DH shifts IT from 'replace' to 'connect'

Tags: A Choose and Book Clinical 5 Credit crunch David Nicholson DH England Informatics Infrastructure NHSmail Nicholson NPfIT Standards

22 Dec 2009

NHS informatics in England will move from a “replace all” to “connect all” philosophy, the Department of Health has announced.

Informatics planning guidance for 2010-11 says an updated strategic direction for informatics will be developed over the coming months to reflect the change in emphasis.

The guidance says a new direction has also been agreed for the National Programme for IT in the NHS, which will give the NHS more involvement in decision-making on the scope and timing of implementations.

It also sets out a series of expectations that local community operating plans for 2010-11 must deliver. The guidance says these have updated from previous years because compliant software is now more widely available. The expectations include:

• Risk-assessed plans of how and when each of the Clinical 5 will be used by all the clinicians in a local health community and whether the systems will be procured via local service providers or the Additional Supply Capability and Capacity framework.

• A timeline for the creation of Summary Care Records at all SCR-complaint GP practices in the 2010-11 financial year.

• Plans to complete NHS COnnecting for Health preparations for the implementation of Release 2 of the Electronic Prescription Service.

• Plans demonstrating how digital capabilities are being actively developed to support improved patient experience, such as promoting the use of NHS Choices and providing tools to help clinicians and managers use feedback to improve quality.

The informatics planning guidance reflects the themes of the Operating Framework for the NHS In England 2010-11, which was issued by NHS chief executive David Nicholson last week.

Looking beyond the final year of growth in NHS funding, this stressed that the health service needs to get the most out of the technology that it already has.

The guidance says all organisations should move to NHSmail and that plans for any additional expenditure on locally hosted email services should be supported by a business case covering the cost and benefit compared to NHSmail.

It also says organisations should make increasing use of products available via NHS enterprise wide agreements and only make local purchases when there is no suitable product or service covered by an EwA.

The guidance also echoes the operating framework's concern with costs. It says the cost of implementing Clinical 5 systems should be transparent, with annual figures for 2010-15 for all NHS providers.

NHS bodies are also urged to consider the most efficient and effective models for delivering informatics and technology services to local communities. They are advised to consider larger scale health informatics management, such as a health services informatics approach to back office technology services.

Since the summer, ministers and DH officials have been urging NHS managers not to adopt a "slash and burn" approach to delivering cost savings and to follow the quality, innovation, productivity and prevention (QIPP) agenda instead.

On QIPP, the guidance says strategic health authority chief information officers have already identified their top priority informatics initiatives. It says SHAs will want to sponsor and lead regional informatics initiatives to address these priorities.

It also says communities will be expected to make significant progress on the use of mobile technology to improve quality and productivity.

The DH also wants operating plans to set out how local communities will achieve compliance with widespread use of the NHS Number, the information governance toolkit, standards set by the Information Standards Board for Health and Social Care and the National Infrastructure Maturity Model (NIMM).

NHS organisations are expected to publish their current position on the NIMM and aim to achieve at least Level 3 and ideally Level 4 across the priority elements of their technical infrastructure within the next 12 months.

This year local communities are required to include their informatics planning as part of their mainstream plans, not as a separate document.

Fiona Barr

Summary record roll-out builds momentum (21 Dec 2009) (2)
NHS 'faces pivotal year' - Nicholson (17 Dec 2009) (1)
Operating Framework stresses savings and Darzi (09 Dec 2008) (3)
Shake up in Informatics Planning (10 Dec 2008) (1)

Readers Comments

It's a minor point

22 Dec 09 15:44

But why do we keep hearing about this NHS mail thing? It's an on-line mail system and it works (big deal!). The idea of everyone moving to it for mail though is just daft.

Yes we can connect Outlook to it but it doesn't integrate with the local Active Directory, and over and above this I wonder how much people think is spent on local mail systems. I reckon the answer is pretty well zip - ok quite a bit of disk storage, but we all have users that need larger mail boxes than the NHS mail system supplies anyway.

Many people who are using it are adding in that we must e-mail their proper address to let them know it's there, which means it's just an overhead.

It's an extra resource and allows secure mail so great and as long as it's there it will be used for that. There must be better (more integrated ways) of producing secure mail infrastructures however. Is this not just an excuse to claim another tick in the box for doing something? If this is another mindless target though, please help us all.

NHSmail

23 Dec 09 16:39

Why do people need larger mail boxes than NHSmail provides?

Answer: Because they will insist on keeping all the attachments, it's a mail system not a filing cabinet, sooner people get their heads around that the quicker we can move on.

Should have made NHSmail mandatory when they had the chance, yes it was poor in the beginning but it works now.

Business Ready?

