Clinical health information forum Facing the future · PDF fileDr Charles Gutteridge, ......

Clinical health information

forum

Facing the future

9.30 am

Welcome and introductions

Dr Jonathan Richardson

Chair Clinical Health Information forum

Free prize draw at 3.45 pm

Win an iPod, hamper or the mystery prize

Clinical health information forum: Facing the future

9.45 am - Coleman Suite How eHealth supports the capture, processing and communication of information to improve decisions and outcomes: Examples from the work of Institute of Digital Healthcare (IDH)

Prof Jeremy Wyatt, co-director Institute of Digital Healthcare and Professor of eHealth Innovation

10.15 am - Coleman Suite Managing for health: The promise of the digital record

Dr Charles Gutteridge, national clinical director for informatics

10.45 am - Coleman Suite Changing Practice in Mental Health

Dr Jonathan Richardson, Clinical Director of Informatics ,Northumberland Tyne and Wear NHS Foundation Trust

11.00 am - Coleman Suite Break and browse

11.30 am - Boyne 1 Workshop one

Does technology help clinicians deliver better care?

Delivered by Jeremy Nettles, chair and Jon Lindberg, head of healthcare, Intellect UK

John Burdon Suite Workshop two

How technology has enabled the prison service to achieve efficiency savings and deliver better patient care?

Delivered by Michael McGonnell, deputy lead, Commissioning Offender Health

Coleman Suite Market stalls




12.15 pm - Coleman Suite Lunch & look

12.15 pm - Boyne 3 Optional workshop A [30 minutes]

Testing the NHS Commissioning Board’s Commissioning Intelligence Model

Delivered by Nick Allan-Smith, NHS Commissioning Board

12.45 pm - Boyne 3 Optional workshop B [30 minutes]



1.15 pm - Coleman Suite The third healthcare revolution: Clinical systems Sir Muir Gray, CBE, director better value healthcare, co-director NHS QIPP Programme, Right Care Workstream (via DVD)

1.30 pm - Coleman Suite Consumer Health Informatics – what’s that?

Mark Duman, chair, Patient Information Forum




2.00 pm - Boyne 1 Workshop three

What are the information governance barriers to delivering effective care?


John Burdon Suite Workshop four




2.45 pm - Coleman Suite Informatics: Future direction

Dr Graham Evans, director of informatics and chief information officer, NHS North East

3.15 pm - Coleman Suite The clinical network

Prof Sir John Burn, lead clinician, NHS North East

3.45 pm - Coleman Suite Concluding remarks including prize draw Dr Jonathan Richardson, consultant in old age psychiatry, acting chair clinical health information forum



Clinical health information forum: 2011 survey

The top 5 topics you would like the meeting to cover are:

• Finding out about emerging technologies in health informatics

• Exploring the way in which health informatics technology

can support transformational change

• Highlighting new ways to use health informatics technology

• How to get clinicians involved in IT enabled change

• Providing clinical expertise for IT enabled change programmes



Clinical health information forum: 2012 survey •98% of respondents want the forum to continue

•83% of members cascade information they learn at the CHIF to colleagues

•75% of respondents are currently involved in implementing IT projects

•50% of members feel that clinicians take on a prominent role in IT projects in their organisation

•63% of respondent advised there is a clinical informatics/clinical information lead in their organisation

•75% of respondents would be interested in profession-specific sub-groups




forum

Facing the future

Book now for the next meeting

e-health Insider CCIO workshop on 19 June 2012

How eHealth supports the capture, processing and

communication of information to improve decisions

and outcomes

Professor Jeremy Wyatt

Supporting the capture, processing

and communication of information to

improve decisions and outcomes

Dr Jeremy Wyatt DM(Oxon) FRCP(Lon) ACMI Fellow

Professor of eHealth innovation & Co-director

What is “digital healthcare” ?

“The redesign of health systems and services

supported by appropriate digital technologies”

“Appropriate digital technologies”

Technologies that improve information, communication, or

decision making, including:

Electronic records shared between professions, organisations

or with the public

Decision support for professionals & patients (eg. reminders,

alerts, risk predictions)

Telemonitoring, mobile health & self-care devices

Web-based health promotion & eLearning eg. NHS Local

Virtual reality, serious games, robotic surgery…

What is it all about ?

“Helping patients, health professionals and organisations use information to improve the quality, outcome and efficiency of care”

“Information: organised data and knowledge used to support decisions and actions”

(Shortliffe 1990)

Information cycles in healthcare

Patient care

Records

Insights

Knowledge

Capture data Analyse records

Assemble knowledge Apply knowledge

Learn & apply lessons

Retrieve data

Clinical practice,

self care

Clinical audit,

quality cycle

Research, EBM & behaviour change

Cluster trial of GP teledermatology to prevent

unnecessary referrals in 560 patients

With Depts. of Medical Informatics and Primary Care, AMC Amsterdam

SMS data capture from patients

Aim: is SMS a reliable, valid method to capture

research data from young women ?

Sent msgs about infant feeding to 350 women in

Tayside every 2 weeks; free response number

Reliability: compared SMS responses to:

– Duplicate msgs in 48 women 1 day later

– Phone calls to 62 women

Validity: compared SMS responses to:

– HV records at 2 weeks

– Other factors correlated / not correlated with feeding

method

Funded by NHS Scotland CSO

Whitford H et al, JAMIA 2012

Results 1

Feasibility: 2/350 women could only be contacted by home

phone during study (no mobile, other preferred not to text)

Acceptability: of 74 women asked about use of SMS

messages at end of study:

– 97.3% (n=72) found method convenient

– 100% (n=74) found it easy

– 96% (n=71) that it was not a nuisance

– 100% that it was not time consuming

Comments:

– “I thought it was great, so easy and quick, if you didn’t have time to reply

straight away you didn’t have to and just one letter to reply”

– “Good way for busy mums, modern, easier than paper and email”

Results 2

Reliability reasonable for numerical question:

kappas between 0.76 (95% CI 0.56 to 0.96)

and 0.80 (0.59 to 1.00)

Validity excellent compared with health

visitor data (k = 0.85 (0.73 to 0.97))

Correlational validity as expected between

SMS responses and other demographic /

clinical measures

Information design

As font legibility declines, reading slows and people give more attention to

the words and less to their meaning

Italic text and bold text are less legible than plain text

White text on a shaded or dark background makes text less legible,

unless a bolder typeface is used

EXTENSIVE USE OF CAPITAL LETTERS SLOWS DOWN READING SO

ROAD SIGNS LOOK LIKE THIS: Warwick University

Underline covers up descenders for the letters g, j, p, q and y as well

as commas, & colons; so reduces legibility

Double justification to achieve an even right margin reduces legibility

and reading speed compared to unjustified text of the same font size

For a given

font size,

short lines

or long lines with many words are more difficult to read than lines of

about 10 words

Cramming lines of text so close together that there is no space between them confuses the eye, reduces legibility and slows reading, making errors more likely.

