This Challenges Health Care Services Assignment report described NHS (national health care system) and CRS for health care management.
The National Health Service or NHS is the system funded by public in England. It operates as single payer health care system and is one of the largest and oldest systems in the world. It generally functions from primary taxation fund similar to government body similar to fire departments, police departments able. Thus the services of healthcare are provided to anyone but normally the person should be resident in England, or any other part of United Kingdom.
The core principle of NHS set-up is to provide free services that are non-negotiable but is open to some interpretation over the years. In broad terms, “free at the point of use” means that person who is legitimately registered with the system. It includes UK citizens and also legal emigrants, who are allowed to both critical and non-critical medical care within pocket expenses of any kind. Only certain specific NHS service are charged with certain fees or we can say services-in return-fees: since 1948, there have been certain nominal charges applicable towards services like eye tests, dental care, prescription etc. but the charges are definitely lower than services under private health care system(Navarro R., 2008).
National Programme for Information Technology (NPFIT):
Since 1998, the work has been begun to develop electronic health records (EHR) for patients in England. The plan was to complete this project in 2005. The purpose of this project is to serve over 100,000 doctors, 400,000 nurses and 130,000 other healthcare specialists in England. In 2003, only 3% of the target was met. According to this situation, experts evaluated this problem and specified the main reasons that delayed the project. The first reason is the information technology (IT) budget which is specified locally to reduce financial loads elsewhere. The second reason is the insufficient setting of IT standards. As a result, they recommended supporting the IT budget to solve this issue (Pare, G. 2002). The government agreed of £2.3bn for the new NPfIT in England to implement electronic patient records in all trusts at the end of 2007 (Hendy, Reeves, Fulop, Hutchings & Masseria, 2005). Moreover, this project contains many systems such as NHS Care Record Service (NHS CRS), Choose and Book, Electronic Transmission of Prescriptions (ETP), N3 – The National Network, Picture Archiving and Communications System (PACS), IT supporting GPs, including the Quality Management and Analysis System (QMAS) and GP-to-GP, and NHS Mail (Hendy et.al, 2007).
NHS Care Record Service (NHS CRS)
Care Record Service (NCRS) is the heart of the national programme. It gives an authorised access to healthcare specialists to deal with patients records any time during the week; also patients can access their records online by Health Space service. The demographic information and care and health history for each patient are supported. All of this information is prepared to be available in emergency or out of working hours. Furthermore, the system will assess clinicians select tests and medicines, follow instructions according to National Service Frameworks for patients, and reduce errors in prescribing and treatment (parliament, 2004) .The NCRS will link more 30,000 GPs and NHS trusts in a national system which is Spine to enhance the quality of healthcare connection for primary and secondary care within the England’s medical organizations. In addition, NHS started to implement the system during 2003, and make contracts with National Application Service Provider (NASP) and Local Service Providers (LSP). The implementation phase was divided the county into five clusters geographically. Every Local Service Provider (LSP) is dependable on each cluster by developing electronic patient records for this area, maintaining IT services and systems to connect with the Spine. NCRS is on the basis of two types of records: Summary Care Record (SCR) and Detailed Care Record (DCR) (Hendy et.al, 2007).
Summary Care Record (SCR):
Nowadays, patient records are held in any place where patients can have medical care. These places can only share patients’ information by traditional way such as phone, fax, email or letter, so this may make transferring and accessing this information very difficult. Summary care records are developed to enhance the quality and safety patients care. Moreover, SCR will support health staff by making their work faster, facilitating access patients’ information, giving safe dealing with patient’s situation in an emergency, and confidentiality of records (NHS, 2010). These records will be located on Spine to help the availability to access this information twenty four hours a day and seven days a week (Jalal-Karim & Balachandran, 2008). In addition, Summary Care Records can be accessed in any time from Health Space website. The Health Space account contains: the weight, blood pressure readouts, cholesterol readouts, measurements of alcohol level, any medications, and the appointments date and time (Mikkelsen G, Aasly, J. 2001).
Detailed Care Record (DCR):
Increasing health care service quality in medical sector needs to ease access to detailed medical information of electronic patient records and support the availability of them to success. Therefore, Detailed Care Record (DCR) is maintained detailed information about patients which can be accessed locally in GPs or hospitals. DCR contains personal information about a patient, any medicines that prescribed before to the patient at different periods, tests and X-rays, and any medical treatments. All the previous information facilitates the healthcare clinicians’ job to provide safe and quality care to patients. Moreover, the demand of Detailed Care Record is required to “demonstrate competence, simplify and improve medical decision making, the quality of care, the cost of care, the education and credentialing of providers, the development of medical knowledge itself and to justify use of healthcare resources (K. Neil J., 2004).
