information technology

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An Overview Of NHS Management Devices Information Technology Essay

Abstract

The NHS’s National Programme for Information Technology (“the programme”) is the largest single healthcare IT project in the world, and according to the National Audit Office represents the largest single IT investment in the UK to date (Walley. P. and Davies. C.). The study has been done to describe the overview of the Information Management and Technology (IM&T) in the NHS of UK. With the objective of describing the contemporary IM&T scenario, the study emphasized on elucidating strategic importance of IM&T in the NHS and finding out the shortcomings besieged the NHS in deploying and implementing IM&T strategy. IM&T in the NHS was found to have a significant positive effects and effectiveness to improve the health care and communication. It was observed that information management and technologies are having major impact on the health sector expect it will play an ever growing and essential role in supporting the delivery of health care.. For instance, communications are hugely improved and the service given to the patients is of a far higher quality than before That is, improved patient care is linked to better value from information and the efficient management of information and its supporting technologies is an important issue for improving the efficiency of care delivery and quality of services and outcomes. Though there are a number of barriers have been identified in deploying and implementing IM&T in the NHS. The findings suggest to adopt some measures to overcome the barriers and thus, the quality of health care service will turn into a complete satisfaction to all parties concerned.

Introduction

Information systems and organizations influence one another. Information systems must be aligned with organization to provide information that important groups within the organization need. At the same time, the organization must be aware of and be open to the influences of information systems in order to benefit from new technologies. The interaction between information management and technology (IM&T) and organizations is very complex and is influenced by a great many mediating factors, including the organisation’s structure, standard operating procedures, politics, culture, surrounding environment and management decision. This concept can be expressed as follows:

Organisations

Information Technology

Mediating Factors

Environment

Culture

Structure

Standard Procedures

Business Processes

Politics

Management decisions

Chance

The two way relationship between organizations and information technology. (Sources: Management Information Systems: Lauden and Lauden)

Information and technology both resources are increasingly important as organizations seek to improve their performance. Information and technology resources coupled with human resources help deliver value to organizations in many different ways. Applying information and technology offers new ways to do business, increase the efficiency of business processes, reduces costs, and provides the performance measures used to control improvement. Ultimately, value is delivered not through technology, but through applying information; by improved flows of information which require less resource; by better-quality information and knowledge sharing which improves decision making. In the same way the energy, water and nutrients are transported between different parts of a tree in order for it to survive; information needs to be transmitted efficiently through an organization for it to thrive (Chaffey & Wood, Business Information Management)

The greatest contribution that information makes to organizations is as a resource to improve the performance of organizations and the individuals that work within them. Organisational performance can be improved by utilizing information resources to help deliver better-quality products or services more profitably. Individual performance can be improved by providing employees with more relevant, timely information to support their decisions (Chaffey & Wood, Business Information Management)

The importance of information to organizational performance has been recognized by the IT Governance Institute, which has developed with its member organizations COBIT, a framework intended to assist organizations in managing their information resources. COBIT stands for Control Objectives for Information and related Technology. It was first released by the Information Systems Audit and Control Foundation (ISACF) in 1996. It is not a methodology or a standard, but a practical tool drawn from other standards and methodologies. It focuses on delivering quality information and distinguishes between “information and related information technology (IT)’. COBIT is used by organizations in Europe, Asia and The Americas (Chaffey & Wood, Business Information Management)

The Context of IM&T in the NHS

In the aftermath of World War II, Clement Attlee’s Labour government created the NHS as part of the “cradle to grave” welfare-state reforms, based on the proposals of the Beveridge Report, prepared in 1942 by the economist and social reformer William Beveridge. The idea was that if Britain could work towards full employment and spend huge sums of money during the wartime effort, then in a time of peace equitable measure of social solidarity and financial resources could be redirected towards fostering public goods (Wikipedia, NHS). As the widespread social reform and rebuild, despite vehement oppose from various political corners, Aneurin Bevan, the then newly appointed Health Minister, was given the task of introducing the National Health Service (NHS). Bevan had underpinned his plan for the NHS on the Tredegar Medical Aid Society. Doctors were initially opposed to the reform measure and even organized to try fight against it. Being a shrewd political operator, Bevan had to get them onside involving them with this reformation and managed to push through the radical health care reform measure by dividing and cajoling opposition. Now-a-days, every single person has access to quality health care that is financed through progressive taxation. Before the NHS, millions of citizen had been unable to afford the privatized system and were disenfranchised from access to health care. Though private health care has continued parallel to the NHS, which is used by less than 8% of the population (Wikipedia, NHS). Recently the private sector has been increasingly used to increase NHS capacity despite a large proportion of the British public opposing such involvement.

