Title: Local Clinician Involvement in Clinical Information Systems: Necessity or Luxury
1Local Clinician Involvement in Clinical
Information SystemsNecessity or Luxury A
Review of International Experiences
- ASSIST (Harrogate, Preston)
- October 1 2, 2003
2(No Transcript)
3Questions to be discussed
- Is it important to solicit meaningful physician
input early and often and act upon it? - Does finding meaningful ways to engage physicians
require creating an organizational climate and
culture that respects the heart of medicine? - Is this the key to maintaining physician loyalty
and involvement?
4- Some management teams believe that ideas should
be well fleshed out and ready for implementation
before discussing them with physicians. - When that occurs, do physicians feel their input
is actually sought? - And if they recommend changes at that point, will
it be difficult for management to retreat and
follow another course of action?
5- How can one best square the need for
centralised/standardised policy with getting
local support and use? - Does the opinion of national clinical bodies
matter?
6Outline
- The Danish Experience
- The New Zealand Experience
- An American Experience
- The British Experience
- NPfIT Clinicians Involved?
7The challenge of being an afternoon speaker
8Outline
- The Danish Experience
- The New Zealand Experience
- An American Experience
- The British Experience
- NPfIT Clinicians Involved?
9EPR in Danish Hospitals
- 11/14 counties have an IT strategy for the health
care sector. - As of 2001, there were a total of 52 EPR projects
in the country. - The projects were in different phases and were
controlled on different levels - Between 5 and 10 of all beds in Danish
hospitals are covered by an EPR system.
10Whats most interesting about Denmark is
11Pre-MedCom
- Late 80s
- A GP who also worked P/T in hospital biochemistry
lab - Chief pathologist at the hospital
- Head of IT in the county
- Proposed a project for Funen County IT strategy
- Electronically transmitting lab results
12MedCom Today
- Over 90 of 2000 GP clinics/practices are
computerized - 86 use their computers to send and receive
clinical EDI messages - 10 of non-users
- Those who will retire in next 3 years
- Those just starting without the capital (1-2 year
delay)
13MedCom Facts
- Used by ¾ of the healthcare sector
- gt2,500 different organisations
- All hospitals, all pharmacies, all laboratories
and 1,800 general practices take part - Two million messages a month are exchanged (over
60 of the total communication in the primary
sector)
14MedCom Facts (contd)
15MedCom Facts (contd)
16MedCom Facts (contd)
- MedComs standardised messages implemented in 50
IT systems, including - 16 doctor systems
- 12 laboratory systems
- 9 hospital systems
- 4 pharmacy systems
17MedCom Facts (contd)
- Physicians pay for their own systems
- Upcoming agreement with County Association and
the PLO will mandate electronic communication - Specialists use of computers range from 40-90
depending on the county with their use of EDI
clinical messages ranging from 15-70
18MedCom funders
- 1/3 from Ministry of Health
- 1/3 from County Association
- 1/3 from Other Sources
- Ministry of Social Services (recently)
- Danish Doctors Association (early on only)
- Dan NET
- Danish Pharmacy Association
19Seven Driving Forces
- Communication benefits of MedCom
- Improves dialog with hospitals
- use to wait 5 days for results of tests (now
almost as soon as it comes off the equipment) - Automatically notified when patient registered in
an Emergency department - Discharge summaries now arrive within 1-3 days
(use to be 4 weeks) standard set by Counties
20Driving Forces (contd)
- Out of Office Hours (OOH) system mandated
- Started 1997
- GP available from 1600 - 0800 hours (could be up
to 3 GPs present) - 30 across the country some based at hospitals
- Negotiated by PLO and County Association
- GPs doctors had to learn how to use a computer if
they wanted to be paid
21Driving Factors (contd)
- Peer influence collegial pressure
- GPs go to see each others computers
- PLO wrote conversion software to facilitate the
transfer of patient data from one GP to another - Access to the Internet (2-3 times/day)
- e.g. waiting times for x-rays for all clinics in
Funen County - can see what procedures are done at each clinic
- can decide with patient where they should go
22Driving Factors (contd)
- County Support
- Provides GP with a diskette of all their patients
when first starting (been doing since 1992) - Training done by data consultant visit practice
regularly - Help desk
- Practioner coordinator for each specialty
(psychiatry, general surgery, etc.) - Works 2 hours/month
- Coordinates wishes of GPs to hospitals and
vice-versa - IT agenda moved forward through them
23Driving Factors (contd)
- 7. Standards set by MedCom
- Contract signed with Counties and PLO obliging
everyone to use them - Clinicians and vendors involved!
