NPfIT: The Biggest Computer Programme in the World Ever Sean Brennan Clinical Matrix

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NPfITThe Biggest Computer Programme in the
World Ever !Sean BrennanClinical Matrix
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Why do the cows in the Isle of Man have better
computers that the NHS?
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But..

• Daisys Record is a by-product.
• The Primary objective is to milk her.

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Why does my dog have a better electronic health
record than I have?
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Clinical History
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So why do we need clinical IT?
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Today in the NHS (England)

• Will spend 170 million
• 2000 every second
• 10 million settling litigation claims
• 110 people will die due to adverse events
• 1230 people will suffer an adverse event
• 270 people will catch a hospital acquired
  infection
• 2.8 million on treating patients who have MRSA
• 1.3 million on treating patients who have had an
  adverse drug event

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Today in the NHS (England)

• 200,000 people will get help in their home from
  the NHS
• 1.2 million will visit their GPs
• 160,000 will be treated in NHS Outpatients
• 140,000 will visit an NHS dentist
• Over 1400 babies will be born
• NHS Direct will receive 3,500 calls seeking
  advice
• Labs will perform millions of tests
• The NHS is a very BUSY organisation.
• 3 million critical processes each and every day.
• If totally supported by electronic records that
  would be approx 30 MILLION new transactions each
  day!

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So

• Computerising the NHS is a very big and very
  difficult project.
• But lets NOT just add technology to existing
  workflow.Isnt there a better way?

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Spanish Brasero wasted opportunity?
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Here is Edward Bear,coming downstairs now, bump,
bump, bump, on the back of his head,
behind Christopher Robin. It is, as far as he
knows, the only way of coming downstairs, but
sometimes he feels that there really is another
way, if only he could stop bumping for a moment
and think of it
A.A. Milne 1926 Illustration E.H.Shepard
192614
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Its about change

• We need to change the way care is delivered
• IT enables change to happen
• The current model is no longer appropriate

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Visits GP/practice nurse
Is visited at home by care worker/midwife etc
Visits Outpatients
In-Patient
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Goes to the
Use NHS
pharmacy
Direct.online
Attends as
Uses the
in-patient
Visits
Home Health
GP/practice
Care Guide
nurse
Calls OOH
Visits Out
Calls 999
service
Is visited at home
Patients
by GP, nurse, social
/ care worker,
midwife etc
Calls NHS
Visits a
Direct
walk-in
centre
Visits the
Attends AE
dentist
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We must use technology to support change

• Not just add technology to existing ways of
  working

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LSP
LSP
Integration Bus
Integration Bus
Cluster wide Data Repository
Cluster wide Data Repository
iSoft i.EPR / Lorenzo
EMIS PCS
Torex PSE
InPractise Vision
Niche Clinicals
iSoft i.EPR / Lorenzo
EMIS PCS
Torex PSE
InPractise Vision
Niche Clinicals
Portal
Portal
LSP
Integration Bus
Cluster wide Data Repository
LSP
iSoft i.EPR / Lorenzo
EMIS PCS
Torex PSE
InPractise Vision
Niche Clinicals
Integration Bus
Cluster wide Data Repository
Cerner
EMIS PCS
Torex PSE
InPractise Vision
Niche Clinicals
Portal
Portal
LSP
Integration Bus
Cluster wide Data Repository
IDX
EMIS PCS
Torex PSE
InPractise Vision
Niche Clinicals
Portal
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What does it look like?
NASP
National Data Repository
eBooking
PDS
PSIS
eTP
Transaction Messaging Service
LSP
Integration Bus
Cluster wide Data Repository
iSoft i.EPR / Lorenzo Cerner Or IDX
EMIS PCS
Torex PSE
InPractise Vision
Niche Clinicals
Portal
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What will it do?
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So whats in it for you and your patients?

• This is the biggest national clinical change
  programme ever carried out in the NHS
• It will affect you and all your clinical
  colleagues
• It will impact the way that you practice and
  improve the way you treat your patients by
• Ensuring that the right information is always
  available at the point of care
• Making it easier and faster to book appointments
  order tests and see results, anywhere
• Helping to ensure consistent good practice
  treatments
• Reducing prescribing errors
• Stops the paper chase. Making huge savings on the
  30 of all NHS costs that are associated with
  recording, transporting, storing, and looking for
  information!

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OK so what do I get out of it?

