IT in the NHS: clinical information systems

by Leicestershire Health Informatics Service 13. October 2011 15:12

Clinical information systems (CISs) are used by GPs, hospitals and others to manage clinical and administrative information and to improve the quality of healthcare. The complex IT requirements in healthcare have led to the development of numerous CISs to deal with a range of requirements, such as the issues surrounding data maintenance, patient confidentiality and the concept of the paperless patient record. By collecting and integrating data these systems can deliver key information to the right staff so they can use all the facts to make effective, timely, proactive decisions.

EMIS and SystmOne are the CISs you are most likely to come across in our area. SystmOne is used by healthcare professionals across the UK and is predominantly used in primary care, though its use in secondary care settings is growing. Modules for GP, prisons, child health, community units and palliative care are currently widely used throughout the NHS and in the last year, a number of secondary care modules have begun to be rolled out. These include modules for community and acute hospitals, accident and emergency, maternity, mental health and social services.

The system, which now holds over 20 million patient records, has full document workflow management, text messaging, self-check-in systems and online functionality, all built into the core. It helps GPs to maximize QOF points, streamline their work processes and most importantly allows clinicians to concentrate on patient care.

Over the last couple of years we have been deploying SystmOne clinical computer system for GPs across Leicester, Leicestershire and Rutland and we have recently begun on EMIS web deployment as well. GPs can use either of these systems to:

·         Replace paper-based medical records of registered patients

·         Support health promotion and health screening

·         Manage patients’ appointments

·         Record the clinical monitoring of patients with long term conditions

·         Generate prescriptions, manage repeat medicines and the electronic transmission of prescriptions

If we take a closer look at one of the function of a CIS we could consider the volume of medicines doctors prescribe which continues to increase as national policy and better informed patients drive health improvement. People are being screened and pro-actively treated, rather than waiting until they become symptomatic to find out they have something wrong with them. For example, a patient who is diagnosed as hypertensive may be managed with up to 3 or 4 medicines. If they also have other cardiovascular risk factors, they may be prescribed a statin and aspirin on top, so they can very quickly go from taking no medicines at all, to taking 4, 5 or 6 different ones. All of this information needs capturing, and it would be a hugely time consuming task for practices to do this manually, due to all of the cross referencing that needs to be performed. Modern computer systems can easily cope with this, which in turn allows information to be searched and grouped, allowing patient records to be reviewed and managed in the most appropriate way possible.

Prescriptions themselves have been generated by computer systems for some time, but they are increasingly being produced with bar codes. Special readers in pharmacies can scan the encoded information, reducing the risk of error in translation of the prescription. GP systems can produce batch prescriptions to enable repeat dispensing of regular medicines. This is usually more convenient for the patient and reduces some of the administrative work involved with repeat prescribing systems in practices. It will soon be possible for prescriptions to be sent electronically, directly to a pharmacy of the patient’s choice, eliminating the need for a paper prescription altogether.

Clinical information systems are continually increasing in functionality as they become more widely embedded across the healthcare sector. The facts and figures they can collate and generate support better management of services within the NHS and lead to greater coordination between the NHS and other care providers such as social services. The take-up of CISs across all levels of the NHS will provide the means for more informed decision making and ultimately lead to even better care for patients.

We can help

If you are interested in knowing more about SystmOne or EMIS please contact us

Links to more clinical systems info

A one-stop guide for clinicians involved in deploying IT systems – from NHS Connecting for Health

GP Systems of Choice (GPSoC) - a scheme through which the NHS funds the provision of GP clinical IT systems in England

Patient engagement: the GP challenge

by Leicestershire Health Informatics Service 28. July 2011 12:14

GPs are contracted by the Department of Health to provide core services to their patients. Practices can also choose whether or not to provide extra services on top of the core services, called enhanced services. Enhanced services are intended to expand the range of services to meet local need, improve convenience and extend choice. The Department of Health commissions and updates the three types of enhanced services each year:

  • Directed Enhanced Services (DES) - must be provided or commissioned by the PCT for its population
  • Local Enhanced Services (LES) - locally developed services designed to meet local health needs
  • National Enhanced Services (NES) - services to meet local needs, commissioned to national specifications and benchmark pricing

This years directed enhanced services relate to extended hours access, alcohol related risk reduction, learning difficulties health checks, osteoporosis diagnosis and prevention and patient participation.

The patient participation DES came into effect from 1 April 2011 and runs until 31 March 2013. The initiative aims to ensure that patients are involved in decisions about the range and quality of services provided by GPs and commissioned by their practice. As an incentive, practices meeting the DES requirements can earn an extra 30 Quality and Outcomes Framework (QOF) points which, when converted into income, means an extra £1.10 per patient registered with the practice. So if your list size is 6,000 patients - it’s worth over £6,500 each year!

There are a number of key steps to the patient participation DES:

  1. Develop a patient reference group (PRG) to gain the views of patients and enable the practice to obtain feedback from the practice population. Traditionally practices have developed patient groups through volunteers and regular meetings, but the latest guidance makes it clear that virtual groups, consulted via email, will be satisfactory.
  2. Agree areas of priority with the PRG
  3. Collate patient views through the use of a survey at least once a year, looking at a broad range of areas which could include convenience of access (opening times, ability to book ahead, ability to be seen quickly, telephone answering), patients’ experience of the treatment and service they receive, the physical environment in the surgery and other issues specific to each practice
  4. Provide the PRG with the opportunity to discuss the survey findings and reach agreement with the PRG on any changes to services
  5. Agree an action plan with the PRG and seek the PRG agreement to implement changes
  6. Publish a report on the survey results, actions taken and subsequent achievements on the GP practice website. (The DES guidance specifically states that where a practice does not already have a website, one must be set up. It will not be sufficient for practices to use their NHS Choices page to publish information relating to the DES.) The report must have been completed and publicised on the practice’s website by no later than the 31 March each year the DES covers. Failure to publish a report by the 31 March deadline date will result in no payment being made to the practice under the terms of this DES for the year concerned.

We can help
If you are a GP looking to survey patients we can help. We can provide an online survey which has been agreed with the Local Medical Committee (LMC), together with a report on the findings to publish on your site, enabling you to easily consult and report to your patients. In short, we can make it very simple for you to take part in the DES and achieve those valuable QOF points.

Vist our website to find out more

Find our more about patient participation and the DES:

Directed Enhanced Services 2011/12 - info on the NHS Employers wesbite

Patient participation directed enhanced service (DES) for GMS contract: guidance and audit requirements for 2011/12-2012/13 - by NHS Employers

FAQs: Patient participation directed enhanced service - by NHS Employers and the BMA

Understanding what matters - A Department of Health guide to using patient feedback to transform services

Patient participation groups in primary care - lots of useful info from the BMA

About the author

Rupal Patel, blogging for NHS Leicestershire Health Informatics Service, your one-stop-shop for information management and technology. Writing about some of the work we do, discussing IT issues, introducing some of our terriffic staff and generally shedding a little light on the world of health informatics. Visit our website at:

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