EHTO Trends in Health Telematics in the European Union


	Updated: Dec 6, 96
UNITED KINGDOM

POLICY AND FUNDING

The National Health Service (NHS) in the United Kingdom has a well-developed information management and technology strategy, which evolved in close cooperation with users. Funding is mainly a local responsibility though central financing has been made available for some development projects and for general practitioner (GP) computer systems that meet national standards. The strategy was developed centrally but its implementation is a local responsibility. It deals with issues such as creating the infrastructure, ensuring value for money and training staff.

KEY INITIATIVES

The information management and technology strategy launched in the early 90s featured four major central initiatives. These aimed at facilitating progress through implementation of a carefully phased programme which included:

promotion of projects:
- Community Information Systems for health care Providers supporting initiatives for community based health care and providing a framework for migrating to person-based systems
- Hospital Information Support Systems
- information systems to support the development of healthcare purchasing
- Integrated Clinical Workstation: to identify the requirements of clinical users and the benefits of using workstations in different clinical settings across all sectors of healthcare, including assessment of the benefits and issues of capturing, exchanging and presenting referral and discharge planning information in a user-friendly manner.
- development of an Electronic Patient Record to help healthcare professionals in acute hospitals to give better care to patients.
development of an IM & T infrastructure including:
- a unique patient identification number
- a network of shared NHS administrative registers with basic patient administrative details
- a national NHS-wide electronic network (data, voice and radio) facilitating information sharing and able to support both national applications and communications between local networks.
- a national thesaurus of coded clinical terms developed with the support of groups of recognised medical specialists and designed to serve the needs of clinical care, epidemiology and public health, medical audit, outcomes and resource management
- national standards for messaging, data transmission and coding
- a security and confidentiality framework which emphasises disclosure of information only on the basis of authority and the need to know
maximising value for money:
- helping to define requirements for users with common needs
- setting quality standards and creating a system for certifying compliance
- national guidance on the development of business cases and benefits realisation
helping personnel to prepare for the changes involved
- development of a national training strategy (see below)

At national level the Information Management Group was established in the early 1990s within the NHS Management Executive with wide-range responsibilities for development and promotion of an information management and technology strategy. It has been active in monitoring the progress of information and communications technologies in healthcare. More recently an Association of IM & T Staff (ASSIST) has been set up in the UK. In addition, a number of professional bodies at national level interested in IT applications have set up their own specialist groups. This includes doctors in primary health care, nurses and the Royal Colleges.

TRAINING

The IM & T strategy includes a comprehensive training strategy coordinated by the NHS Training Directorate. Delivery of training is a local responsibility and the strategy includes provision of financial support for local training coordinator posts and local learning centres. The NHS Training Directorate has issued guidelines indicating that 10% of a project budget should normally be set aside for training, though in reality the proportion of local budgets devoted to training is probably less than this.

DATA PROTECTION

The UK has several pieces of legislation governing use of and access to computers and medical records. The Data Protection Registrar, who has statutory powers under the Data Protection Act monitors developments closely. Within the health service, security and confidentiality of patient data is treated very seriously, particularly with the development of the NHS-Wide Networking infrastructure. A special section has been created within the Information Management Group to deal with the issues involved.

DEGREE OF PENETRATION

Around 90% of general practitioners are computerised, and though initially this was mainly for office support, they are working increasingly with computerised medical records. The Information Management Group, in order to ensure coherence and compatibility between GP systems, as well as links with hospitals and Family Health Service Authorities, has produced a set of requirements for accreditation. This covers practice and patient registration details, a prescribing and dispensing system, a basic patient medical record format compatible with the Read coding system, reporting/recall facilities, payment systems and data security/ confidentiality requirements.

A survey published by the Information Management Group in 1993 covering 95% of acute hospitals showed that most hospitals had yet to implement integrated systems. It showed substantial investment in hospital information support systems (£162 million divided evenly between capital investment and revenue costs), and the bulk of respondents seemed reasonably satisfied with their systems. In specific areas, the survey showed that almost 100% of hospitals use patient administration systems. A large proportion also use key departmental systems (pharmacy 81%, laboratory 69% and radiology 67%). Most also use management applications for ledger, payroll and personnel activities. Finally, some of the newer application areas are expanding including casemix (68%), contract management (56%) and nursing (52%). Order systems are being implemented more slowly.

NETWORKS

A national network (Healthlink) for exchanging administrative information between GPs and Family Health Service Authorities has been operating since 1991. The Information Management Group has subsequently set up a project to develop a national NHS network capable of supporting all clinical needs. Framework contracts were signed earlier this year with BT and Mercury (the major UK network carriers) to provide networking services to the NHS, including national NHS electronic mail services. There is considerable interest in exploiting the potential of the network for accessing clinical information sources and developing telemedicine applications, and the NHS Executive has recently established an advisory group to promote these.

At local level networks are funded out of local budgets on a cost/benefit basis. Many sites have now implemented intra-hospital networks, and are looking increasingly to supporting the transfer of data across organisational boundaries. The main thrust in this direction seems to come from GPs, especially practices which have their own budget, who are seeking access to waiting list information, pathology and radiology reports.

There is little use of telematics either for epidemiological purposes or for access to knowledge-based systems though a major research project is being established in this field. There are some developments in relation to transfer of X-ray images and digital images from CT scanners, MRI etc but these are essentially at an experimental stage.

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