The NHS in England is controlled by the UK government through the Department of Health (DoH). The DoH controls ten Strategic Health Authorities (SHAs), which oversee all NHS operations, particularly Primary Care Trusts. In addition, several Special Health authorities provide services to the devolved NHS administration. The Information Centre for health and social care is out of them.

The NHS information strategy, Information for Health, published in September 1998 provides a framework for IM&T (Burns 1998). This focuses on the NHS as a whole, but predictably aims to ensure strategic implementation at primary care level first. This is inevitable, given “The New NHS White Paper’s” commitment to modernization of GP systems (Mitchell 1998). The strategy states the case for electronic patient and electronic health record (EPR and EHR) and links this to their importance in supporting strategic ‘strands’.

In 1992, IM&T for NHS at local level has carefully been developed based on primary local needs but remaining in accordance with the five basic principles set out by the NHS Information Management Group (IMG). The new national IM&T strategy, Information for Health, has resulted in some caution at the local level since IM&T mangers have not wished to implement local strategic policies without confidence in their conformance to national requirements and the reality of an IM&T strategy at the local level is a much more complex issue. However, the development of the IM&T strategy continued, with an objective to facilitate system replacement. Now, the new national strategy, published in September 1998, closely matches the local strategy in terms of aims and means of information provision.

The implications for IM&T are frequently considered alongside issues of direct care. The most recent shift is embodied in the Department of Health’s information strategy, Information for Health, published in September 1998. This paper provides the context for an examination of the issue of developing an IM&T strategy at the national level contemplating the requirements for NHS information management. The IM&T strategy of any organization hinges upon the objectives of business and followed by information needs. This concept can be shown as below:

(Source: Information System Department., Morecamble Bay Hospitals NHS Trust, 2001), Information Management and Technology Strategy Executive Summary, version 1, November (2001),

The issue of implementing the new information strategy alone is broadly addressed within the Information for Health strategy document. The information Policy Unit of the NHS Executive has also produced published guidance. This has been supported by input to various forums for examination of the issues from the point of view of information specialists within the NHS.

A strategy for clinical and management information systems does not exist in isolation from the past. Previous information systems, activity processes based on these and the human components of each are the legacy inherited by IM&T implementation projects. The implementation framework of Information for health looks at various means for encouraging local development issues to drive strategy (Smith et al.2000).

The NHS-wide networking system is an initiative at the heart of the IM&T strategy for the NHS, it is an integrated approach to inter-organisational communication, which includes purchasers, providers and GPs within the NHS (Susan Knight, 1995). NHS-wide networking covers everything from mobile communications to the electronic transmission of images (Susan Knight, 1995) as well as various sections of NHS. The-wide networking of the NHS can be shown as follows:

(Source: Price. P. and Crookes. A. “Information Management Technology Strategy”, Version 1, January 2008)

Objectives

The focal objectives of this case study can be depicted as follows:

To assess the strategic importance of information management to the NHS.

To ascertain and elucidate the problems in deploying IT in the NHS.

To recount the causes of the problems and correlate to these causes to technology, people and information resources used to support information management in the NHS and finally

To suggest some appropriate usages of IM&T which will enable NHS to improve the efficiency of care delivery and communication that leads to quality of service and outcomes.