Role of it systems in Health Care Services:
IT systems are very useful in hospitality industry. This system could handle the details related to every department involved in hospital operation. It is generally designed to manage the patient details, administrative, financial, legal documents, HR related to details, Employee details etc. These systems are designed in such a way that it vanished the paper based information processing. The most important IT system in hospital is care record keeping of patient. The care record is a patient record which generally consists of patient demographic information, laboratory test results, medical history, allergies details, medication, the hospitalization details along with the reason, any X-rays or images taken for that patient etc. The X-rays and scans are now easily kept in a computer instead of sheets or films. The record could be entered in the system at the time of diagnosis or whenever a particular test is performed. It could be updated with discussing the patient or by taking feedback form Once the record has been entered it could be access by the authorize person at any point of time. This information will be reliable in nature and help the hospital staff in treating a patient in case of any emergency. Even the patient could see the complete details of his medical history. This information could be transmitted to any place whenever required. This record will help to provide best quality services to patient and also helps in managing the patient (Sauer C and Willcocks L., 2007).
Challenges Faced by NHS to Implement CRS
The execution of Care Record Service in the National Health Service is one of the most complex and elaborate implementation of innovative information technology ever carried out in the sector of healthcare. This case attempts to address the process in which NHS implemented CRS in GPs and hospitals. It also discussed the advantages and the reason why CRS us implemented. The failure factors and the challenges faced during the implementation of the project will also be discussed.
- The first and foremost challenge faced by the NHS while implementing Care record service in its daily routine is the Skill set which needs to be installed in the employees of the organization. The entire NHS sector is going through a transition phase and the older employees who were trained in the time when Computers and IT network were not so robustly used in health care services still find it difficult to work with IT based systems. It is difficult for those employees to get trained in a new system which will be an up gradation on existing system. The transitory phase of learning a new system is slow in its pace making it very difficult for NHS to implement the system in all hospitals fully.
- One of the big trust of NHS known as royal free established in Hampstead has openly criticized the new CRS system by stating that it has been costing them millions of pounds to cope with the new system implementation as it is causing unnecessary delays in patient appointments and the activity which is recorded by the system is also not very accurate. It has also been observed by them that the time consumed for per patient has gone up and they need to hire 40 new administrators in the hospital to get the same level of work done (Peltu M, Eason K and Clegg C., 2009).
- Another challenge which is faced by NHS in installing the new CRS system in hospitals is their integration with the old legacy system which is keeping the records for the hospitals from years. The new software which is developed for CRS is more sophisticated and advanced which requires faster processors and storage capacity. The older systems in many hospitals are not able to support the requirements of new CSR which is posing a challenge in front of NHS to successfully implement it. The alternatives which are available with NHS is to replace the entire system which is very expensive and time consuming process or drop the idea of implementing the new CRS system which undermines the long term objective of NHS to successfully record and manage the data of all its patients in a dynamic way which can be accessed by hospitals and clinics of NHS network anytime from anywhere (Bates DW. 2005).
- The speed of CRS is also a challenge for NHS. The slow implementation and digital learning process of the health care service providing staff member is causing delay in the response time of accessing the records and the aim and objective of the entire CRS implementation is to ensure that data can be accessed quickly. The NHS is attempting various measures to ensure that the time consumed in data accessing and processing is reduced from previous levels to meet the goals of the program.
- Another challenge faced by NHS is the changing scope of the project. The CRS program of NHS was initially developed for maintain the record of patients at the hospitals managed by NHS but in the middle of implementation process the scope was changed to incorporate general practitioners and clinics which are also under the purview of NHS. The changing nature of the program requirements also made it difficult for NHS to implement the program successfully and meet all the required criteria.
- The basic idea behind developing a national level CRS program of NHS was to develop the patient record management at various regional and local centres and the integrate them under one big umbrella of NHS so that these records are available to any member of network from anywhere in the country but after the initial phase of development the idea was changed into developing a standardized system for all hospitals and clinics. Many academicians and professional criticized this approach with the argument that non involvement of the local applications reduces the sensitivity of the system towards the local needs and a standardized product does not have the flexibility of incorporating changes required to make it more suitable for a local area. This has created a lot of problem for NHS to implement it and they had to undergo a series of changes to customize the system for each hospital (Berg M, Aarts J and van der Lei J. 2003).