Case study: Quality of Life in breast cancer

Aims:

1. Develop a graphical profile to “diagnose” and

communicate defective QoL

2. Use this to identify which services each

person needs to reduce their QoL defects

3. Quantify the impact of this in a randomised

trial of 200 women after breast surgery

With Monika Klinkhammer-Schalke & Wilfried

Lorenz, Regensburg, Germany

Klinkhammer M et al, B J Surgery 2012

Quality of Life profile

Based on: Wyatt JC, Wright P. Medical Records 1: Design

should help use of patient data. Lancet 1998; 352: 1375-8

QoL trial results

Proportion of women with overall QoL above 50

points at 6 months:

• 15% more QoL profile

women above 50 points

than controls (p<0.05)

• NNT = 7

• Most marked effects in

emotion and coping

• Can we apply this in UK,

and to other conditions ?

Implanted CardioMEMS sensor & transmitter in distal branch of descending PA

External device sending data to home hub; on screen questions and chart

Telehealth devices

SR of 46

RCTs in

HF –

mortality

More acceptable, effective

prescribing alerts

Randomised experiment in 24 junior doctors,

each viewing 30 prescribing scenarios, some with

prescribing alerts

Compared same alert text, some interruptive,

others non-interruptive

Funded by Connecting for Health, carried out by

an Academic F2 doctor

Scott G et al, JAMIA 2011

Interruptive alert

Interruptive

Non-interruptive

Results

Doctors receiving interruptive alert 10 X less likely to

make prescribing error as those receiving no alert (p

< 0.001)

Doctors receiving non-interruptive alert 5 X less likely

to make error (p < 0.001) – still useful

Non-interruptive alerts more acceptable

Potential impact in NHS M&E SHA

Assumptions:

Population of NHS M&E = 15M

Emergency admission rate is 9.2% pa. (HES)

65 admissions per 1000 due to ADRs, of which 72% are avoidable. Each

ADR admission lasts median 8 nights, case fatality is 2.3% (BMJ 2005)

GP error is responsible for 50% of ADR admissions; 75% of GPs currently

turn off their interruptive alert system (conjecture)

Non-interruptive alerts reduce prescribing errors to one fifth (our results)

Current position Non interruptive

alerts Savings

Avoidable ADR admissions pa. 64584 45209 19375

Avoidable ADR deaths pa. 1485 1040 446

Avoidable bed nights pa. 516672 361670 155002

Plausible eH technologies that failed

Diagnostic decision support (Wyatt, MedInfo

‘89)

Integrated medicines management for a

children’s hospital (Koppel, JAMA 2005)

MSN messenger triage (Eminovic, JTT 2006)

Smart home applications (Martin, Cochrane

review 2008): “The effects of smart technologies

to support people in their homes are not known.

Better quality research is needed.”

33/30

Instant messaging triage by NHS Direct nurse

Avoiding technology push

1. Start with the information problem:

Who is concerned ? individual decisions

communication, team work

Where in the info cycle does problem occur, & why? data capture, presentation

data analysis

knowledge assembly, use

2. Decide if ICT can help, and how

3. Pilot system, evaluate benefits

Disciplines represented in IDH

eHealth innovation group

Discipline People

Health psychology KC, SI, JW

Evidence synthesis, practice guidelines SS, JW

Clinical knowledge and decision support JW

Pharmacy / cyber-pharmacy KY

Internal medicine / medical informatics SS, JW

Evaluation & research methods JW

Usability engineering SP

Global health promotion GCM

Conclusions

Innovation often requires a shift of perspective

Disruptive innovation entails significant workflow changes

Digital Healthcare concerns psychology as much as technology

We need to design, develop, evaluate and deploy new digital healthcare solutions

Key IDH activities include NHS engagement, rigorous R&D, innovation & education – new MSc

Zebra shadows from hot air balloon

National Geographic

Case study: persuading students to join

NHS Organ Transplant register

Persuasive features:

1. URL includes https, dundee.ac.uk

2. University Logo

3. No advertising

4. References

5. Address & contact details

6. Privacy Statement

7. Articles all dated

8. Site certified (W3C / Health on Net)

889 students recruited in 5 days to internet-based trial

Same joining rate (38%) in persuasive & control groups

• Overall, 336 decided to register, including:

• 126 (49%) of 260 blood donors (HR 1.46, p=0.02)

• 65 (38%) of 173 who know a donor/recipient (NS)

• 68 (23%) of 296 who initially said “maybe”

• 22 (10%) of 232 who initially said “no” !

Interpretation:

• NHS should target young blood donors

• Fogg’s guidelines do not apply in this setting

Funded by NHS Chief Scientist Scotland

Nind et al, JMIR 2012 (submitted)

RCT of impact on joining decisions

Where I’ve come from: service & research

1980 1985 1990 1995 2000 2005 2010

NHS

Publishers

Other

Edin. Dept AI

Westminster

Brompton / IBM

Stanford

ICRF

UCL

Amsterdam

Uni Dundee

MBBS MRCP

ILTARS

ACORN

NICE

eHealth

MRC fellow

eH, DSS RCTs

KM Centre

ICRF clin units

Cochrane, BMJ Clin Evidence

NeLH CfHEP

Evaln book

DaT

HIC Director

SCT

eHealth Innovation Group strategy

1. Engage with the real

problem, users & context

2. Use theory to clarify

problem & identify

potential solutions

3. Co-design, test solutions

4. Pilot studies (safety,

feasibility)

5. Large scale RCT

Based on MRC Framework for

Complex interventions 2008

Engage with

problem

Apply theory,

identify potential

solutions

Co-design &

test solutions

Pilot studies

Large scale

trials

Engagement with problem owners

Europe: EU Commission (Argos project); WHO

Bellagio eHealth group

National: NHSDirect Innovation Committee;

Connecting for Health evaluation programme

Regional: NHS iTAPP & STH Boards

Local: Arden Telehealth Board; informatics

strategy

Evaluation adviser for:

– NHS: Simple Telehealth, NHS local, Let’s Get Moving

pilot

– SMEs: Psychology Online, Poikos Technology, etc.

– Industry: Medtronic, GE Healthcare

Some health problems we are working on

Health problem Approach

Long term conditions & self management

Who benefits from NHS Simple Telehealth ? Public acceptance of telehealth NHS local / diabetes patient portal (WMS) Uptake of NHS cardiac rehabilitation services

Drug related admissions Predicting chemotherapy-related nausea, neutropenia (WMS) Reducing prescribing errors RCT

Obesity Does NHS “Let’s Get Moving” work ? Reducing weight gain in 1st year students

Back pain & arthritis Making sense of back / hip / knee MRIs (WMS)

Mental health Self assessment & communication of risk (WMS)

Cancer Direct improvement of quality of life RCT

Health promotion Faster development of effective interventions: • Persuasive web sites - NHS Organ Donor Register RCT • SMS to improve diet of children in Mexico / 2nd world

Emergency care in community

Jewellery carrying encoded personal data

Other R&D activities

Challenge Approach

Enhancing NHS uptake of effective digital healthcare Systematic reviews on telehealth Summaries for NHS staff, Guardian network readers

Psychology of decision support Reducing automation bias Making alerts less intrusive

Targeting services to those who most need them Alternative formats for risk information about the elderly (WMS)

Making clinical reports safer, more informative Using information design to maximise impact on clinical decisions

What should guidelines tell us ? Persuasive wording; focus on what / who / where / when

Neuromarketing to benefit society Faster development of more acceptable, effective interventions, eg. SMS wording / schedule [WMS]

Exploiting routine NHS data (EU TRANSFOM project €7M)

When can we safely apply SPC, data mining, forum mining ?

