BMA guidance on the Northern Ireland HSSPS ICT Programme


December 2007 Summary
A ten year Information and Communication Programme (ICT) was launched in March 2005 by the Minister for Health, Social Services and Public Safety. The following projects are included in the remit of the programme:

Electronic Record
The establishment of a unique electronic record for each individual in Northern Ireland. This would contain structured data, text and images generated from a variety of sources.

Health and Care Number (HCN) project
This will provide a unique identifier for each patient. The HCN number is being implemented in GP and Patient Administration Systems and it is hoped that this will be completed by the end of the year.

Primary Care ICT Programme
This includes the GP ICT Modernisation project which has enabled access to secure email, the internet and Trust Intranets for all GP practices in Northern Ireland. The electronic transfer of radiology results is in the process of being rolled out.

Person-centred Community Information System (PCIS)
This project aims to deliver a single integrated community health and social care record for all patients receiving community based services

Picture Archiving and Communications System (PACs)
Plans are in place to deliver a national digital imaging system.

Electronic Prescribing in Hospitals
Plans are also in place to deliver electronic prescribing in hospitals.

Electronic Prescribing and Eligibility System – EPES
Any claim for an exemption from prescription charges, on the grounds of being in receipt of Social Security Benefit, will be automatically checked against Social Security computers.

BMA work
The BMA has set up a Northern Ireland IT subgroup. The membership is as follows:

Dr J Courtney, NI representative to the IT Working Party (UK) (Chair)
Dr B Patterson, Chairman of Northern Ireland Council
Dr C Hamilton, Northern Ireland Committee for Public Health Medicine and Community Health
Dr P Conneally, Northern Ireland Consultants and Specialists Committee
Dr E Deeny, Northern Ireland General Practitioners Committee
Mr G Millen, Northern Ireland Medical Students Committee
Mr J Chong Li Ong, Northern Ireland Medical Students Committee
Dr E Harper, Northern Ireland Staff and Associate Specialists Committee
Dr C Bleakley, Northern Ireland Junior Doctors Committee

There is also a NI GP IT Committee and NI issues are raised at NI Council and the BMA Working Party on NHS IT where NI is represented by Dr J Courtney.

A NI ICT Strategy Board was set up by the Department of Health and is in place to oversee development of various ICT projects. A number of workshops have been held with stakeholders to develop this strategy with an initial emphasis on General Medical Services (GMS) and a draft should be available shortly.

Electronic record
The ICT Programme Board has been keen to realise some of the added benefits of the recent modernisation of ICT in the HPSS. There are various records which are now available electronically. One strand of this is to make available an emergency care summary, initially to out of hours providers and subsequently to A&E departments and to the wider service. A separate project has now been identified to take this forward in pilot form working closely with colleagues in Scotland who already have such a system in place. At their recent meeting in February, NI Council had a discussion about the relative merits of making a medical summary available more widely. The profession broadly welcomes the opportunity to realise the benefits that this could bring but is mindful of the difficulties that NHS Connecting for Health have experienced. The proposals are that an initial upload would contain a modest amount of information with this being built on as the problems are met and solved. This is a similar approach to that taken by Scotland and Wales and NI hopes to learn lessons from projects in the other three countries.

GP ICT modernisation
The GP ICT Modernisation Project has now completed its remit and has involved connecting all GP surgeries to the HPSS network and making available secure internet access and secure email on the HPSS system. An end-project questionnaire is being developed to examine the use of these services. Project responsibility has passed to a new Primary Care ICT Strategy Board. The remit of the new Board will be to look at all aspects of the provision of ICT to the wider primary care teams including independent contractors and a number of sub-groups of this Board have now been formed. One of the initial products of this has been a draft ICT strategy for GMS which has just been released to the service for further comment.

Health and care number project
The Health and Care Number Project has been undertaken together with its sister project the GP ICT Modernisation Project. This is replacing the old Chi number and numerous hospital numbers with a new unique patient identifier to be used across the HPSS. Health and Care Numbers have been inserted in all GP systems and Trust Patient Administration Systems. The rollout of electronic patient Registration Links at GP surgeries completed ahead of target, with connection to all practices complete by April 2007. In parallel with this the Health and Care index was linked with the General Registry Office in January 2007. The project is also working with the PCIS Project Team to plan for the interfacing of legacy community systems, and the integration of the HCN into PCIS. All PASs are sharing demographic changes via the HCN Index. The main task now is to ensure the integrity of the data by ensuring that the data is accurate and the duplication of numbers minimised.

The person centred community information system (PCIS) project
The Person Centred Community Information System (PCIS) Project aims to establish a single integrated community health and social care record for all patients and clients in respect of community based services. Fujitsu Services Limited has been appointed the PCIS Preferred Bidder, with the agreement of a contract pending.