Methodology

The study has been carried out thoroughly studying different books on information management and technology of different authors and it’s related other books and other published magazines. To understand the concept of information management and technology, an extensive literature review of different research articles on the same issue has been done as well. Moreover, huge amount of data and information has been gathered from the website related to NHS. Secondary data, predominantly, has been used in this case study.

Limitations

No work is from any limitation. The study has been conducted through some limitations. Some of these are identified below.

The study was carried out based on secondary data published in different articles on information management and technology in the NHS. So, the question of pragmatic outcomes in perspective of current position of IM&T in the NHS may arise while interpreting the results.

The study was conducted based on a case study problem provided by the course teacher. So, every aspect has been done in pursuit of instructions mentioned in the case study. It has been pondered to be irrelevant to do any thing out of jurisdiction of the case study.

The study has been accomplished within a stipulated time fixed by the course teacher. As a result, there was no scope to gather primary data which may raise question reality and pragmatism of the findings.

Literature Review

There has been not a single study so far on the issue of IM&T in the NHS. Some worth-mentioning outcomes of these studies are stated in the following with shortened.

Knight. S. (1995) in a study on “The NHS Information Management and Technology Strategy from a mental health perspective” shows that computerised information offered clinicians an exceptional opportunity to improve standards of patient care not only by accessing and exchanging relevant information on individual patients but also by immediate access to pertinent and up-to-date research in their field. Rapid developments in computing technology could offer healthcare professionals new opportunities for achieving their objectives.

Jones. D. and Wilkin. D. their study on “Information management and technology (IM&T) in primary care groups and trusts: the gap between national strategy and local implementation” reveals that the quality of data currently available to Primary Care Groups and Trusts(OCG/TS) is generally perceived by IM&T leads as being poor and is seriously hindering progress and there is a gap between the vision described in the national information strategy and the ability of local organisations to deliver targets.

Smith. L. and Preston. H.(2000) in a study on “Information management and technology strategy in health care: local timescales and national requirements” discloses that present information management and technology of NHS at local and national level doesn’t meet the requirement of parties concerned in the NHS. The chief obstacle, aside from resource implications of introducing a new principal information system, was the timescale of the national strategy.

Walley. P. and Davies. C. (2002). in a study on “Implementing IT in NHS hospitals-internal barriers to technological advancement” shows that external factors are not the only reason for the slow introduction and implementation of IM&T in the NHS, but there are some internal barriers that significantly limit the implementation process including an unsupportive organisation structure, irreconcilable differences in stakeholder requirements, the low status of the project team, a poor understanding of process management issues and organisation politics.

Findings

Findings are subdivided into three sections such as (a) analysis of strategic importance of information management and technology to the NHS, (b) describing the problems in deploying IT in the NHS and recounting the causes of these problems (c) suggesting some appropriate approaches of IM&T in the NHS which enable it to improve the efficiency of care delivery and thus influencing the quality of service and outcomes.

Strategic Importance of IM&T in NHS

Information, with its associated technology, is one the most important resources in the National Health Service (NHS). Health Information Management and Technology, now-a-days, is an utmost issue in the information technology arena which involve the application of clinical knowledge, information technology, data base management and administration of health sector. Health records are a base for health care planning and management decisions, legal and administrative purposes, research, identifying trends for the treatment of the disease and for evaluating the standards and quality of patient care. Moreover, it was evident that lack of an IM&T strategy had contributed to a very unconfused approach to identification of information needs (Smith et al.,2000).

The overall aim of the information Management and Technology (IM&T) is to support better care and communication through the appropriate use of information management and technology in the NHS. Healthcare organisations like hospitals or clinics where different aspects of patient care are delivered from very different sources, the swift access to comprehensive information and communication between groups involved in treatment is very much essential. Because, computerised information offers clinicians an exceptional opportunity to improve standards of patient care not only by accessing and exchanging relevant information on individual patients, but also by immediate access to pertinent and up-to-date research in their field (Susan Knight, 1995). Today it is observed that rapid developments in computing offer healthcare professionals new opportunities for achieving their objectives.