- The overall timetable for implementation is unrealistic, and trusts continue to face uncertainties. The need to renew the patient administration system in most trusts represents a bottle-neck, with timings published in the NHS Care Record Service: Indicative Deployment Plan not tying in with promises of detailed electronic patient records being provided by the end of 2007.
- Because of all the changes and reversing of the scope and implementation strategy of the entire program has overrun the budget and time frame estimated for the program. The cost of implementation has also enhanced exceptionally making a constraint on many hospitals to stop implementation after initial phases. Many hospitals has reviewed the program after implementation of initial phases and observed that the cost of implementation reaches far above the benefits associated.
- It is also observed by the stakeholders at both internal and external level that there is a lack of clear vision and objective among the users of NHS CRS program. The program is inspirational on theoretical terms but when it came to practically use it a lot of ambiguity developed around it. This makes it difficult for end-users to use an EHRS which will be integrated into day-to-day working practices. There is a negative impact on the perception of user towards the CRS program which makes it more difficult to remain motivated and enthusiastic about a new program (Brennan S. 2007).
Advantages Associated with Care Record Keeping in Hospitals
The major advantage for government and hospitals for promoting the care record is to analyse the data and then react on it. It has been suggested that the proper collection of data, its management and the use of information within healthcare systems will determine the system’s effectiveness in detecting health problems, setting priorities, identifying innovative solutions and allocating resources to improve health outcomes. For example if the majority of population in a country is suffering from a common disease then in that case the government could focus its spending on that particular area so that it could provide the quality services and could reduce the expenditure on that disease in near future. For private hospital this data could help them to organize their services and develop their specialities on this disease so that they could gain the maximum from it. The care record is also helpful from the insurance company’s point of view. They can ask the government organization to provide health related information for an applicant and then based on this report they could decide whether to cover the applicant or not (Boaden R, Joyce P. 2006).
The NHS Care Records Service will help in the process of NHS moving away from its existing records for patient, which is essentially centred on the organisation, to records for patient which is fundamentally centred on the patient. It will put together a process if patients caring throughout the boundaries of the organisation safe and sound and more competent. This process in addition will provide the patients with access to a record which covers care throughout the organisations. In due course, the organisations of NHS will progressively keep more care records on the computers which can be linked with each other. This will allow a safe and secure access to the information pool.
Implementation of information technology in any public sector of a country suffers from quite a few problems. This one is also no exception. NHS CRS has suffered from some very serious problems which has delayed its implementation. Advice has been sought from the providers of health care from various disciplines for the successful design of the NHS CRS. This has been done to make sure that it can serve the purpose for the professionals and to make guidance available on efficient training. Consultation from the patients has also been asked for.
During the very first stage of execution of IT the tasks involved are the distribution of information and categorization phase. The problem in this phase is to keep up the set of information that will be uploaded on the user interface for that will be used by different organizations or the local care giving centers. The second stage which generally looks at the process of the communicating and transacting calls for replacement of the legacy systems with new platform. It is without doubt a massive challenge. Additional concerns entail taking charge of the monetary transitioning, providing services of integrated nature and making a list of electronic records. Wide ranging development and training of the stakeholders who are internal for the process is imperative for this stage (O’Neill, 2000). In the third phase which is also known as the stage of vertical amalgamation of different technologies, the communication and integration between different teams and internal stakeholders are of utmost importance. The issues that are faced with for the successful implementation of this phase are exposure levels of internal legacy system, compatibility of different formats etc. In the phase of horizontal integration the technical problems which are present generally take place due to the amalgamation of diverse databases and resolve conflicting system requirements across different functions and agencies (Hendy et.al, 2007).
Reflections on the Process of Developing This Report
The learning curve has been quite steep while working on this particular project. The learning was twofold due the dual nature of this project which consisted of one group task and one individual task. The first and foremost thing which I have learnt while executing the tasks for this particular project is how to work in a team for efficiently carrying out a project. The other very important learning was about effective communication theories. As we know it is very important to communicate effectively in a closed group while carrying out some project, we learnt how to communicate effectively with the help of this project. The importance of strategic planning has also been appreciated by us while doing this project.
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