Where now for Primary Care ICT

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Where now for Primary Care ICT

• Simon de Lusignan
• Primary Care Informatics - SGHMS
• www.gpinformatics.org

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Primary Care Informaticshttp//www.gpinformatics.
org

• Information knowledge in the consulting room
• Data Quality
• Knowledge Management
• Telemonitoring

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Overview

• Two themes
• Primary Care Professionals need access to the
  knowledge base.
• Clinicians need to learn from their clinical data
• Two sub-plots
• Careers in Primary Care Informatics?
• Does knowledge management provide the unifying
  theme?

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And a caveat

• Nobody wants to be a GP right now

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Introduction

• The future for Primary care ICT is to accelerate
  learning
• By access to knowledge bases
• Primary Care National electronic library for
  Health (NeLH-PC) as an exemplar
• By learning from your own clinical data the
  standard of medicine practiced
• PCDQ (Primary Care Data Quality) Program as an
  exemplar

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Background

• The knowledge base is expanding
• Types of knowledge
• How clinician learn
• What learning strategies are effective

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Expanding knowledge base

• In relation to the professional knowledge base,
  NHS professionals cannot possibly retain in their
  heads all current and emerging knowledge about
  the work they do.
• Healthcare is an international business and the
  knowledge base constantly changes and grows.
• Information for Health

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Types of Knowledge

• Two types of knowledge
• Explicit
• what is expressed and recorded
• EBM is a special type of formalised explicit
  knowledge
• Tacit
• Held within us experiential, intuition,
• Subdivided into mental models of the world and
  technical element."
• Polyani (1966,) Takeuchi and Nonaka (1995.)

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NeLH Epistemology of knowledge

• Simplified terminology, "knowledge" and "knowhow"
  
• Knowledge is applied to explicit knowledge -
  principally highly formalised I.e. EBM.
• Knowhow the technical element of tacit knowledge
  - the "know how to do it sort." Often how to
  apply the evidence-based.
• NeLH Knowledge Management Resource.
• URL http//www.nelh.nhs.uk/knowledge_management.a
  sp

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Starting point

• The information retrieval systems available in
  General Practice are relatively difficult to
  access during consultations
• ..emergent technologies like NeLH offer
  opportunities
• we advocate a system whereby professional
  organisations such as RCGP might contribute to
  the process.
• Sullivan F et al. An information retrieval
  service. BJGP 1999491003-7.

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Shift towards learner-centred education

• Old think
• Passively listening to lectures
• Educator decides topic
• Read a journal or text book
• Errors should be forgotten / denied

• New think
• Actively participate in learning
• You decide the topic
• Problem solving, simulated cases
• Errors are a learning experience

Wyatt JC. Clinical Knowledge in the
Information Age London RSM, 2001
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New think is not universally accepted

• Implementation strategies preferred included
• small group
• continuing education with a specialist
  (urologist) and a general practitioner as a
  facilitator,
• lectures and patient education materials.
• Of least interest were
• Internet access,
• interactive computer systems,
• distance education modules.
• Puech M, et al. Local implementation of national
  guidelines What do
• general practitioners suggest will work? Int J
  Qual Health Care 199810(4)339-43

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Reviews of the evidence point towards certain
themes

• Our data show some evidence that interactive
  CME sessions that that enhance participant
  activity and provide the opportunity to practice
  skills can effect change in professional practice
  and, on occasion,health care outcomes.
• Based on a small number of well-conducted
  trials, didactic sessions do not appear to be
  effective in changing physician performance.
• Davis D et al. Impact of formal continuing
  medical education do continuing education
  activities change physician behavior or health
  care outcomes? JAMA 1999 Sep 1282(9)867-74

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Emerging evidence supports complex interventions

• the complex educational intervention
  exemplified the best form of knowledge
  translation (the integration of knowledge into
  practice), moving the practitioner from
• awareness of new guidelines
• to agreement with the guidelines and
• finally to adoption and adherence,
• following well-defined patterns of adoption and
  based on principles of adult learning applied to
  CME.

Davis D. Clinical practice guidelines and the
translation of knowledge the science of
continuing medical education. CMAJ 2000 163
(10 )1278-9
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Method to move primary care on.

• Access to the knowledge base
• Learning from own clinical data

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NeLH-PC

• www.nelh-pc.nhs.uk

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NeLH-PC access to knowledge

• Signposts to key papers modernisation agenda
• Produced daily
• Personalisation - My NeLH-PC
• Searchable electronic index - Metadata
• Special EBM search engine
• Three tier searching Guidelines, Summary of
  EBM, Medline clinical queries
• Flat hierarchical structure
• Moving from GUI to flexible database driven
  interface
• Appropriate re-authoring

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Part of NHS strategy

• Specialised web sites - Virtual Branch Libraries
  - will focus on mental health, cancer and primary
  care.
• Building the Information Core
• The public and NHS staff will be able to access
  information on local care services and how best
  to use them through nhs.uk and evidence-based
  information and clinical guidelines through the
  National electronic Library for Health (NeLH).
• The NHS Plan

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NeLH-PC usage

• Usage end of morning, all afternoon
• UK working hours
• Tue, Wed, Thur busiest days
• .nhs.uk and .ac.uk largest users
• Over 750k hits May 2002
• Most used parts
• Site index search (NeLH-PC Directory)
• EBM Search
• Personalisation
• Cross Indexing

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NeLH-PC Usage (2)
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Development help needed...

• Knowledge officers to build collections, or use
  our index cards
• Passive or Interactive
• Address the meta-data issue
• Integration with clinical systems and existing
  information sources
• e.g - BNF - Clinical evidence

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PCDQ Learning from your own clinical data

• www.pcdq.org

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LOCAL Feedback

• Laminated summary for PHCT
• Read Coding aids
• Brief local Read Code training
• Local query set

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All sorts of gratuitous comments about the
practice data, for the people who didnt make the
meeting. All sorts of rude remarks and
suggestions (only joking!)
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Clinical Governance Cycle

• Unifying concept

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A model for Clinical Governance
On-line paperless
EBM Portal
Improved Patient Care
Data recording
Theme III PCDQ
Data extraction
Feedback
Data pooling
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Summary
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Summary

• Is learning how to exploit whats there more
  important than more technology?
• What role for primary care informaticians?
• Is accelerating learning (knowledge management) a
  important as ICT?

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www.nelh-pc.nhs.ukwww.pcdq.orgwww.gpinformatic
s.org

• Thanks for listening
• slusigna_at_sghms.ac.uk