One of the essential functions for clinical effectiveness is information ( NHS executive 1996a) and clinical and management information systems have considerable potential for improving the efficiency of care delivery and communication and thus influencing the quality of service and outcomes ( Susan Knight, 1995).The variety and complexity of clinical contexts is such that only the computerisation of clinical records and computer assisted input protocols are capable of handling the task effectively. Heightened awareness of health needs assessment has raised the profile of achieving a match between needs and outcome (Hensher and Fulop, 1999).

Morecamble Bay Hospitals NHS Trust (formed on 1 April 1998) has identified a number of benefits to health care in the NHS’s IM&T. The essence of these is described as follows:

IM&T support directly to the doctors, nurses etc. during performance of their core duty, the treatment of patients, and thus it improve the patients’ care, clinical practice and effective health management.

IM&T is needed to give a clear view and aggregated picture to senior clinicians and management of the trust performance against key managerial and clinical performance indicators. Executive Information systems (EIS) can typically help with this issue.

IM&T is required at every level of NHS to support Integrated Care Pathways.

IM&T makes significant changes in IT training for clinicians, managers and other users.

It may reduces patient and staff time wasted on the retrieval and re-collating of patient care records

It may help to improve the information available to patients and the public about their care and the services provided.

IM&T can help to monitor of Health Improvement Programme (HImP) targets and National Service Framework requirements.

Moreover, Clinicians identified the need for access to patient clinical histories and current information. The information specified is that which would create a patient based longitudinal record. The clinical staffs see this longitudinal record as being necessary to support them in their day to day work and doing so provide the means to improve quality of care. The Electronic Patient Record (EPR) is a lynch-pin of the national IM&T strategy. The needs identified as essential in providing clinical care appear in appendix 1. In addition to these, generic needs were identified appear in appendix 2 (Smith et al.).

Problems in deploying IT in the NHS and recounting the causes of these problems

Organisations are confronted with many information management problems and issues. In many ways, the growth of electronic information (rather than paper) has only worsened these issues over the last decade. According to the James Robertson, common problems in deploying and implementing information management in the service or non-service based organisation as follows:

Large number of disparate information management systems.

Little integration or coordination between information systems.

Range of legacy systems requiring upgrading or replacement.

No clear strategic direction for the overall technology environment.

Limited and patchy adoption of existing information systems by staff.

Poor quality of information, including lack of consistency, duplication, and out-of-date information.

Little recognition and support of information management by senior management.

Limited resources for deploying, managing or improving information systems.

Lack of enterprise-wide definitions for information types and values (no corporate-wide taxonomy).

Lack of clarity around broader organisational strategies and directions.

Difficulties in changing working practices and processes of staff.

Internal politics impacting on the ability to coordinate activities enterprise-wide.

While this can be an overwhelming list, there are practical ways of delivering solutions that work within these limitations and issues.

The NHS has been experiencing most of them problems in deploying IM&T and criticised over the implementation of its National Programme for IT which is designed to provide the infrastructure for electronic prescribing, booking appointments and elective surgery, and a national care records service. The programme has run into delays and overspends, with the initial budget of £2.3 billion over three years officially revised to £12.4bn over 10 years and some sources putting it as high as £20bn Critics including the House of Commons Public Accounts Committee and the National Audit Office claim the project is falling behind schedule. In addition, 93% of doctors within the NHS are not confident their patients' data will be secure, some GP practices have begun to advise all their patients to opt-out of the scheme, and privacy campaigners have claimed the national care records system breaches patients' privacy rights.

One of the greatest challenges to the successful introduction and implementation of IM&T in the NHS is the development of an information culture (Susan Knight,1995). Staff members were asked to consider the functionality, usefulness and effectiveness of currently used information systems, identifying the strengths and weaknesses of each as perceived by them. The results from this confirmed without any doubt the anecdotal evidence that information needs were not being met. When asked to describe their information needs in the short and long-term staff found this more difficult but the use of relevant prompts allowed a clear picture to be established for incorporation into the strategy. In addition to functionality, views were also elicited on topics such as responsibility for data capture, training in use of corporate systems, and general attitudes to IM&T in the health care setting (Smith et al.,2000). The process of establishing the information needs requires the involvement of staff in all disciplines and all levels. The establishment of an information management partnership between managers, end users and IM&T professionals is essential if effective information management is to be achieved (Silk 1193). Moreover, it is important for NHS Trusts to ensure that all staff are equipped to use information systems productively and are able to use the information that get from such systems (Susan Knight,1995).

