

It also spells out the need to use proven systems until better ones becoming available. Interim systems are expected to range from very specialised departmental systems through to hospital-wide patient adminsitration systems.

NHS Connecting for Health, the agency in charge of the national programme, is already working with trusts and strategic health authorities on specific requests for help on interim systems.

Speaking at a DH press conference today, NHS medical director and interim director general for informatics Sir Bruce Keogh said that NHS informatics has been through some “turbulent times.”

However, he stressed that the move on interim systems was not a licence for open season. “If people start going it alone it could be at a huge opportunity cost.”

The review says trusts urgently need systems that can benefit patients and clinicians. It says many proven systems are available that offer real benefits and that these should be used until better alternatives are ready.

Trusts will be able to get interim systems through their LSP or buy directly from suppliers using the Additional Supply Capability and Capacity framework contract.

Speaking at the press conference, Gordon Hextall, acting head of CfH, denied that the move represented the abandonment of the strategic goals of the NHS IT programme.

“As the recent National Audit Office report pointed out, it will take four years longer to put systems in everywhere,” said Hextall. He said in many cases trusts needed systems ahead of 2012 that can help them deliver care.

He said interims could be particularly helpful in terms of departmental systems but indicated that they could also apply to larger PAS systems. “If a hospital has a PAS that is not spine connected, it could get huge benefit from getting a system linked to the spine.”

“There is no departure from the strategic vision, but a greater emphasis on standards and being able to have information flow across different care settings and care providers.” He said that there would be no hard and fast rules, with trusts dealt with on a case by case basis.

“There would need to be a business case and it would need to be funded locally, unless it was something the LSP were contracted to deliver locally,” said Hextall. “LSPs will be the starting point. If trusts want to buy independently they could buy through ASCC.”

Asked whether national funding would be made available in some cases, Hextall told E-Health Insider: “It could be.”

He added: “We have tough contracts in some places and in others we will have to be imaginative.”

Questioned on how soon NHS trusts could get clarity on how they can purchase or get hold of interim systems Hextall declined to be drawn, but said that to be of use interim systems would have to be delivered rapidly.

Asked whether trusts that deploy interim systems now will have to move again when strategic systems become available, Hextall said the consultation with the service had provided the clear message that they still want the strategic national programme vision delivered. “Everyone was content that strategic solutions need to be deployed when they are ready.”

Hextall told EHI that CfH was there to assist NHS trusts and was already responding to specific requests for help. “We have started already on areas like document management and e-prescribing. If there is any way of us funding nationally then we will. We are here to help.”

Although no hard and fast details were announced today, Hextall indicated that one existing option would be for NHS organisations to use would be the 61 clinical vendor contracts awarded by CfH in May’s ASCC framework contract.

Jon Hoeksma

Readers Comments

Stratospheric level strategy?

maryhawking@tigers.demon.co.uk

10 Jul 08 20:41

On first reading I admit to being confused on this report. There is a lot of good stuff on the need for using information and developing informatics skills but there seems to be little attention to primary care or acknowledgment of the complexities of detailed care records. In fact the 5 critical requirements for secondary care (secondary care is mentioned quite a lot) don't seem to include a medical record at all. What am I missing? We all know that the NHS is a GP and primary care free zone :->>

Interim interim systems?

maryhawking@tigers.demon.co.uk

11 Jul 08 07:47

I thought Millennium *was* an interim solution - along with iPMS and SystmOne? so are these new interim solutions supposed to cover the gap until a definitive LSP system (Lorenzo, Lorenzo level 4, Millennium whatever level constitutes a strategic solution ) is developed? and if so, what about Millennium release 0 to x?

Interim?

11 Jul 08 10:31

I am opening a book on how interim "interim" will be. Is this the same use of "interim" that was used to describe the use of PIAG as an "interim" option while we obtained proper consent to the use of patients' information?

LORENZO Level 4??????????

11 Jul 08 10:51

Can someone tell me what LORENZO Level 4 is please?

LORENZO Release 3 has not been designed yet - so what is LORENZO Level 4?

Anyone in charge here?

11 Jul 08 14:03

What a planning nightmare for trusts this is!

I and others working around NPfIT have fantasies about the existence of the following two documents...

1. A single document equivalent to the Output Based Specifications (2003) [I know it was three pdfs] - outlining what functionality is to be delivered by the program: taking into account subsequent scope revisions, contract change notices and changes in contracted suppliers.

2. A document outlining the functionality of each of the LSP major system's versions / Levels / 'R' values and whether they are deployed, deployable, firm deliverables (with expected dates) or aspirational.

I have contact with LSPs, NASP, first and second level suppliers and CfH officials. My guess is that such information is not being systematically withheld - it just does not exist in one place or in one group's hands. Meanwhile conflicting 'definitive' statements, rumours and speculation masquerading as information circulate.

Great though this site is - it would be great to hear something other than "The first we heard of it was on e-Health Insider" from NPfIT players.

iPM future??

14 Jul 08 09:47

So how does this affect the roll out of future releases of iPM across the North West for the orgs that are currently using it or had it in the plan to use?

Explaination of Lorenzo Level 4

14 Jul 08 15:38

Lorenzo Level 4 is the major upgrade to the Lorenzo PowerPoint Marketing Slides. Ah! My heart warms to think that I was there at the Launch of Lorenzo Level 1 all those years ago!

LORENZO Level 4

15 Jul 08 12:17

I've been working on LORENZO (on and off since the inception of the project) - and I've not heard of LORENZO Level 4?

Just how long is this project going to be allowed to continue?

(post edited by EHI)

Open season on opportunity costs

15 Jul 08 16:09

If we are to be locked into the ASCC, which was no more about proven interim solutions than the original LSP list, then we're still doomed.

The opportunity cost of the 4 year delay so far must be quite huge if the benefits are to be believed. I would have been more modest in the original claims, but continuing to believe that the CfH structures are worthy to deliver is fantastic (as in fantasy land).

Where do we sign up for interim NCRS system funding?

15 Jul 08 22:42

This is a great opportunity for eHealth Insider to assist the NHS. The source and method of funding the interim solutions towards NCRS will be gratefully received. Great Idea! It will get round those great blights in providing the NHS with what they need. Could alleviate the Planning blight!

Accountability and responsibility

16 Jul 08 11:12

It is all very well for this latest Review to reposition the NPfIT goal posts to a position where NPfIT has a chance of delivering something substantial, but, given the massive product delays and disappointments on the acute side, I wonder when senior CfH directors and managers are going to be held accountable and asked to justify why we should still believe in them. After all if I, as as CIO, had peformed is such a way, I would probably be out of a job by now.