- MedCom tests and certifies vendor systems
- Steering committee of paying agencies meets every
3 months to review compliance data
24- The Danish GPs are so automated that
25Outline
- The Danish Experience
- The New Zealand Experience
- An American Experience
- The British Experience
- NPfIT Clinicians Involved?
26(No Transcript)
27New Zealand Facts
- Over 95 of GP offices are using one of nine
Practice Management Systems - 75 use their systems to electronically send and
receive clinical messages such as laboratory
results, radiology results, discharge letters,
referrals, delivery of age-sex registers to their
IPA/PHO, etc. - 50 of GPs now use the Internet on a regular
basis from their offices - including
communicating with their patients.
28New Zealand Facts (contd)
- Specialists use of computers range from 30-90
depending on their region. The private
specialist use of a full EMR is limited to
15-20. - Like the Danes, GPs increasingly favor referring
patients to specialists who are able to send
information back to them electronically.
29AGPAL ACCREDITED
30New Zealand Facts (contd)
- Used by 75 of all healthcare sector
organizations in New Zealand. - All hospitals, radiology clinics, private
laboratories - 1,800 general practices.
- gt 600 specialists, physiotherapists, other allied
health workers - Over 3 million messages a month are exchanged,
- 95 of the communication in the primary health
care sector.
31PUBLIC KEY INFRASTRUCTURE
GP Practice
32Driving Forces in New Zealand
- Unlike the Danish success story, HealthLink
received no government funding to initiate the
service and its growth and success is based
entirely on the market model of supply and
demand.
33Driving Forces (contd)
- The development of IPAs (Independent
Practitioner Associations) encouraged the uptake
of information technology in primary care in New
Zealand. - IPAs paid the costs for their member GPs to
access the HealthLink network as part of their
membership services. - HealthLink facilitated change by offering an
electronic claiming only service for claims
submission free of charge for the first 6 months.
34Driving Forces (contd)
- The past decade has also seen the emergence of
the new position of Practice Manager within a
physician general practice. - The Practice Manager has become a pivotal person
to assist with the installation, management and
training for any physician office system. - The Practice Manager responsibilities include
financial management, IT and the human resource
function in larger practices.
35HealthLink increasingly used to assist with
chronic disease management
36- As a result of these applications of information
technology in primary care - Child immunization rates went from 75 to 95.
- Control of diabetes improved for patients with
HbA1c higher than 9 pre-enrolment was 34 and
this was reduced to 7 post-enrolment - There was an 80 reduction in wait time for
statins for diabetes patients. - There was a reduction in acute admissions - this
was running at 9 per annum. By 2002, the growth
rate was reduced to near 0.
37New Zealands critical success factors
- A national health identifier NHI
- Early adoption of HL7
- Development and acceptance of the 1993 Privacy
Act and the 1994 Health Information Privacy Code
along with practical implementation of these - Mandatory electronic claiming for GMS (government
subsidies for GP care) - Collaboration with private and public
organizations - Multi-vendor co-operation and understanding of
the business opportunities
38NZ critical success factors (contd)
- Healthlinks strategy has always been to work
very closely with primary care physicians - to stay close to them and to support them.
- HealthLink is intricately and comprehensively
tied to the GPs - like the parmesan in the spaghetti is how one
observer described it.
39An interesting aside
- At one stage the New Zealand Government spent
several millions of dollars on an alternative
product The Health Intranet of New Zealand. - This failed at the point where they tried to
connect the Intranet to General Practice computer
systems. - The GPs were very unhappy to let government
representative agents touch their computers
making the Health Intranet impossible to
implement on the ground. - The government agents had no understanding of how
General Practice works
40NZ critical success factors (contd)
- HealthLink employs nurses to act in liaison roles
with General Practice, and so provide direct
contact with the GPs. - HealthLink provides a help desk that has become
the GPs first point of contact when requesting
help with their EMRs - like the Danes. - HealthLink has also stayed very close to the GP
system providers again like the Danes.