Global eHealth Bellagio declaration, Kenya / Rwanda RCTs

UK survey of EHR hospital

implementation Methods:

Jha instrument (NEJMed 2009) sent to random

sample of UK acute hospital Trusts

Freedom of Information officer for each Trust

coordinated response

Calculated Jha score for each hospital: % of EHR

functions that reached Jha’s stage 1 (whole hospital

implemented) or stage 2 (1 ward or dept.). Maximum

= 32

Preliminary results:

70% response rate - 117 hospitals

Teaching status: 60 (51%) teaching

Size: mean 617 beds, median 556, IQR 450-781

English hospitals: 49 (48%) Foundation Trusts

Preliminary EHR survey

results Mean EHR implementation score: 39%

(normally distributed, SD 14%, median 38%,

IQR 27%-50%)

Variation of score with hospital characteristics:

– No difference if hospital in England (CfH) vs. Wales

(Informing HC) / Scotland (eH Strategy) / NI

– Big difference with teaching status: mean 45% for

teaching, 34% for other hospitals (p = 0.001, t test)

– No difference with hospital size, Foundation status

– ANOVA confirms teaching status is only significant

predictor of EHR implementation

– 88% of variance in score accounted for by other

factors

Avoiding over optimism

We all welcome evaluations that conform

with our expectations, however poorly

conducted, but…

Conveniently forget to cite (or even

publish) studies with disappointing

results

Ioannidis JP. Contradicted and initially stronger effects in highly cited

clinical research. JAMA. 2005;294:218-28.

Improvement in study methods over time

year1970 1980 1990 2000

1

10

100

1000

Diagnostic Odds Ratio (log scale)

Liu JLY, Wyatt JC, Deeks JJ, Clamp SE, Keen J, Verde P , Altman DG. Systematic reviews of clinical decision tools for acute abdominal pain. Health Technology Assessment 2006

Randomised trial of Quality of Life

profile

QoL randomised trial flow chart

Post-op patient with

breast cancer

Baseline QoL

assessment

3 month QoL

assessment 6 month QoL assessment

(end point)

12 month QoL

assessment

9 month QoL

assessment

CP orders ad hoc QoL

therapies

QoL profiles & reports sent

to CPs

No further QoL therapies

No further QoL therapies

Control

patients

QoL profile

patients

Breast cancer specific therapies (including physiotherapy) suggested by local guidelines

QoL therapies guided by QoL

profile & report

All patients

Key:

QoL: quality of life

CP: coordinating practitioner (=GP)

Digital healthcare innovation opportunities

Health

promotion Screening Test choice &

interpretation

Prognosis;

drug choice &

dose, self care

Supported

self care

Clinical activities:

Appropriate technologies ?

Web sites,

SMS msgs

MSN triage,

kiosks Telemedicine,

decision

support

Prescribing

alerts, telehealth,

prediction rules

Virtual ward

or hospice

Healthy Symptoms Diagnosis Long term condition

End of life

Lifeline

Why digital healthcare ?

Old model of care

Focus on acute conditions, reactive

management

Hospital centred, disjointed

episodes

Doctor dependent

Patient as passive recipient; self

care infrequent

Information & Communications

Technology (ICT) used rarely

Technology dominates

New model

Focus on long term conditions,

prevention & continuing care

Integrated with people’s lives in

homes & communities

Team based, shared record

Patient as partner; self care

encouraged & supported

Dependent on ICT & devices

Clinical needs dominate

The healthcare information cycle

Patient (self) care

Records

Insights, evidence

Knowledge

Knowledge access,

application

Capturing more accurate

requirements from 303 general

practitioners Time trade-off experiment (conjoint analysis)

on 303 GP members of Medix, a UK-wide medical

ISP

Each GP chose between systems with different: – reliability (95%, 99%, 99.9%)

– places to access (One location in a single health

care premises, anywhere within single healthcare

premises, anywhere, including home use)

– who could access (clinical staff alone, clinical and

NHS administrative staff, access by NHS and social

services staff)

GP acceptance of system features

Wyatt, Batley & Keen, J Eval in Clin Practice 2010. doi:10.1111/j.1365-

2753.2009.01217.x

GPs wanted a

system 14s faster

to compensate for

access by social

care staff !

Wyatt et al. J Eval Clin Practice 2010

Managing for health: The promise of the digital

record

Dr Charles Gutteridge, national clinical director for

informatics

Dr Charles Gutteridge Clinical Informatics

Managing for health:

The promise

of the

digital record

Patients in your heart

Patients in mind

Patients and families



Management matters – securing influence

17 years

From bench to universal application

We don’t have that much time


314114000


230063004


160643000


Machine readable

31411400 Recommendation to reduce meat intake

230063004 Heavy cigarette smoker

16064300 Anaerobic exercise 3+times/week



Better health is not a science problem


Using data collected at the point of care


0

10

20

30

40

50

60

70

80

01 June 2008 01 June 2009 01 June 2010 01 June 2011 31 May 2012

Scatter plot : AGE at presentation against DATE of presentation 1030 A&E attendances involving 397 patients who had 15 or fewer

completed episodes between October 2008 and December 2011

Linking activity to service use


0

10

20

30

40

50

60

70

0 50 100 150 200 250 300 350 400 450

Total consults per patient 406 patients who attended A&E between Oct-2008 and Dec-2011

for whom the diagnostic SNOMED CT code selected was [417357006 Sickling disorder due to hemoglobin S]

or one of its 31 more specific descendents

Health is about knowledge

What is ahead for me?

What does this mean for me?

What should I do?

How did I do....what is next?


Health cycling for patients

Me

Personalised data

Interpretation Choices

Health actions



Health cycling for clinicians

Me

Personalised data

Interpretation Choices

Health actions


Practical skills

Clinician as coach

Expert data clinicians

Innovation for patient

controlled data

North East & Yorkshire & Humber LSP – Accenture PACS supplier – Agfa RIS supplier – HSS 14 trusts

London LSP – BT PACS supplier - Philips (later replaced by Sectra) RIS supplier – iSoft 21 trusts

North West & West Midlands LSP was CSC Alliance PACS supplier – GE RIS supplier – HSS 40 trusts

South LSP – Fujitsu (later replaced by CSCA) PACS supplier – GE RIS supplier – HSS 35 trusts

How PACS and RIS were delivered

•LSP: local service provider – a company under contract to supply all of the requirements of the PACS programme within a region.

East of England & East Midlands LSP – Accenture PACS supplier – Agfa RIS supplier – HSS 17 trusts


Where did we get to?

