Professionals and patients need clean clear knowledge for decision making just as they need clean clear water for hand washing

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• Professionals and patients need clean clear
  knowledge for decision making just as they need
  clean clear water for hand washing
• Water may look clear but be polluted and
  poisonous

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At present people simply hold out a basin to
collect knowledge, or dip a bucket in the sea of
PubMed, one of the wonders of modern healthcare
but peer review is no guarantee of freedom from
pollutants - bias and errors due to chance- or
poison due to the deficiencies of the peer review
and editorial process
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Rainfall Earth
Sea Rivers
Underground springs
Wells
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3 types of generalisable knowledge
Knowledge from research - Evidence Knowledge
from measurement of healthcare performance-Statist
ics Knowledge from experience-Of patients and
clinicians
2 types of particular knowledge
Knowledge about this patient Knowledge about
this service
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Why a National Service is needed

• Nationally produced knowledge is not put into
  practice, or even available consistently
• Clinicians are confused by multiple sources of
  NHS/DH advice
• Clinicians and patients have different sources of
  knowledge
• Every organisation has a different knowledge base
• More agency and part time staff- only the patient
  is constant
• Urgent , important safety information cannot be
  promptly delivered

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National Oral Health Knowledge Service
Generation Organisation Localisation Mobilisati
on Utilisation
Co-ordinated procurement Production National
Library for Oral Health Library of Tools and
Rules Map of medicine evidence based
pathways, NHS Care Record Service N3 National
knowledge decision support Patient
professional Education services
Question Answering Service

Better Consultations, Better Decisions,
Better Communication
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Rainfall Earth
Sea Rivers
Underground springs Reservoirs
Wells Settling and
sunshine Filters Chemical purification Water
fit for drinking
Sewage
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Water sub stations
Bottled water
Pepsi
Whisky
Pumping stations
Thirsty people
Clean clear water
Sewage
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The false positive rate is especially important
in low prevalence settings where the number of
false positives may exceed the number of true
positives

• Booth JCL et al (2001)
• Gut 49 (Suppl 1) i4 column 1 Section 3.1 lines
  23-27

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The false positive rate is especially important
in low prevalence settings where the number of
false positives may exceed the number of true
positives

• Booth JCL et al (2001)
• Gut 49 (Suppl 1) i4 column 1 Section 3.1 lines
  23-27

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Royal Cornwall Lab Service
Muir Gray Date of Birth 21/06/1964 NHS Number 400
186 6897 ELISA test on 7/4/2006 26.5 Hepatitis C
is of low prevalence in Cornwall. National
Guidance is that diagnosis should be confirmed by
PCR test in low prevalence populations For PCR
test click here For access to full text of
National Guidance click here
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The future is not a destination like Manchester
or Bradford, waiting for our arrival it is
something we have to create
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The future is here it is just not evenly
distributed
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Healthcare 2011
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2006----------------------2011
Professional centred
Patient
centred Effectiveness efficiency

Value Opinion based

Evidence based Event

Pathway Organisation

Network Structure

System Clinical practice peripheral

Clinical practice central Money driven

Knowledge driven Research
findings
Systematic
reviews
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Most patients in 2011 will

• Feel responsible for their own record
• Know their NHS number
• Read and think about the quality assured
  knowledge sent to them before the consultation
• Enter their own data before the consultation
• Use a decision aid before taking the decision to
  have an operation
• Know where they are on a care pathway
• Accept that medical knowledge is of variable
  quality

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Lets stop making bits of Lego we need to decide
what we want to build Lets move from visions
to plans
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• Muir Gray has familial hypercholesterolaemia
• Every six months he receives an email reminder to
  have a blood test
• He receives 2 SMS reminders if no blood sample is
  received within 2 weeks
• If no specimen is received his GP receives a copy
  email
• If there is a result is sent to the GP and to his
  Healthspace where it is stored in sequence
• Appropriate advice and support is automatically
  generated

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New style consultations
Patient learns about condition from NHS Direct TV
at home at the suggestion of the GP or
receptionist Patient interacts and informs using
patient data entry Face
to face consultation Patient works through
options using a patient decision aid, considering
likely outcomes against their values
Face to face consultation Patient
reflects at home , drawing on the values of other
patients from the Database of Individual Patient
Experiences
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Muir Gray is told he needs implants for his third
molars