41NZ critical success factors (contd)
- HealthLink spend a lot of effort on demonstrator
and beta testing sites. - They also work closely with the physician EMR
vendors to debate projects thoroughly at all
stages before during and after implementation. - Many of the HealthLink initiatives were a result
of demand of the primary care physicians - e.g. discharge summary from hospitals, radiology
test results (DI), orders (still in progress),
delivery of claiming data i.e. responding to
market needs
42- Was it important to solicit meaningful physician
input early and often and act upon it? - Yes absolutely.
- HealthLink has always worked very closely with
physicians, physician organisations and physician
EMR vendors to deliver quality information to
General Practice. HealthLink always strives to
be responsive to the physicians as its first and
foremost obligation.
43- Did HealthLink find meaningful ways to engage
physicians? Did it require creating an
organizational climate and culture that respected
the heart of medicine? - Yes, basically by delivering a service that was
totally devoted to serving the needs of the
Physicians, by understanding the nature of
General Practice as a business and acting always
in accord with needs of General Practice. - The organisational climate and culture were /
still are aligned to respecting physician needs.
44- Did HealthLink take the view that ideas should be
well fleshed out and ready for implementation
before discussing them with physicians? - Generally true although HealthLink also spent a
lot of work on demonstrator and beta testing
sites. They also worked closely with the
physician EMR vendors to debate projects
thoroughly at all stages before during and
after implementation. - SG comment Many of the HealthLink initiatives
also were as a result of demand of the primary
care physicians (users of service) examples are
discharge summary from hospitals, radiology test
results (DI), orders (still in progress),
delivery of claiming data i.e. responding to
market needs
45- If so, did physicians feel their input is
actually sought? And if they recommended
changes at that point, was it difficult for
management to retreat and follow another course
of action? - Yes. However, the focus of Health link has always
been on supporting the physicians. Cant think of
situations where Health link management had to
retreat. - However, in discussing HealthLink, we should
probably compare it with the New Zealand
Government efforts to run its own network the
Health Intranet of New Zealand. - In this case, management did have to make a
serious and very public retreat. - There were several years of fighting while
management tried to impose its will on the
sector, but management ultimately lost. - HealthLink is now an authorised provider of
network services for physicians, and has the
blessing of the Health Intranet Governing Body.
46- How did HealthLink manage to balance the need for
centralized / standardised policy with getting
local support and use? - Health link undertook extensive consultation with
the sector (mostly users rather than govt.) at
all stages in the development, and ongoing work
to get consensus agreement regarding policies and
standards. - SG comment There were user groups, consultation
with stakeholders before a new service (like Lab
orders) could actually work i.e. preliminary
steps with this one were agreement to work
forward, LOINC code adoption, understanding of
all issues from various stakeholders. - HealthLink also participated with teaching
programmes involving all vendors and Practice
Managers this was another way to obtain useful
feedback from the market
47- 6. Did the opinion of national clinical bodies
matter? - Yes principally the IPAs who took an active
interest in the debate.
48The Kiwi docs are getting ready for
49Outline
- The Danish Experience
- The New Zealand Experience
- An American Experience
- The British Experience
- NPfIT Clinicians Involved?