5 cluster contracts from 10yr contracts in 2004

128 trusts with PACS (42 pre 2006)

4 cluster data stores - archive 2m studies/month

87 trusts have RIS systems

Performance management and benefits realisation

IS integration since June 2009

Interim data sharing solution via IEP available for all 2010


New Storage Solutions: Cloud based?

Variety of options, min storage, scalable,

supplier linked, utility based etc


Grid computing for image analysis


Advice on-line



Feedback



Comparing cleanliness ratings with infection rates

Greaves et al, 2012 Arch Int Med

NHS Choices Measure Other variable Spearman

Rho p value

Patient perception of cleanliness

Rate of MRSA bacteraemia (per 1,000 bed days)

-0.30 <0.001

Patient perception of cleanliness

Rate of C. difficile infection (per 1,000 bed days)

-0.16 0.04



Enabling patient knowledge

Explicit strategies for empowerment

Digital data for patients

Clinical goal setting

Data exchange

Listening


Tailored for patients


Dr Charles Gutteridge Clinical Informatics Dr Charles Gutteridge Clinical Informatics

Clinical goals


Listening and descriptive logic


The ‘right now’ challenge


Creating local networks

Getting smarter

Semantic networks for health

Changing Practice In Mental

Health Informatics 10.45am


Consultant In Old Age Psychiatry

Clinical Director of Informatics

Northumberland Tyne and Wear NHS Foundation Trust

and

Chair Royal College of Psychiatrists Informatics committee



Overview

• Electronic patient record

• Clinical dashboards

• Current provision

• Progress

• Future approach

“By all means keep a … for amusement,

but keep the more reliable ….. for work".

BMJ,..99.

“By all means keep a car for amusement,

but keep the more reliable horse for work".

BMJ,1899.

Ref Loudon I, Doctors and Their Transport, 1750-1914, Medical History, 2001, 45: 185-206

The purposes of the clinical record

• To record risk assessments to protect

the patient and others

• To record the advice given to general practitioners, other clinicians and other agencies

• To record the information received from others, including carers

• To store a record to which the patient may have access

• To inform medico-legal investigations

• To inform clinical audit, governance and accreditation

• To inform bodies handling complaints and inquiries

• To inform research

• To inform analyses of clinical activity

• To allow contributions to national data-sets, morbidity registers

• To act as a working document for day-today recording of patient care

• To store a chronological account of the patient’s life, illnesses, its context and who did what and to what effect

• To enable the clinician to communicate with him- or herself

• To aid communication between team members

• To allow continuity of approach in a continuing illness

• To record any special factors that appear to affect the patient or the patient’s response to treatment

• To record any factors that might render the patient more vulnerable to an adverse reaction to management or treatment

Improving standards in clinical record-keeping,Ian Pullen & John Loudon,Advances in Psychiatric Treatment (2006), vol. 12, 280–286

• 15% of outpatient

appointments were

affected by missing

clinical information

• In 20% of these

cases patients were

exposed to risk (as

judged by the

doctors involved).

Brief history of RiO in Newcastle

1997 – Trust completed clinical information system procurement –

began implementation of InteHealth

2002 – Migrated from InteHealth to RiO

2003 – Started clinical rollout in Community Mental Health and Early

Intervention In Psychosis teams

2006 – NTW Trust formed through merger -

• One of the largest MH Trusts in the country

• Direct contract with supplier

2010 – Trust achieved Foundation Trust status

2011 – Currently

• 3500 users covering a population of 1.2 million

• At peak approx. 900 concurrent users

• Complete coverage by March 2012 including a diverse range

of services.

Enhancing RiO Access Data Collection

• Variety of data collection methods used

• Recurring themes raised in all areas

• Directorate

• Medical

• Trust – All users email

– Over 700 responses

Team / Ward Data

Medical Staff Data Trust Survey

Recurring

Themes

Clinical Forms

• Lean workshop over 80 clinicians and patient user groups

• Went live with core documentation for 3500 users in October 2011

• Care Programme Approach Association National Award

• Review planned in March 2012

Data Entry/Mobile Access

• Vodafone mobile access solution available

Clinical Standards

• Developed NTW Clinical Standards for Electronic Record Keeping

Scanning and Document Capture

• Upgrade of the scanned document section 2012

Clinical Coding

• Work stream planned during 2012

Northumberland/Partnership Working

• Access Newcastle Social Services summary of risk, directly from RiO

Speed of RiO

• Upgrade to v6 included full hardware upgrade

Progress on issues

Differences in and out of the

national programme for IT

RiO in NPfIT

• Clinical and risk

management information

in one place

• Available to multiple

users at multiple sites at

all times

• Changes often in a

challenging time frame

RiO out of NPfIT

• Local configuration

• Enables a sociotechnical

approach

• Changes made in a

realistic time frame

Good quality information is a driver of

performance for clinical teams and

helps ensure the best possible care for

patients.

• providing timely, relevant information for clinical teams, presented in

easy to understand formats, with high visual impact

• utilising multiple sources of existing data, even across organisational

boundaries

• providing clinical information across multidisciplinary teams

• displaying information in ‘real time’ without delay for data cleansing

• allowing local configuration and comparison against national data sets

• permitting regular changes to displays, as required by the local teams,

to keep the information relevant and up to date

Clinical Dashboards help to drive this process by:

Clinical Dashboards

Acute Mental Health Ward Dashboard

Early Benefits

Benefit Baseline 2009 September 2010

Length of stay 102 days overall

for 01/12/2008 -

30/11/2009

90 days overall* for 01/12/2009 -

31/10/2010

Falls assessment

recorded

19%** 77%

Risk assessment recorded 17% 93%

MDT assessment recorded 54% 87%

*11 months **March 2010

NTW dashboards

©

Patient view

©

Lessons learned from Clinical Dashboards

Care Pathway

Access

Assessment

&

Formulation

Treatment,

maintenance

& support

Transitions

between

services /

pathways

Disengagement

& Discharge

Quality Standards

Care Pathways

EPR RiO

Quality Standards

Care Pathways

EPR RiO

Data

Warehouse

Quality Standards

Care Pathways

ESR

Safe guarding

Acute Trust

EPR RiO

Data

Warehouse

Quality Standards

Care Pathways

ESR

Safe guarding

Acute Trust

EPR RiO

Clinical Dashboard

PDF

Spreadsheets

Data

Warehouse

Standardised Quality outputs

Q and P Dashboard Data

Quality

Data

Quality

Quality Standards

RiO Champions

Care Pathways

ESR

Safe guarding

Acute Trust

EPR RiO

Clinical Dashboard

PDF

Spreadsheets

Data

Warehouse

Standardised Quality outputs

Q and P Dashboard

NTW Caldicott and Health Informatics Groups

Urgent and Planned Care Caldicott and Health Informatics Groups

Data

Quality

Data

Quality

External Communication

Clinical System Content Build Maintenance

Clinical requirements

Business requirements

= Design/Build/Test/Train = major change = minor change

<<------------------------------------------------- RiO --------------------------------------- >>

• 9th of November National Mental Health Informatics

Network Congress

• Royal College of Psychiatrists

• Department of Health Informatics Directorate

• NHS Information Centre

• British Computer Society.