Electronic referral management system (ERMS)
An Electronic Referral Management System (ERMS) is being developed to support the Integrated Clinical Assessment and Treatment Services project announced in January 2006 by the Minister for Health as part of a reform of outpatient services and designed to reduce waiting times for treatment. The Minimum Data Set (MDS) for referrals has been agreed and the GP system providers have completed the necessary changes to allow letters with this MDS to be produced automatically. The system-generated referral template has been rolled out to practices. Renovations for the new centre are underway and recruitment for service and centre staff has begun. The additional function of being able to send referrals electronically will be the next phase of this project and this is expected in the next year.

The BMA Central Consultants and Specialists Committee (CCSC) and General Practitioners Committee (GPC) have produced a joint document which aims to set out the key guiding principles of referral management schemes. Read the referral management principles.

Telehealth
In early 2007 Northern Ireland health minister, Paul Goggins, announced a £1m investment in telehealth and telemedicine initiatives across the country. Telehealth is now expected to feature in the Department of Health, Social Services and Public Safety’s programme of reform.

Clinical oncology information system
Thanks to the Clinical Oncology Information System (COIS) all cancer units can now access the single continuous patient record for patients undergoing chemotherapy – including direct access to pathology and radiology reports.

Cross border issues
The BMA in Northern Ireland share the concerns expressed by other nations regarding cross border issues and the fragmentation of the once UK wide systems which underpinned the NHS. They have urged caution, while striving to reflect local needs, not to allow the national framework against which health and social care is delivered to disintegrate.

Information governance
This is an area of concern to BMA in Northern Ireland. Discussions are being held with the Department of Health, Social Services and Public Safety (DHSSPS) to take this forward but as yet no decision has been taken. The BMA will keep fully involved in these discussions particularly in light of the concern expressed about the NHS Care Records Service in England.

General medical service information system (GMSIS)
This project has been launched by the DHSSPS and discussions are taking place regarding the possible use of the information held on GP systems. This will seek to use anonymised information from GP systems to provide better support for commissioning and public health. Identifiable data could also be used if necessary but the BMA would not support this option. The proposed system would extract patient level data such as gender, age and location along with medical history records such as therapy, prescribed medication, GP encounters and referrals, from some 363 practices operating in NI. There are a number of options for frequency of data collection: daily, weekly or monthly updates.

A pilot scheme has now been carried out using data acquired from 7 practices, and has reportedly been well received by the GP practices involved. However, the BMA has expressed concern on a number of issues associated with the project such as governance of the database, the intrusiveness of the data collection process, consent and ownership of patient data and the performance management aspect.

Archiving GP records
GP records are increasingly becoming electronic and there exists some concern about the ability to ensure that the full record follows the patient. At present only the paper record transfers. There are also issues regarding the need to re-key much information when a patient moves to a new practice. The GP2GP record transfer project which is being rolled out in England will help to address some of these problems but the long term archive is still a concern and currently the transfer and storage of paper consumes a large amount of resource. The NI GP IT committee has viewed a presentation about archiving of GP records by microfilm and software to allow the information to be viewed by practices. This could potentially allow a large reduction in paper flows to occur although would not allow coded information to be electronically transmitted and received into existing GP clinical systems. The archiving would complement the GP2GP project. Further discussion is required to see whether this would be worth a pilot project.

Picture archiving and communications system (PACS)
The NIPACS project was formally launched at a conference held in November 2004. The outline business case was finalised in July 2006 and a procurement process is in process. It is hoped that contracts will be in place by the end of the year.

Electronic prescribing in hospitals
The HPSS ICT Strategy includes the introduction of electronic prescribing support in hospitals. This is a long-term project which will require large scale change in working practice. Consultation on the strategy suggested that for many reasons (the most significant being patient safety, risk management, clinical governance and cost control) the HPSS should move more rapidly to explore the implications of electronic prescribing and, subject to approvals and funding, begin implementation. The Department’s Chief Pharmaceutical Officer has agreed to take forward initial work to identify and evaluate options for electronic prescribing in hospitals, including a review of hospital pharmacy ICT.

Electronic prescribing and eligibility system – EPES
EPES is an “Invest to Save” project through which claims for exemption from prescription charges on the basis of being in receipt of a qualifying Social Security benefit will be automatically (electronically) validated against Social Security computer records.

In July 2006, the Department contracted with Hewlett Packard to develop, install and support this project. This system is still in its initial start-up phase. Design, testing and piloting should begin in October and be completed within a year, with full roll-out to all Community Pharmacists achieved a year later.

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© British Medical Association 2008

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