50But first
- Selected observations from the American literature
51- Much research has been done in an attempt to
identify the key factors that predict EPR/EHR
implementation success. Over 150 factors have
been identified, but only two, top management
support and user involvement are consistently
associated with successful implementations. - Sittig D
- The Importance of Leadership in the Clinical
Information System Implementation Process - November 2001
- http//www/informatics-review.com/thoughts/leaders
hip
52- Experience suggests several factors that may
increase acceptance and use of clinical
information systems by physicians. First, broad
physician involvement in the selection and
implementation of the system from the outset is
essential. Systems with no real sponsorship from
the medical staff are likely to fail. - Anderson J
- Increasing the Acceptance of Clinical Information
Systems - MD Computing Jan-Feb 16(1) 62-5 1999
53- Clinician buy-in will require that their
involvement is substantial and real. The project
team must have strong clinician representation
from the outset and throughout the project,
including the planning, implementation, and
post-implementation phases. Clinicians need to
believe that the decisions they make matter. - Krall M
- Achieving Clinician Use and Acceptance of the
Electronic Medical Record 1998 - http//www.kaiserpermanente.org/medicine/permjourn
al/winter98pj/emr.html
54- The need for physician involvement with clinical
information systems has been advocated since the
first installations in the 1960s. Even though
the initial systems were rather rudimentary, the
systems that were backed by strong physician
leadership have been able to evolve and develop
into sophisticated tools as information
technology has become integrated into all facets
of clinical care. - Schneider M et al
- Physician Involvement in Clinical SystemsA
Cost-Effective Investment - HIMSS Proceedings, Session 125
- 2000
55- The healthcare systems that engage their
clinical constituents early and often in the
beginning will reap huge returns when these
clinical leaders support the necessary changes
that will occur as clinical information systems
are rolled out. - Schneider M et al
- Physician Involvement in Clinical SystemsA
Cost-Effective Investment - HIMSS Proceedings, Session 125
- 2000
56- Whether or not the CPR project leader is a
physician, heavy involvement of physicians is
common to all awardees, as members of both the
CPR project staff and governing committees.
Physicians with direct roles in the CPR efforts
typically continue to devote at least some of
their time to clinical practice, which appears to
be important to retaining credibility with the
medical staff. - Metzger JB et al
- Lessons Learned from the Davies Program
- 2000
- http//www.cpri-host.org/davies/nuggets.html
57One Particularly Relevant American Experience
- Kaiser Permanente (KP) is a not-for-profit group
model HMO (Health Maintenance Organization) with
headquarters in Oakland, California. - The organization is divided into regional service
areas spanning the United States from Hawaii to
the East Coast. - It has used a centralized organizational model
for their business and information technology
operations since 1997. - Kaiser has eight million members and 80,000
care-givers across all regions (2/3 in
California).
58- The Kaiser Permanente Colorado Regions CIS
implementation began with 2 medical office pilot
sites (80 physicians and 80,000 members) in 1997
and was successfully completed (500 additional
physicians and 250,000 additional members)
between March and October, 1998. - The region has achieved full CIS usage and has
eliminated use of its paper records for all but
archival purposes.
59Kaisers research findings
- 80 percent of the success of system
implementations the size and complexity of KP-CIS
is attributable to managing human factors. - Commitment from, and involvement of clinicians in
the implementation of a project is of utmost
importance. - Involvement is best achieved by soliciting active
participation from both providers and staff from
project initiation through project closure and
beyond. - .
60The KP approach
- When Kaiser Permanente undertakes any project,
the project leaders develop a series of Guiding
Principles that provide direction during the
entire project to the project team and to the
larger KP community. - Once defined and accepted by executive
management, these guiding principles are
communicated throughout Kaiser Permanente.
61The Kaiser CIS guiding principles
- The leadership and sponsors must be visible,
available, and supportive throughout the project. - The rationale for implementing KP-CIS must be
understood across the Program. - Implementation activities must focus on realistic
timeframes that address system usability at the
point of care. CIS must be based on acceptable
clinical content. - Providers and staff must believe that CIS
enhances their ability to achieve superior
clinical outcomes and improve provider/patient
relationships. - Providers and staff must be continuously involved
in CIS planning, implementation, and maintenance. - Regions must take the lead in implementing CIS
62Kaiser guiding principles (contd)
- Providers and staff must acquire the skills to
effectively use CIS. Skills acquisition must
accommodate individual learning styles. - Practicing providers and staff members must be
engaged as members of the project team to ensure
credibility with the staff, compatibility with
the local culture and work flow, and clinical
utility. - Honest, timely, regular, and pertinent
communication to the user community is essential
to adoption. - Providers and staff must be prepared to adapt to
the changes that CIS will bring. - The appropriate technical and clinical support
structures must be in place to ensure adoption
and continued use of CIS.