There are a number of barriers have been identified in implementing IM&T in the NHS. The essence of these is described as follows:

All NHS organisations are facing financial pressures and a major aim of the national IM&T strategy is to ensure that IM&T, as with any function, must give value for money. The trust has spent approximately £250,000 in 1998/99 on its IM&T provision, which represents 1.3% of its turnover. This level of expenditure is not excessive for a NHS acute hospital but the functionality received is relatively poor when compared with the functionality and cost of modern systems (Smith et al.,2000). In addition, mangers control budget and wanted reliable information on which to manage. They have frequently failed to achieve their goal because the systems have not been fed by reliable data use for operational clinical purpose (Susan Knight,1995).

Lack of skills and knowledge are frequently compounded by negative attitudes towards information systems, whether an information system is a success or not depends on the attitude of the staff that are using it. Even the best system will fail unless staff are committed to it (Susan Knight, 1995).

Lack of awareness of the consequences of not achieving National targets, therefore starting these plans to late (Morecamble Bay Hospitals NHS Trust, 2001)

Moreover, NHS Bureaucracy, lack of organisational vision, available capability within systems, lack of clinical ownership and priority fatigue are also some the problems in deploying IM&T in the NHS (Morecamble Bay Hospitals NHS Trust, 2001).

This above mentioned problems with respect to deploying information technology and implementing information management in the NHS do not provide an exhaustive list, but do offer a series of lacking or impediment that can be used to guide for the future planning and implementation of information management activities.

Several appropriate approaches of IM&T in the NHS (The recommended IM&T Strategy)

Improving information management practices is a key focus for many organisations, across both the service and non-service sectors. This is being driven by a range of factors, including a need to improve the efficiency of business processes, the demands of compliance regulations and the desire to deliver new services. In many cases, 'information management' has meant deploying new technology solutions, such as content or document management systems, data warehousing or portal applications. These projects have a poor track record of success, and most organisations are still struggling to deliver an integrated information management environment. Effective information management is not easy. There are many systems to integrate, a huge range of business needs to meet, and complex organisational (and cultural) issues to address (Robertson, 2005)

The NHS has frequently been the target of criticism over the years. The criticism has been done over many things with respect to health services (like, access control, politicisation, paying twice, waiting lists and 18 week target, super bugs etc.), but the criticism with respect to information management and technology is not totally pin-point. Though the Primary Care Trust and the local health community have already made substantial progress in implementing many of the components of the National Programmme for information technology, like electronic prescription service, choose the book, Lorenzo, N3, information governance etc. The UK government and NHS national leadership have consistently argued that major capital investment in IT is necessary to transform services. Fragmented information systems, as in the US, prevent health services providing consistent data and can damage patient care where doctors may not have an overview of patients records held by another NHS body (Wikipedia, NHS). Despite considerable efforts over 30 years, patients records today are still predominantly paper based (Susan Knight, 1995). Only 7% of practitioners are satisfied with the current information management and technology (Wikipedia, NHS).

There are several ways to improve information management and technology in the NHS. A recent article by a practicising GP, published in the BMJ, suggested ten practical ways that information management and technology in the NHS could be improved. These are listed below:

1. Send discharge summaries and clinic letters electronically to prevent the need to scan: Clinicians still receive all letters from hospitals in paper format only. This means that a member of staff has to scan them into the patient's electronic medical record. It results in mistakes, with letters sometimes being scanned into the wrong set of notes. All hospital letters are produced on computers, so it seems surprising that they still cannot be sent to practices electronically.