23 Dec 09 20:55

NHSmail is ok if email is all you want or need. If you have a mature exchange (2007 or better), an AD environment in the trust and/or LHC that supports TLS encryption with 'Opportunistic TLS active', unified messaging, OCS, ESR, linked to AD for RAS/SSO/ID then it is'nt for you at the moment! 'how about a timeline for a feature rich deployment' or alternatively if you are made to dumbdown for arguable 'benefits' then we will never get the mobility required. It's really about the business not the politics...

e-mail is full communication system

23 Dec 09 21:42

I have to disagree that e-mail is just communication, I think that fails to grasp how modern communications work. Old style filing structures on a hard drive sonewhere just don't cut it any more. the context of messaging means that e-mails actually the primary communication and so, by default, storage system.

I guess the proof is that if NHSmail fitted the bill, everyone would be using it.

As currently provided, it serves no point and should form part of the CFH's savings.

mail anyone

njames@gotadsl.co.uk

23 Dec 09 23:30

It would be handy to be able to send the odd image from one site to another that isn't using say IEP or BBrad where it is clinically urgent, and using a method that is safe and secure.
However that'll be up to 16mb uncompressed for a single image and 512kb per frame of CT with about 200 per study (for DICOM images) which is a tiny bit too large for NHS mail.
That would need a bigger capacity limit.

Why Did The Integration Agenda Take So Long

alex@alexgeddes.com

25 Dec 09 01:57

In 2003 when the National Local Service Provider Contracts across the then five Clusters was negotiated, integration was essential. It remains essential. Legacy systems have to interoperate in a multi-system environment until replaced.

If you take Chelsea and Westminster Hospital, it made the London Local Service Provider choice of IDX LastWord work to the LSP contract request for tender. Today the hospital has a fully integrated array of systems tht includes level 5 NHS system functionality. This is based upon the London NHS LSP award but moved forward in spite of the London Cluster NPfIT Programme. The Hospital has assured system integration, business change and continuity of operations through clinical engagement.

It is inconcevable that this debate goes back to integration without concern for communications across the patient care pathways.

NHSMail

maryhawking@tigers.demon.co.uk

27 Dec 09 20:05

I thought this was for secure transmission of patient identifiable information?

In my experience certainly not very secure

29 Dec 09 11:28

My colleagues and I use public-private key encryption / digital signatures for secure email transmission between us. NHS mail does not have this, rather a ring-fenced system providing a sort of walled security.

Hence, I have received several NHSmail emails containing extremely sensitive information where the sender had obviously clicked accidentally on my name in an addressbook list (or mistyped). These continued to be sent despite me immediately warning the sender - perhaps his secretary?

I suspect that because NHSmail has been declared "secure" people drop their guard and send information that would be better transmitted by a properly secure method.

So if you want to send any sensitive information to me - you can easily get my public key - and DONT just click on an addressbook, or risk mistyping my address.

NHS Mail - the elephant in the room...

30 Dec 09 10:58

The only security offered by NHS Mail is that inherent to https, i.e. the transport of data between client and server.

The completely free services from, to name but two of the many providers, Google and Live both provide this level of security if you decide to use it. Equally your Outlook client will encrypt the data travelling between it and your local, or remote, Exchange server and your Exchange servers will happily and easily encrypt data in transport between any organisations, NHS or otherwise, (although very unfortunately, and I imagine very purposely, not between your local mail service and the NHS Relay as this would immediately, and at no cost at all, render NHS Mail null and void …)

As several other comments have said, in our brave new world of collaboration and joined up working NHS Mail serves at best as an expensive but unnecessary tool that occasionally can be proved to be useful to a very small minority of NHS staff and at worst as an absolute barrier to progress, communication and local innovation.

Sadly, as with many other bright idea’s from the centre over the past few years, I fear we are already at the “too much money and too many careers riding on this” stage and so NHS Mail cannot be allowed the quiet and peaceful decline into retirement it deserves both functionally and financially.

I don't see the problem

davidcurtis@nhs.net

30 Dec 09 14:50

I must be missing something. Or maybe I'm starting from a pretty low base. All our Trust has is a fairly ropey local email service along with outlook and we're told it's not secure to send email to other organisations. Our IT support is not strong and when people try to send something confidential outside of the Trust the standard practice seems to be to send a password-encrypted zip file followed by the password in the next message. That's if they bother to do anything at all. If we move over to NHSMail then we lose absolutely nothing apart from having to host the service. We will also gain web access to our email, calendars, contacts etc. If a substantial proportion of other organisations also move other then we can immediately start using it to email documents and have email conversations about patients. I think other things might follow.

For us going to NHSMail would represent a substantial improvement on the status quo and I'm all for it.

I see the problems

31 Dec 09 20:23

Want to respond to both - the original article - yes, fine interoperate the systems we have been unable to upgrade because of the NPfIT mirage. Thanks a bunch.

NHSMail - great so long as you want to talk to the DoH. Actually we want to talk with the public. We have encrypted local traffic. The problem is NHSMail. We can send encrypted to any citizen.

And worse, any small solicitors can link to use the Criminal Justice email solution for free. The NHS could have produced a secure inclusive email solution that enabled locally resilient and feature rich email to interoperate, but they didn't. I wonder why.