63Lessons to be learned from Kaiser
- Unwavering executive support during the CIS
implementation was a major factor in its adoption
by the user community. - Implementing a CPR produces extraordinary change
in nearly every facet of operations. Success
would be unlikely without executive commitment to
support of these changes.
64Kaiser lessons (contd)
- Early in the KP-CIS application development
effort the designers found that there was no
single best way to use a CPR in the clinic. - Hence, KP-CIS was designed to enable, not to
enforce, changes in workflow processes, patient
flow, and practice style. - Even the appearance of a workstation in the exam
room causes clinicians to reconstruct their basic
patient/clinician interaction.
65Kaiser lessons (contd)
- Identify and appoint physician-advocates
throughout the organization. - Clinical workflow change is more successful when
physician advocates communicate the rewards and
benefits to the user community. - It is necessary to develop formal communications
for physicians who are to use this new CPR to
assist them in understanding how the system will
impact their work.
66Kaiser lessons (contd)
- Provide regular feedback, progress reports and
updates on project status. - This is essential to allay fears related to the
high impact of a CPR on medical practice. - Ensure bi-directional communication throughout
planning and implementation. - Offer frequent and consistent communications
regarding changes under development.
67Kaiser lessons (contd)
- Identify and appoint representatives to the
appropriate project teams. - Each department and facility will perceive they
have unique needs. A variety of specialties,
varying levels of practitioners, and geographic
areas must be represented on project teams to
account for these diverse perspectives. - The project teams serve as a forum to express,
discuss, and evaluate differences in physical
layout, physician practice style, staffing mix,
and models from department to department and
location to location.
68Kaiser lessons (contd)
- Plan for recurrent objection themes from
clinicians. - A common provider objection is the perception
that they must perform clerical tasks that take
time away from patients. - Clinician order entry may seem to be more labor
intensive for some primary care users than for
specialists. - For example, internists may have more complex
patients than pediatricians.
69Kaiser lessons (contd)
- Handling recurrent objections provides the
ability to - Ensure usability and acceptance of change. If
users do not perceive that the level of
disruption will be minimized over time,
acceptance of the change is compromised. - Address user expectations and concerns,
especially during the first 4-6 months, when
resistance to change may be most prevalent.
70Kaiser lessons (contd)
- One of the early steps in the implementation
process was gathering requirements and making
decisions about their relevance to KP-CIS in the
first release of the product. - There was a balance to be achieved between
functionality that was desired by clinicians
versus functionality that was required for a
successful implementation nationally. - Not everything could be included if business
drivers, such as schedule and cost, were to be
met. Yet legal, medical, or crucial operational
functions had to be included in order to provide
quality care to Kaiser patients.
71Kaiser lessons (contd)
- The KP-CIS project developed a deployment
schedule that optimizes the use of national team
resources but minimizes overall impact to the
regional operations. - Each region is responsible for its own
deployment, supported by the national KP-CIS
team. - Each region is in a different state of readiness
from an infrastructure point of view and each
region has to work around its own operational
constraints. - As an example, implementation during influenza
season, a peak patient load time would be
disadvantageous to patient care and to acceptance
by clinicians.
72Kaiser lessons (contd)
- Because implementation and CIS acceptance is
primarily the responsibility of each region,
teams in the different regions were formed to
manage the deployment and organizational change
processes. - The team composition included practitioners,
formal and informal leaders, clinicians with
informatics expertise, representation from
different specialties, and different levels of
practitioners from varied geographic locations. - The likelihood of successful adoption increases
as more types of potential users have a voice in
guideline development and implementation plans.
73In closing from Kaiser
- Commitment from, and involvement of, end users
(particularly the clinicians) in the
implementation of a project was also of utmost
importance. Involvement is best achieved by
soliciting active participation from both
providers and staff from project initiation
through project closure and beyond - Wolfe J
- Implementing a CPR to Serve Kaiser Permanentes
Eight Million Members - HIMSS Proceedings, session 85
- 2000
74Everything in life is relative
75Outline
- The Danish Experience
- The New Zealand Experience
- An American Experience
- The British Experience
- NPfIT Clinicians Involved?