• British Computer Society- Hosting

• Royal College of Psychiatrists- sponsored

• Executive committee

• Links to the National Mental Health Information Board

National Mental Health Informatics

Network

Clinical health information forum

Facing the future

11.00 am - Coleman Suite Break and browse

11.30 am - Boyne 1 Workshop one

Does technology help clinicians deliver better care?


John Burdon Suite Workshop two




12.15 pm - Coleman Suite Lunch & look

12.15 pm - Boyne 3 Optional workshop A [30 minutes]



12.45 pm - Boyne 3 Optional workshop B [30 minutes]



1.15 pm - Coleman Suite The third healthcare revolution Sir Muir Gray, CBE, director better value healthcare, co-director NHS QIPP Programme, Right Care Workstream (via DVD)



The third healthcare revolution: Clinical systems

Professor Sir Muir Gray CBE, director Better Value

Healthcare, co-director, NHS QIPP Programme,

Right Care workstream

Great innovations of the first and second

healthcare revolution

• MRI and CT scanning • Statins • Antibiotics • Coronary artery bypass

graft surgery and stents • Stents • Hip and knee

replacement • Chemotherapy • Radiotherapy • Randomised controlled

trials • Systematic reviews

The First The Second

- All health services, world wide, face 5 major problems-

• FAILURE TO PREVENT PREVENTABLE DISEASE • INEQUALITIES AND INEQUITY • PATIENT HARM • WASTE OF RESOURCES • UNWARRANTED VARIATION IN

– QUALITY, SAFETY & OUTCOME, – ACTIVITY & COST

2011

Need & Demand

€

Carbon

BetterValueHealthcare

• Is epilepsy care in Northumberland better than epilepsy care in Durham?

• Who is responsible for the service for people with bipolar disorder in Middlesbrough?

• Did the service for people who are breathless North of the Tyne improve last year?

• Is the service for frail elderly people getting better in Sunderland and who is responsible?

• How many asthma services should there be in the North East and is that different from the number of services for frail elderly people

Systems based health care


A SYSTEM is a set of activities with a common set of objectives and an annual report (also known as a programme or service)

A NETWORK is a set of individuals and organisations that deliver the system’s objectives (a team is a set of individuals or departments within one organisation)

A PATHWAY is the route patients usually follow through the system/network

Definitions


Objectives Criteria Standards Performance Minimal Achievable Excellent (Annual Report)

•To diagnose asthma quickly & accurately


A healthcare system is a set of activities with a common set of objectives; an example of a set of objectives, for an asthma healthcare system is set out below: •To prevent asthma •To diagnose asthma quickly and accurately •To slow the process of the disease by effective and safe treatment •To help the individual afflicted adapt to the challenges •To control symptoms and the effects of disabilities •To involve patients, both individually and collectively, in their care •To make the best use of resources •To promote and support research •To support the development of staff •To report annually to the population served


Hierarchy Network

Dr Jones is a respiratory physician in the Derby Hospital Trust and last year she saw 346 people with COPD and to provide evidence based, patient centred care, and to improve effectiveness, productivity and safety

Dr Jones estimated that there are 1000 people with COPD in South Derbyshire and a population based audit showed that there were 100 people who were not

referred who would benefit ; she needs to practise population medicine

Dr Jones, the co-ordinator of the South Derbyshire COPD Network and Service has responsibility, authority and resources ( i day a week and support ) for Network development Localisation of the Map of Medicine Quality of patient information Professional development of generalists, and pharmacists Production of the Annual Report of the service

She is keen to improve her performance from being 27th out of the 106 COPD services, and of greater importance, 6th out of the 23 services in the prosperous counties


Map of Medicine - COPD

Neither markets nor bureaucracies can

solve the challenges of complexity

Order from www.offoxpress.com Or find the kindle version on the Amazon Kindle store

http://www.offoxpress.com

http://www.offoxpress.com

Consumer health informatics – what’s that?

Mark Duman, chair, Patient Information Forum

Consumer Health Informatics – what’s that?

Mark Duman

www.pifonline.org.uk

16 May 2012

http://www.pifonline.org.uk/

Agenda

• What is PiF?

• Consumer Health Information and it’s role in:

• Choice

• Shared Decision Making

• Record Access

• Challenges for CHI and health infomaticians

PiF Guides Shared Personal

Health Records – Jun’12

Activities: 1. Literature review 2. Workshops/ Interviews with people,

policy, clinicians & commissioners 3. Provider survey Content: • Where we are today • Vision for the future • Definitions & current legal framework • Case studies • What’s needed for this to work • Signpost to other resources

Information vs. Informatics

Consumer Health Information (CHI)

Information and support around:

• Health & wellbeing (e.g. leading a healthy lifestyle or prevention)

• Conditions & treatment options (including self-care)

• Services - how to choose & use them

Q. Where do you make the most daily choices?

What patients want… (Picker, 1m patient study)

• Fast access to health advice

• Effective treatment delivered by staff you can trust

• Involvement in decisions & respect for patients’ preferences

• Clear, comprehensible information & support for self-care

• Physical comfort and clean, safe environment

• Emotional support and alleviation of anxiety

• Involvement of family and friends and support for carers

• Continuity of care and smooth transitions.

Darzi (2008)

“An NHS that gives patients and the public more information and choice, works in partnership and has quality of

care at its heart.” High Quality Care for All

137/42

NHS Constitution – Rights (2009)

…to be given information about your proposed treatment in advance, including any significant risks and any alternative treatments which may be available, and the risks involved in doing nothing.

…to be involved in discussions and decisions about your healthcare, and to be given information to enable you to do this.

White Paper (July 2010)

“First, patients will be at the heart of everything we do. So they will have more choice and control, helped by easy access to the information they need about the best GPs and hospitals. Patients will be in charge of making decisions about their care.” (Page 1)

Informed Choice?

Case study: a hepa...what? • Excellent consult with general surgeon

• “I want you to see a hepatologist”

• Where to start?

?!

Case study: a hepa...what? • Excellent consult with general surgeon

• “I want you to see a hepatologist”

• Where to start?

• ‘Hepatologist Manchester’ into Google

• British Liver Trust – database; difficult to keep current, no performance rating; just name...

• Speciality, publications, extra-curricular activities?

• Choose & Book – NW only

• Ask your GP – ‘I don’t know if I can do that!’

• Still awaiting copy of referral letter

• ‘He’s not in clinic today’

Shared Decision Making

2.3 “shared decision-making” to become the norm.