2. Allow hospital diagnostic codes to be sent to practices electronically:

To maintain the completeness of a patient's electronic record, it is needed to extract information on diagnoses and procedures from hospital letters and enter the appropriate Read codes into the patient's record. This creates extra work for clinical staff and also introduces variability in coding, because different doctors will often code the same diagnosis differently. Information on diagnosis and operative procedures is already coded for all hospital admissions by trained teams of clinical coders. As code for different hospitals has been established, they can use these for their mutual correspondence.

3. Allow the electronic transfer of records between practices:

When any patient informs the doctor that they will be leaving his or her practice, patients are often amazed when doctor tell them that the electronic medical record that have laboriously constructed about them has to be printed off, stuffed into an envelope, and posted on to their new practice. If their new general practitioner works in a computerised practice, someone has to re-enter all their data into their new electronic record. The work created for clinician by re-summarising and re-entering information on our new patients' medical histories imposes a major burden on clinical staff. Furthermore, the current system can result in long delays before patients' notes arrive at their new practice and, in time honoured NHS fashion; some of these notes never arrive at all. The NHS also needs to consider what it proposes to do with the vast amount of historical clinical information stored on paper records and how it proposes to convert this information into electronic format.

4. Improve the arrangements for sharing information: Many patients are treated in both primary and secondary care. It would therefore seem logical to allow general practitioners and hospital doctors to view each other's records on the patients they are jointly managing and to update their own records with information collected by the other. Just think of the unnecessary investigations that could be prevented if general practitioners could download laboratory results from hospital records. They would then also perform much better on audits of the process of care, as many of these are about ensuring that appropriate physical examinations and laboratory investigations have been carried out.

5. Start coding outpatient encounters: Outpatients are the "black hole" of NHS information activity. More than 40 million outpatient appointments take place every year in the NHS in England, but the concerned authority of NHS knows very little about what goes on during these consultations. Unlike hospital admissions, information is not collected and coded on the diagnoses that patients are being treated for or the investigations and procedures they undergo in outpatient departments. This needs to be rectified, given that an increasing amount of care is being delivered in outpatient settings. As with codes derived from hospital admissions, any diagnostic and procedure codes derived from outpatient consultations also need to be sent electronically to practices.

6. Make the Lab-Links system work better: Lab-Links is a system that allows laboratory results to be sent electronically to practices and filed in a patient's electronic medical record. According to government figures, more than half of general practices now have the opportunity to make use of this facility. Unfortunately, in practice, Lab-Links fails regularly. A second problem with Lab-Links is that some departments at local hospital, such as radiology and pathology, are not yet able to use the system. This means that the results of many investigations still have to be entered manually into patients' electronic medical records.

7. Improve the speed and reliability of NHSnet: NHSnet is the network that links general practices, hospitals, and other NHS establishments. Its improvement is crucial if the NHS information technology strategy is to meet its objectives. It is observed that The internet connection at the residence is quicker than the one in the practice room, which has to serve many doctors, nurses, several managerial and administrative staff, and any attached medical students. Inevitably, if even any body try to use the practice's internet connection at the same time, it simply gri44nds to a halt.

8. Take responsibility for maintenance away from general practices:

The doctors and managers in practice are responsible for the information technology systems that are used. This includes responsibility for ensuring that the systems stay on line, for security and virus checking, for backing up data, and for many other information technology related activities. Unlike hospitals, general practices do not have large information technology departments to do all these tasks for them. There is no reason to undervalue the role technician or expertise of technology, but the NHS may delegate some responsibilities to the general practitioners related with the technology functions. Because nearly 10 000 general practices exist in England, the NHS cannot realistically provide each general practice with a team of information technology support staff. This means that the only long term solution to this problem is to store patients' electronic records on central servers that the primary care trust is responsible for maintaining and that practices access through NHSnet. However, clinical staff need to play a key role in shaping these developments, to ensure that supporting clinicians in their work and improving patient care remain the driving forces behind any such changes.