76- Crucially, all of the ERDIP projects have
involved clinicians and had clinicians on the
local project teams. "We would not have achieved
all we have without the level of clinician
involvement we've had." - Philip Crouch
- ERDIP programme manager
- http//www.nhsia.nhs.uk/text/pages/inform/informis
h6/informp5.asp - 2003
77- The Walsall ERDIP project was managed by a small
team with the support of the NSF groups. This
close involvement of clinicians was important and
any national programme office will require people
with operational experience. It is also
necessary to avoid turning larger programmes into
a project management industry. - Walsall Core National Evaluation report
- 5/11/2002
78Key messages for ICRS, derived from the South
Staffordshire experience
- The EHR is still in its early stages of evolution
so that continued learning from formative and
summative evaluation, co-ordinated across
different communities and different suppliers,
will be important. - Questions of who will be responsible for this and
how it is linked to system supplier performance
will need to be answered. - South Staffordshire Electronic Record
- Development and Implementation Project
- Final Evaluation Report
- July 2003
79Key messages for ICRS, derived from the South
Staffordshire experience
- ICRS will facilitate new ways of working through
process redesign and culture change, and should
be designed as part of a whole systems approach. - There is a need for clearly defined sponsorship
and management arrangements adopted as part of
the national implementation, which might include
Primary Care Trusts, clinical networks and Chief
Information Officers. - A successor to the LIS process is required,
taking account of new NPfIT developments, to
support integrated systems development across
local communities.
80- There needs to be an effective national lead with
clear links to national priorities and
implementation arrangements. - National roles include policy leadership,
decisive action on outstanding implementation
issues, implementation support and a co-ordinated
change management, evaluation and learning
programme. - There are major issues to be resolved around the
NHS/Supplier boundary, including the involvement
of suppliers in community wide system strategy
development, agreement on data sharing policy,
allocation of responsibility for process resign
and benefits realisation, project management
roles, and integration of systems across
boundaries.
81- Dr John Pilling stresses not only the careful
preparation necessary for such a scheme, but also
the absolute need for clinician involvement
throughout and constant liaison, through a
committed project team, between all those
involved. These are lessons that are of equal
validity not just for this PACS project, but for
every IT project in the healthcare field. - http//www.bjhc.co.uk/issues/v19-7/v19-7editorial.
html
82And from New Zealand
- UK - Clinician involvement essential in IT
planning says BMJ - http//www.hinz.org.nz/ihealth/ihealth.htm
83- It is not the choice of device but involvement of
clinicians that counts. - I could go on, but there is no, one solution that
will fit all clinical scenarios. It is
imperative that clinicians are involved in all
these discussions and that we do not decide what
types of mobile devices will work for them. - Sue Wilson
- Head of IMT (acute services)
- Sherwood Forest Hospitals NHS Trust
- http//www.e-health-media.com/news/item.cfm?ID496
- Aug 18, 2003
84Fear not, we are making progress
85EHR and ICRS similarities
- They are both complex change management projects.
- The challenges surrounding change management are
more significant than the technical issues
involved. - They both necessitate a migration from a
patchwork legacy situation to the future long
term vision. - Success will not be achieved without a planned
and phased migration. - They both demand clarity about the vision for
local health care services and the way that IT
and information will be used to underpin them. - They cannot be implemented by either the private
or the public sector working alone. - A clear and well managed division of
responsibilities will be required.
86Outline
- The Danish Experience
- The New Zealand Experience
- An American Experience
- The British Experience
- NPfIT Clinicians Involved?
87NPfITs official position
- Patient, clinician and supplier engagement is
critical to the ultimate success of our solution.
We - are meeting regularly with SHA chief executives
and four lead CEOs - are integrating the work of the 28 CIOs with
NPfIT - have a consensus from the Medical Royal Colleges
on a core patient summary or data spine - have consulted with over 240 clinicians and NHS
IT professionals in producing the initial OBS - have now got a core group of clinical
representatives working in the Design Authority - We recognise that two way communication and
involvement is vital.