International evidence shows that involving patients in their care and treatment improves their health outcomes,17 boosts their satisfaction with services received, and increases not just their knowledge and understanding of their health status but also their adherence to a chosen treatment.18 It can also bring significant reductions in cost, as highlighted in the Wanless Report,19 and in evidence from various programmes to improve the management of long-term conditions.20

www.nhsdirect.nhs.uk/DecisionAids

http://www.nhsdirect.nhs.uk/DecisionAids

Record Access

2.11 We will enable patients to have control of their health records. This will start with access to the records held by their GP and over time this will extend to health records held by all providers. The patient will determine who else can access their records and will easily be able to see changes when they are made to their records. We will consult on arrangements, including appropriate confidentiality safeguards, later this year.

Personal Health Records Motivate Consumers to Act • 1 in 14 Americans use a personal health record (PHR)

• They know more about their health, ask more questions, and take better care of themselves

• 1 in 3 PHR users take a specific action to improve their health

• Most pronounced among hard to reach - multiple chronic conditions, less education, lower incomes

• Usage rates of these tools are relatively low but have doubled over the last two years.

1,849 people California HealthCare Foundation

15 Dec 2009 – 10 Jan 2010

• Information not recognised as a ‘therapy’

• Not integrated into care provision

• Lack of quality standards

• Focus on measuring provision not delivery & outcomes

• Fixation on products not behaviours

• Requisite CHI expertise mainly unrecognised

But CHI faces many challenges...

Information: first line therapy?

Integrate into delivery

http://healthguides.mapofmedicine.com/choices/map/hypertension1.html



Consumers Tapping Social Media To Access Health Information • PwC survey: one-third of US

consumers use social media to access health information

• Nearly 90% ages 18 - 24 say they would trust health information on social media websites

• More than 80% say they would use social media to share health information.

www.ihealthbeat.org/articles/2012/4/17/consumers-tapping-social-media-to-access-health-

information.aspx; 17 April 2012

http://www.ihealthbeat.org/articles/2012/4/17/consumers-tapping-social-media-to-access-health-information.aspx















Parents of Children With Cancer Distrust Online Health Info, Study Says

• Forthcoming study in Sociology of Health and Illness finds that parents of children with cancer try to avoid online health information.

• Researchers say parents may distrust or be afraid of information on the "worst-case scenario" for their child's condition.

www.ihealthbeat.org/articles/2012/3/23/parents-of-children-with-cancer- distrust-online-health-info-study-says.aspx#ixzz1uypTGNX5; 23 March 2012

"One of the reasons we were

interested in exploring this

issue is that so much research

and media coverage had

examined how the Internet was

breaking down barriers

between patients and

caregivers and their physicians.

But that wasn't that case in our

study.”

Elizabeth Gage, Professor of community health

and health behavior , Buffalo School of Public

Health and Health Professions

http://www.ihealthbeat.org/articles/2012/3/23/parents-of-children-with-cancer-distrust-online-health-info-study-says.aspx






















www.theinformationstandard.org

http://www.theinformationstandard.org/

Production

• To high standards

• With user involvement

Distribution

• Using appropriate media

• Available at the right place & time

Delivery

• Integrated into clinical care

• With professional support

Outcomes

• Clinical effectiveness

• Safety

• Patient experience

• Behaviour change

Feedback

• Evaluation

• Review

The whole pathway needs attention

Behaviour change

Despite concerted efforts to tackle the “effectiveness of consultations between patients and clinicians,” the biggest problem is the “reluctance of clinical staff to provide active support for patient engagement.”

Recommends replacing annual review with 2 visits

• data collection (1)

• delivery of the test results

• agree action plan, goals and objectives (2)

• patient decides next appointment

www.rcgp.org.uk/PDF/CIRC_Care_Planning.pdf (Sep 11)

http://www.rcgp.org.uk/PDF/CIRC_Care_Planning.pdf

Internet Skills Performance Tests: Are People Ready for eHealth? • General population lacks the skills to keep up

• Lack of information and strategic Internet skills, which, in the context of health, are very important

• Also problematic for younger generations, despite considered skilled Internet users

• The results of the study strongly call for policies to increase the level of Internet skills.

www.jmir.org/2011/2/e35/ ; 01Nov09-28Feb10, 88 subjects in NL

http://www.jmir.org/2011/2/e35/

http://www.jmir.org/2011/2/e35/

CHI Charter (work in progress)

1. ...is an intervention that impacts health & wellbeing

2. ...must adhere to quality standards

3. ...provision must be integrated into health & care delivery

4. ...must be delivered in a supportive setting

5. ...must be measured in terms of impact on health outcomes.

Much awaited...

Challenges for health infomaticians

1. Do you recognise information as a therapy?

2. What benefits do your systems deliver to patients?

3. How well are you communicating these?

4. Are you and your patients digitally monitoring your health and wellbeing?

Consumer Health Informatics – what’s that?

Mark Duman

www.pifonline.org.uk

16 May 2012

http://www.pifonline.org.uk/

Clinical health information forum

Facing the future

2.00 pm - Boyne 1 Workshop three

What are the information governance barriers to delivering effective care?


John Burdon Suite Workshop four




2.45 pm - Coleman Suite Informatics: Future direction

Dr Graham Evans, director of informatics and chief information officer, NHS North East

3.15 pm - Coleman Suite The clinical network

Prof Sir John Burn, lead clinician, NHS North East

3.45 pm - Coleman Suite Concluding remarks including prize draw Dr Jonathan Richardson, consultant in old age psychiatry, acting chair clinical health information forum



Informatics: Future direction

Dr Graham Evans, chief information officer and

director of informatics, NHS North East

Clinical Health Informatics Forum

“Informatics: Future direction”

16th May 2012

Dr Graham Evans

Chief Information Officer/Director of Informatics

• Looking back…..

Agenda

• The future……………………..

• Created 64 years ago

• A long-held ideal that good healthcare should be available to all, regardless

of wealth or ability to pay

• One of the largest employers in the world; Chinese People’s Liberation

Army, the Indian railways and the Wal-Mart supermarket chain. Employs iro

1.3M people, approx. 1 in 23 of working population*.

• Men and women now live an average of 10 yr’s more than they did in 1948.

• Patients in England the right to choose between providers for non-emergency treatment.

Looking back – the NHS its origins and ideals

Whilst there have been significant NHS delivery improvements over recent years…

These factors have placed significant pressure on

the NHS “system”

Hence the need for……….

Reform and transformation!

Technology had (has) a part to play

* Expected to be less in 2012

• Back in 2002, the National Programme for IT (NPfIT) an ambitious multi

billion £ programme of investment designed to reform how the NHS in

England uses information to improve services and patient care.

• The aim was to create a fully integrated electronic care records system, for

the NHS in England.

• The original objective was to ensure every NHS patient had an individual

electronic care record which could be rapidly transmitted between different

parts of the NHS, in order to make accurate patient records available to

NHS staff at all times.

• The Programme (as we knew it) was officially terminated in 2010, although

some programmes continue.

Looking back – the NHS its challenges (NPfIT)

"Sometimes when you innovate, you make

mistakes. It is best to admit them quickly and

get on with improving your other innovations."

– Steve Jobs – Apple inc

Looking back – the NHS its challenges (NPfIT)

Looking back – Our Journey

“So what have Informatics done for us in the NE?”