• Access to knowledge/guidelines
• Real-time decision support
• Access to ALL the patients information
• Reduction in administrative data collection
• Provide clinical information for secondary
  analysis
• Reduce inappropriate referrals
• Plan discharge
• Opportunities to re-design the service

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NCRS What are the benefits?
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Benefits.

• Access to clinical knowledge
• Access to all the patients information
• Better communications
• Decision support
• Easier ordering and prescribing
• Access to digital images (X-Rays)
• Care pathways and protocols
• Quality clinical information for audit and
  research

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Hospital discharge letters

• Illegible
• Written in haste
• Arrive two weeks after discharge

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Benefits Access to knowledge
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TInternet

• The Good, the Bad and the Ugly

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Benefits

• Reduce Illegibility

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Illegible Writing kills Patients!

• Doctors writing illegibly are still killing
  patients
• Advise doctors to write in CAPITAL LETTERS
• It is writing in lower case in a hurry which
  causes mistakes
• Medical Defense Union in BMJ 1992305604

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Benefits

• Decision Support

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Prescription Error Rate
Admission Drugs - 24 patients had 1 error (or
more) -                     - 2 items in error
per patient  Discharge Drugs - 19 discharge
prescriptions had error -                    
- 1.4 items in error per patient   Total Error
Rate - 21.5 patients had error in prescription
on admission / discharge - 1.7 items in
error per patient
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Drug Errors Causes

• Human Factors 42
• Labelling 20
• Communication 19
• Name Confusion 13
• Package Design 6

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Advantages of Electronic Medicines Administration

• Clarity
• Schedule compliance
• Audit trail
• Alerts/Warnings

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But..

• Computer errors on the increase!
• 46 errors in transcription and documentation
  phase
• 36 errors at drug dispensing
• 13 errors at prescription phase
• 4 errors at drug administration
• Automation does not equal safety. Training is an
  issue
• Don Detmer Properly structured automated systems
  can reduce error rates substantially. However,
  simply installing an automated system will not
  magically eliminate errors.

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BenefitsWarnings
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Useful Warnings !

• The drug you are about to give the patient will
  react with one they are already on.
• The dose you are about to give the patient is
  incorrect for their body mass.
• On bottom of Coke bottles
• Open other end

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What will make it work?

• Whats in it for me ?
• Benefits to me as a clinician
• Benefits to my patients
• Benefits to my organisation
• Is it easy to use?
• Is it responsive? (i.e. quick!)

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Making it easy to use

• The Interface The London Underground

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Ways to improve clinical data capture
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User Interface

• Touch Screens
• Handwriting Recognition
• Bar Codes
• OCR Forms
• Light Pens
• Voice Recognition

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Touch Screens for clinicians

• In certain conditions excellent
• Operating Theatres
• Sterile Stores
• Reception areas

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Bar Codes

• Invented in1948 by Bernard Silver and Norman
  Woodland
• 1949 first patent issued 1952
• Trial by Bar Codes?
• But.was it the Irish who invented it?

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Bar Codes Uses in healthcare

• Drugs
• Laboratories
• Meals
• Fluids
• Positive Patient ID
• X-Ray films

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Light Pens

• Rapid
• Easy to use
• Used at Wirral
• Removes need for keyboard
• Rapid (Did I say rapid?)

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Optical Character Recognition

• Useful for patients use
• Complete data before consultation
• Good for surveys
• Where multiple data items are collected
  Anaesthetic information in theatre
• Paper is good !

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Voice Recognition

• Opportunities
• Radiology
• Pathology
• Clinician Reporting
• Discharge letters
• Outpatient letters

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1992 NHS IMT Strategy
Havent we been promised all this before? Why
should we believe it this time?
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This time..

• Top of the office commitment
• Huge increase in resources
• Tight contracts
• Buying a service not a single system
• Local Service Providers accountable
• Recognition that it is NOT just an IT project

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But..

• Local Vs.. National
• We MUST engage clinicians
• We MUST be open and honest about timetable
• We MUST acknowledge it is difficult AND different
• We SHOULD ensure we have the right focus
• We MUST learn from history

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What annoys clinicians?

• Change for the sake of change
• Dodgy evidence
• Quicker doesnt always mean better
• Systems that dont fit clinical workflow
• Feeding the beast
• Slow systems
• Not enough workstations
• Interfering computers
• Too many alerts
• Complicated systems/poor user interface

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Thank You Merry Christmas Happy New year

• sean.brennan_at_clinicalmatrix.com