88- Professor Martin Severs from the University of
Portsmouth has joined the National Programme as
Director of Clinical Assurance he will take the
lead on developing and ensuring clinician
involvement in the National Programme. - Professor Severs told the conference that in his
first three weeks in post he had already reviewed
levels of clinician involvement - I found there extensive levels of involvement of
clinicians at all levels of the programme. He
admitted that this finding had quite surprised
him. - E-Health Insider
- National Programme 'Mobilises' for Delivery
- 27 Mar 2003
89- The National Programme stresses that clinicians
and other NHS staff have been consulted on
specifications and requirements from the outset.
Most of the input into the OBS for ICRS has come
from clinicians working full time in the NHS,
stated Mr. Granger. - Professor Peter Hutton, head of clinical
engagement with the national programme, added In
two to three weeks there will be an announcement
on a route in for almost everyone in the NHS to
be involved. From that point on we will be taking
a lot more note of individual user requirements.
- Granger Confirms Centre to Allocate LSP Contracts
- E-Health Insider
- August 14, 2003
90But there are other views
- A particular concern is limited engagement with
clinicians so far. - Lack of clinician involvement has been a
consistent theme in past failures. - There is a culture here that means you just
cant force solutions on clinicians, they have to
be cajoled and persuaded. - E-Health Insider
- April 2003
91- Despite some early discussions, many general
practitioners and consultants have not heard of
the integrated care record service or the
information spine. - Nick Booth
- Sharing patient information electronically
throughout the NHS - BMJ, 327114-115, 19 July 2003
92- News of the National Audit Offices involvement
in reviewing the national programme was first
reported in Computer Weekly this week, in a
report which stated that the NAO would examine
arrangements for managing high-level risks on the
NPfIT and arrangements for gaining the local
commitment of clinicians. - E-Health Insider
- August 22, 2003
93- Over many years, NHS informatics developments
have suffered from being under-utilised by their
potential users. The position of informatics
should be stressed to empower decision makers to
take steps to harness its capability, notably
through ensuring that clinical involvement in
informatics is enhanced and integral to day to
day working, without which few health informatics
systems will perform up to their promise. - BCS Health Informatics Committee ASSIST
- More Radical Steps (2003) Initiatives
- August 2003
94Questions to be discussed
- Is it important to solicit meaningful physician
input early and often and act upon it? - Does finding meaningful ways to engage physicians
require creating an organizational climate and
culture that respects the heart of medicine? - Is this the key to maintaining physician loyalty
and involvement?
95- Some management teams believe that ideas should
be well fleshed out and ready for implementation
before discussing them with physicians. - When that occurs, do physicians feel their input
is actually sought? - And if they recommend changes at that point, will
it be difficult for management to retreat and
follow another course of action?
96- How can one best square the need for
centralised/standardised policy with getting
local support and use? - Does the opinion of national clinical bodies
matter?
97Let the discussions begin
98ICRS roll out
- Phase 1 by end 2004
- Phase 2 by end 2006
- Phase 3 by end 2008
99ICRS phase 1 - 2004
- Booking of outpatient appointments online
- NHS email and access to online knowledge
- Electronic laboratory and radiology results
- Some clinical communications e.g. GP referral
letters - Providing simple functionality and making best
use of existing systems
100ICRS phase 2 - 2006
- Access to a more detailed patient record
including - specialist results
- GP prescribing record
- hospital discharge summaries
- Digital imaging
- Computerised referrals and requests
- Migrating on to active and interactive
functionality
101ICRS phase 3 - 2008
- Working towards full integration of health and
social services including - decision support software
- screening
- community wide prescribing
- computer support for care planning
- Supporting advanced features e.g. telemedicine
- Continuing development and enhancements
102Key milestones
- Summer 2003
- Final Output Based Specification to be completed
for ICRS - Short-list of LSP applicants to be finalised
- October 2003
- Initial contracts to be awarded for two LSPs
(London and North East England) - Contract to be awarded for e-booking service
provider - November 2003
- Early implementation work commences
- December 2003
- Further three contracts to be awarded for
remaining LSPs - April 2004
- National roll out of Phase 1 of ICRS begins in
earnest