Looking back – Journey continued…

Within an aligned informatics strategic framework -

implement ‘pathway based’ technologies that; supports

and informs clinical decision making; enables, care

closer to home, facilitates, flexible mobile working and

reduces demand on hospital services.

The North East Informatics “Vision”

Aligned

People

Process Technology

QIPP

Strategic programmes • Summary Care Record (SCR) • Electronic Prescription Service (EPS) • SystmOne • Image Exchange Portal (IEP) • Map of Medicine (MoM) • Pathways / ECS • 111 • Standard Templates to support care Pathways (Eol, LD etc.) • GPIT • PCT Commissioning systems and support

Collaborative programmes • Stroke data capture system • Videoconferencing • Telehealth solutions • WebEx • Information Governance campaigns

Plus Informatics Services • Professional Programme Management • Informatics Programme Governance with PCOs • Information Governance advice/guidance • Change and Benefits Management • Requirements, Design, Engagement and Service Management

The patient at the centre

Align to deliver QIPP

Joining the “system”

Looking back – North East “delivered”

Clinical Networks – OVOF

• Strategic networks, with Informatics enablement/support

• Business/Service focus

• Accelerated Solutions Events (ASE)

• Cross cutting solutions

Clinical Health Informatics Forum (CHIF)

• HI focused Clinicians who will act as a specialist resources

• Forum where Clinicians find out about current local/national initiatives

• Best practice sharing with each other/their networks

• Clinician involvement in IT enabled Transformational change programmes

• Develop governance structure / escalation route to DHID Clinical

division/alignment to other groups.

Looking back – CSF’s = Clinical engagement

Looking back – CSF’ = Patients…

• Patient Engagement and involvement

• Rich resource of Knowledge

• Eager to help shape the future

• Networks existed

Safer Care North East

Patient Carer Public Engagement

(PCPE)

• Patients our “ultimate customer".

• NPfIT had its challenges, the NE progressed on many fronts

• 100% Foundation Trust provider landscape (autonomy and choice)

• Excellent clinical engagement – Our customers

– Informatics involvement in service development and transformation

– Clinical Innovation Teams – Leadership, Sponsorship, Ownership

– Clinical Health Informatics Forum (CHIF)

• Patient engagement – Our customers

– Patient Safety - Safer Care North East

– Clinical Safety Management System (CSMS via CSO)

• Much of what we do fits with the future state direction

Looking back – Reflection of the journey

Looking forward

The Future - The NHS “its accountability”.

More localised

Less top down

Innovative

Outcomes Focused

Responsive

Clinicians leading

Open

Transparent

• Informatics services will be radically different from today:

– Some national (DHID/CfH) and regional (SHA) functions and

services will transition into receiving organisations where

appropriate

– not all current activities and services will continue

– some “must do’s” will be delivered, but differently

– new system design predicated on 9 key principals

The Future - the new “Informatics system”

1. Patients, the public and health and social care organisations will have access to information,

technology and services that meet their needs at the lowest possible cost.

2. There will be a clear policy owner (in the DH or the NHSCB) for all IT systems and services and they

will be formally appointed as the system or service SRO.

3. The NHS will build on the best of what it has, maximising investments made to date. Value for money

will underpin decision making and we will be open and transparent about costs and benefits.

4. Decisions will be taken as close as possible to the front line: action will only be taken centrally where it

will be more effective and there is a single, clear need across the NHS.

5. There will be a wide, varied and dynamic market of capable and engaged suppliers of healthcare

systems and services.

6. The NHS will be an informed customer of IT systems and services.

7. IT systems and services will be connected across business, technical and service boundaries.

Standards will ensure consistency and support clinical safety.

8. Non-informatics professionals and clinicians will see the connection between having a strong

informatics capability at an individual and organisational level and improving outcomes for patients

and the public.

9. There will be an active community of informatics specialists, clinical informaticians, leaders and

change managers to embed informatics into day to day work.

The Future - Informatics “design principals”

DH • Policy Ownership

• SRO Responsibility (social care & public health)

• ALB Sponsorship

• DH Portfolio Management

Health & Social

Care Policy

The Future - NHS informatics

NHS

Informatics

Strategy

NHSCB Information Strategy

IT Strategy

Strategic Delivery Model

Policy Liaison

Oversight of Information

Standards & IG

Strategic Supplier & Market

Development

Levers & Incentives

Business & Enterprise

Architecture

Informatics Leadership &

Professional Development

Portfolio Management

Global Leadership &

Exploitation

Best Practice & innovation

NHS Policy Policy Ownership and SRO Responsibility

(patients, commissioning, information, choice)

Patient

Engagement

Insight &

Informatics

(PEII)

Directorate

Customers

Patients

Local Authorities

Commissioners

Providers

Information Centre

for Health & Social

Care Programme

Delivery

Service

Delivery/

Operations

Assurance &

Accreditation

Finance &

Commercial

Delivery

Standards Delivery

Commissioning

Support Commissioning

Support Commissioning

Support

Smaller

Estate

Smaller Skilled

Workforce

The Future - the business context

Cost reduction

And improved

outcomes

through service

Transformation

Closing the loop

Outcomes, Quality

improvements &

Transparency enabled by

Information

“Choice” and

commissioning

intelligence enabled by

Information

QIPP

Creating

intelligence

as data is

analysed

and

interpreted

Care records

your records

form the

primary

source of

data

The

Information

revolution

Leading to

patient-centred

care

Improving

service quality

and outcomes

for you

Promoting

benchmarking of

outcomes

by clinicians

Allowing you to

share information

from your record

with others

Enabling

more direct

communication

between you &

your professional

Giving you greater

ownership & control

over your care

Encouraging

clinicians and care

professionals

to respond to your

needs and capture

data at the point

of care

Enabling you

to make properly

informed

choices

Leading to

easily understandable

Information

published by a range

of organisations to

meet your needs

Improving

data quality

as data is exposed

to professional scrutiny

and the quality of

data improves

Leading to

greater

transparency

through routine

publication of

core data

The main source for

aggregate data

for secondary uses

such as research

The

Information

Revolution

The Future - the “Information Revolution”

Are we connected?

• 77% households have access to internet

• 45% of internet users used mobile phone [23% 2009]

• 6 million accessed internet via mobile phone for first

time 2010-11

Reference : ONS 2011

The Future - the “Information Revolution”

Reference : ONS 2010

Steady increase in internet usage by

adults over recent years.

Mobile internet access growing fast

On-line, anywhere, anytime:

• SMART Phones

• Digital Services

The Future – the “Information Revolution”

“Information, combined with the right support, is the key to better

care, better outcomes and reduced costs. Patients need and should have far more information and data on all aspects of healthcare, to enable them to share in decisions made about their care ”

Reference: White paper DOH 2010

“Record access for patients is likely to improve their care and their safety”

Reference : Enabling Patients to Access Electronic Health Records:

Guidance for Health Professionals RCGP Sept 2010

We are connected!

So what about health and care?

