National Program for Information Technology (NPfIT)

The NHS CfH presenting the NPfIT remains to be a crucial organization for providing guidance and observing progress of policy development across all five clusters (showed in figure 4.3) [129]. One of the main roles of the NPfIT is to introduce an integrated system called the NHS Care Records Service. Other services will also be supplied by the Program, such as electronic transmission of prescriptions, an email and directory service for all NHS staff (NHSmail), computer accessible X-rays (Picture Archiving Communications Systems), a capability for patients to book outpatient appointments electronically (Choose & Book) and a broadband network (N3).

4.4.1.1 NCRS (National Care Record Service)

The existing EHR project for England, The National Care Record Service (NCRS), allows authorized healthcare professionals access to a patient‟s Health Care Record 24 hours a day, seven days a week. Patients will also be able to have an access to their own health records online through a service called HealthSpace.

The NHS CRS will connect England‟s 30,000 GPs and 300 acute, community and mental health NHS trusts in a single national system called “Spine”. The program started implementation by a national process during 2003, which led to bestow of contracts in December 2003 to one National Application Service Provider (NASP) and five Local Service Providers (LSP), (Figure 4.4).

Figure 4.4: NCRS (One NASP and five LSP). (Source: NHS Connecting for Health)

Figure 4.4 describes how the NCRS will increase the quality and efficiency of healthcare communications within and across a diversity of institutions such as primary and secondary care. Implementation of electronic patient records is taking place locally in England‟s five geographical clusters. For each England cluster, there is one Local Service Provider (LSP), which is responsible for developing electronic patient records in each cluster, supplying IT systems and services in the five regional clusters in England to be connecting to the Spine [130]. The Electronic Health Record (which consist of vital information that will be automatically uploaded), together with the locally created Electronic Patient Records, comprise the NHS Care Record (formerly called Integrated Care Record): „„...a cradle-to-grave NHS Care Record for each patient, which will transcend traditional care organizations‟ boundaries‟‟ [131].

National Application Service Provider (NASP) is responsible for purchasing and implementing IT systems which are common to all NHS users nationally (Figure 4.5) [132].

Figure 4.5: The NHS NCRS.

(Source NHS Connecting for Health)

NCRS based on two components. The first is Detailed Care Record to be used inside local healthcare where the patient care is supplied. Detailed Care Record (such as pathology test results, drugs prescribed or hospital discharge notification) is to facilitate clinicians to improve the quality of diagnoses processes through order tests and prescribe drugs. The other component is the national Summary Care Record which will be stored on a national database known as „the Spine‟,

aiming that important information on a patient can be accessed 24 hours a day, seven days a week.

4.4.1.1.1 EHR Storage (Spine)

The SPINE, the heart of the NHS Care Records Service, is the national huge central database containing vital information (summary patient records) about every patient's healthcare [133].

The NHS spine is creating an electronic record for all England‟s 50 million plus patients, to be feed by critical information from sources, such as GP systems and hospital patient administration systems, from the end of 2004, (Figure 4.6).

Figure 4.6: The Spine – clinical events through time.

(Source: NHS Connecting for Health)

Authorized healthcare professionals can access patient's healthcare Summary Care Record, forming the core of the NHS Care Records Service, e.g. NHS number, date of birth, name and address, allergies, adverse drug reactions and major treatments [134]. Patients will be able to access the NHS spine themselves through „MyhealthSpace‟ on the internet, which arranged should be available in the mid of 2005. All patients‟ NHS Detailed Care Record will be stored at the locally, where most healthcares are administered.

4.4.1.2 Choose and Book

Choose and Book is a national electronic referral service, aims to improve the process of coordination of patient activities. It offers patients an option to choose the hospital or clinic, date and time for their first outpatient appointment and book their appointment by telephone or over the 24 hrs, 7 days a week online service using the internet at a time more convenient to them.

4.4.1.3 ETP (Electronic Transmission of Prescription)

This program aims to improve the quality of primary care service through facilitate GPs role to issue prescriptions faster by transferred electronically to the chemist or pharmacist chosen by the patient and it will be more appropriate for patients to collect their medicines.

4.4.1.4 NHSmail

NHSmail program is providing email and directory service for all NHS staff by NHS Connecting for Health. It gives NHS staff the ability with authorized access to healthcare data to safely and securely exchange patient restricted information between NHSmail users.

4.4.1.5 N3 (New National Network) for the NHS

The New National Network for the NHS (N3) project aims to provide network service and fast broadband connectivity to link England‟s NHS organizations for enabling data to be exchanged reliably and securely. N3 is the heart of NPfIT, as it would be difficult to supply other components of the NPfIT that need higher bandwidth than the previous networks NHSnet and N2 gave.

4.4.1.6 Picture Archiving and Communications Systems (PACS)

PACS project was introduced to improve the quality and efficiency of diagnosis and treatment procedures by providing organized access to digital images into England‟s NHS organizations. It captures stores, delivers and shows clinical digital images such as electronic x-rays or scans.

4.5 Summary

There is no strategy that has yet been achieved in completely deploying an EHR on a national basis. However, Canada, Australia and England have accomplished significant improvement in many elements that can be shared in common such as allowing consumers access their own health care records, the selection and implementation of interoperable standards for sharing and managing EHR, and development of patient data security.

However, the national strategies for EHR provided by any nation are considering the healthcare, political, and market system presented by that nation. These strategies are mainly based on two components, the first is technical and standard issues regarding sharing EHR, and the second is the political evaluations.

The strategies for Canada, Australia, and England were reviewed and showed that all develop national strategies for electronic health records have an advanced EHR programs. National strategies are growing, and moving towards stages of conceptualization, analysis, design, implementation, and testing, but, the development of national strategies is in the early stages.

The main warning to learn from the above review is that, despite significant indications to support approval of EHR, development has been slow to date. Apart from England‟s NPfIT, the growth of those healthcare strategies is in slow stapes;

although the implementation of the NPfIT‟s strategy is moving in protraction steps.

Finally, the main drawbacks of judging the success of national strategies for electronic health records are the lack of existing evidence base, misalignment of financial encouragement, lack of an obvious business case for taking up an EHR and for interoperability between EHR solutions and deficiency in measuring and developing EHR standardization.

Chapter 5

The Influence of adopting