9. Provide more comparative information on practice activity:

Ii is very essential for setting future plan to know the comparative statistics between the practices, both locally and nationally, in areas such as prescribing, hospital referrals and admissions, and use of diagnostic investigations. Theoretically, the NHS should already be able to supply this information by using its existing information systems. However, trying to get this information from primary care trusts or hospitals is very difficult. In the longer term, I is required more sophisticated performance measures of clinical activity, using the information stored on practice's clinical computer system, by building on current initiatives in this area. Because, if this information remains, anybody can use it to identify areas in which are underperforming and so improve the quality and efficiency of the services offer. Many patients and consumer groups would also find this information useful.

10. More in-house training: Training is essential to allow all members of the primary healthcare team to benefit from investment in information technology. The computer skills of general practitioners and other primary care staff vary widely. Some general practitioners need little additional training to allow them to exploit the full value of the electronic medical records and the online resources that are being made available to them through initiatives such as the Primary Care National Electronic Library for Health. However, many general practitioners will need considerable training to allow them to use these resources and help make the NHS information technology strategy succeed. Medicine is an information based discipline, and giving doctors the information and skills they need to practise up to date and evidence based medicine is essential in improving the quality of care the NHS provides.

Moreover, realising the aims of the IM&T strategy requires more efficient communications and information processing within organisation which in turn requires a common infrastructure. The NHS-wide networking system is an initiative at the heart of the IM&T strategy for the NHS; it is an integrated approach to inter-organizational communication, which includes purchasers, providers and GPS within the NHS. There are four main elements to the NHS-wide networking programme which seek to:

(i) Rationalise NHS voice communication facilities.

(ii) Set up a national network for the electronic transmission of data between computers, organisations and people through out the NHS.

Improve NHS radio communications, particularly those used by ambulance services and,

Establish an integrated management organisation to oversee all types of networking data, voice, images and radio (Susan Knight, 1995).

In addition to the above, following suggestions can be considered to improve the IM&T in the NHS which may perk up the quality of health service and care communication as well.

Create an information management capability that provides greater leadership, competence development, co-ordination and direction, allowing the NHS to capitalise on the power of information technology to integrate data and processes across organizational and physical boundaries.

Manage funding to ensure information technology receives the investment it requires.

Capture knowledge of best practice and drive it into the national, regional and local information technology environment

Work with clinicians and the NHS Institute for innovation and improvement to make sure the benefits offered by information technology working practices are delivered.

Co-ordinate procurement to achieve best value, rapid progress and compliance with national data and systems standards.

Develop a complaint choice of systems for a portfolio of critical local applications

Build connectivity, so that all staff the bandwidth and access to devices when they need them and

Create national standards for data quality and secure data interchange between systems at local, regional and national levels.

Conclusions

Implementing information management and technology solutions in a complex and ever-changing even not ever-changing organisational environment is never easy. The challenges inherent in information management and technology projects mean that new approaches need to be taken, if they are to succeed. The study has tried to demonstrate the overview of Information Management and Technology (IM&T) in the NHS. It has clearly observed that the information management in the NHS is the combination of paper based as well as technology based, but most of the researchers found that technology based information management in the NHS has been developing steadily. The British Medical Association produced a press release immediately after the publication of the ‘Information for Health’ strategy which stated the Association’s confidence in the focus of the strategy (Smith et al., 2000).

The fairly straightforward information system revolutionised the information that is now available on patients attending for depot injections. Communications are hugely improved and the service given to the patients is of a far higher quality than before, in so much as there were no missing or lost cards and patients who needed following up are quickly notified. All staff involved, even those sceptical at the beginning, are extremely enthusiastic about the system, as it provided almost immediate benefits to all concerned. (Susan Knight, 1995).

The success of the IM&T strategy depends upon the confidence of the patient, the clinicians and management in the security of information held on NHS systems and transferred across networks. To gain such confidence, all IM&T specialists must address the requirements of the security framework in their locality ( NHSE, 1994c: Audit Commission, 1995). If the IM&T manager is to be effective, a balance between local information needs and national strategies must be established (Smith et al., 2000). The study has outlined a pragmatic, step-by-step approach to implementing solutions that starts with addressing key needs and building support for further initiatives. A focus on adoption then ensures that staff actually use the solutions that are deployed.


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