The Future - the Opportunity

184

QIPP

Regional &

Local Team

Delivery QIPP National workstreams

Policy

Drivers

QIPP Right

Care

QIPP

Productive

Care

QIPP

Long Term

Conditions

QIPP Urgent

&

Emergency

Care

QIPP End

of Life

Digital Technology National Enablers

(e.g. standards, guidance, best practice)

Strategic

Initiatives

Adoption Support

(First of Types /

Case Studies)

Initia

tives

Regis

ter

Practical use of technology in supporting QIPP drivers and key outcome measures

Clinical

Dashboards

Sharing End of

Life

Preferences

Patient

Decision-Aids

Online Pre-Operative

Assessment

Risk Stratification

Personalised Care Planning

Online Meeting Services

• Informatics is a key “enabling part” of the wider service reform agenda,

including:

– Commissioning Intelligence

– Transformation and service reform (Clinical Networks/Senates)

– QIPP

– Organisational change

• It’s not just about IT…………but thinking, behaving and working

differently with; information, systems, services and resources

Aligned

People

Process Technology

The Future - Informatics, vision and enabling

The value proposition (Vision)

Drivers

Information will be key.

Clinical Networks/Senates

must be able to access

professional Informatics

services and knowledge to

deliver better outcomes.

Joining the system - Strategically

• We need to provide health and care services in different ways,

by:

– reducing hospital admissions

– delivering services closer to patients homes

– improving clinical decisions and enabling patient choice,

through, open/transparent data

– providing real time access to the clinical record at all points

of care (pathways), for health/care professionals, and

patients as they become more connected and in control

The Future - the NHS working differently

Courtesy of Orion Health Ltd

• Recorded once & share = integrated care

• Patient and professionals responsibility to record – shared

• Portal/signpost to information I need for my Health

Default – access online

• Data about me / care belongs to me

• No decision about me without me Information Revolution 2011

Patient

Care Coordination

Community

Nurses Allied

Health

Acute

Clinicians

Ambulance

Mental Health

Services

Social

Services

Housing

Services

Care Coordination

A Clear Strategic Vision

– Business/Patient centric (Benefits)

– Informatics enabled

Coordinated;

– Leadership and direction

– Locally implemented

Patient centred;

– Clinically owned

– Measurable, realistic and achievable

benefits

Informatics can “enable” transformational change,

but people make it happen…The Future

“Don’t do the same things better, do better things”

Informatics “transforming”

Th

e r

ole

of

Info

rma

tics

http://images.google.co.uk/imgres?imgurl=http://www.insiteconsultancy.com/20050509_PA_PACS_Laurier_Nobert.JPG&imgrefurl=http://www.insiteconsultancy.com/pacs_and_Telemedicine.htm&h=1944&w=2592&sz=2766&hl=en&start=20&um=1&tbnid=ftc8RuoPxK9tMM:&tbnh=113&tbnw=150&prev=/images?q=PACS&um=1&hl=en&sa=N

Thank you

The clinical network

Professor Sir John Burn, lead clinician, NHS North

East

Sir John Burn MD

Clinical Director

David Nicholson NHS Chief Executive

And Lord Darzi at Centre for Life 2008

Stephen Singleton

NHS NE Med Director

Invited JB to be lead

Clinician for OVOF

Summer 2008

• GP Palliative care registers

• Liverpool care pathway

• Care homes and advanced care planning

• “would you be surprised?”

• 24/7 community support

• Early engagement with 111

• Deciding right

End of Life Care

NHS Clinical Networks

Provide a route to shared decision making

Can help to standardise and simplify

Offer economy of scale

Policy on Clinical Networks

Equity and Excellence heralded a major cultural shift towards

focusing on outcomes of care

Future Forum recommended networks “should have a role

in supporting commissioners and providers” but “need to

define and review their function, form and effectiveness”

Government confirmed clinical networks retained and

strengthened in the new NHS

Objectives

Principles

Focused on quality improvement

single operating model

Regularly reviewed, remaining purposeful

Clinically led, member orgs actively engaged, duty of co-operation

Embedded, leading change, and co-ordinating systems of care

Dr Kathy McLean

Network Categories

•Informal clinical networks

•Formal clinical networks

•Formal clinical networks prescribed by NHS CB

“We propose that these networks are

entitled Strategic Clinical Networks (SCNs)”

Strategic Clinical Networks

• primary, secondary and tertiary care clinicians together, +/- social care and

the third sector, to support evidence based best practice

• lead a change process or co-ordinate care across complex pathways

maintaining and / or improving quality and outcomes

• made up of commissioners and providers, who will be the member

organisations.

• local non statutory org. models, pan England

• geographical patch, single overarching network structure & support team

• Overarching structures aligned with the footprint of clinical senates and linked

with research networks.

Effectiveness

“SCNs are established for five years. Where they remain

purposeful …should be renewed. Where the work

…concluded there should be a process for its

disestablishment

…regular review at the level of the geographical

overarching structures…

Chief Executive

Nurse Director Medical Director

Domain 3 Domain 1 Domain 4 Domain 5 Domain 2

Lead Nurse Medical Lead

CCGs, Providers, Patients and Clinicians

National Level

Sub national commissioning sector

Sub sector level

National Clinical Directors

Strategic Clinical Networks

Clinical

networks

and

Senates

Clinical Networks NorthEast

Themes

Acute Planned Long Term

Functions: team members might specialise and offer

support across networks in their area of special expertise

• Informatics

• Communications

• Transport

• Laboratory services

Themes: Acute, Planned and Long Term Conditions

embrace all of medicine and are too general to be “networks” but a clinical director can be assigned to each to integrate

activities

Existing Networks

Cancer Cardiovascular

Burns Care Neurosciences

Critical Care Chronic Fatigue

Diabetes Neonatal

Pathology Respiratory

Renal Trauma

Prospects for CITs

Maternity )

Child Health )probable SCN

Mental Health probable SCN

End of Life Care FCN

Learning Disability FCN

Acute Care workstreams-sepsis, rehab

Planned Care workstreams-enhanced recovery

Long Term Conditions workstreams-?

New Networks Should we pilot A dementia network? A primary care network?

Universities

•Durham

•Newcastle

•Northumbria

•Teesside

•Sunderland

NHS trusts

• City Hospitals Sunderland

•County Durham and Darlington

•Gateshead Health

•Newcastle upon Tyne

•North Tees and Hartlepool

•Northumbria Healthcare

•South Tees

•South Tyneside

•Northumberland Tyne and Wear

•Tees, Esk and Wear Valleys

CCGs

•Durham Dales, Easington and

Sedgefield Clinical

Commissioning Group

• North Durham Clinical

Commissioning Group • Darlington Clinical

Commissioning Group • Hartlepool and Stockton on

Tees Clinical Commissioning

Group • South of Tees Clinical

Commissioning Group • Newcastle - Tyne

Health Clinical Commissioning

Group • Newcastle Bridges Clinical

Commissioning Group • Northumberland Clinical

Commissioning Group

• North Tyneside Clinical

Commissioning Group

• Gateshead Clinical

Commissioning Group

• Sunderland Clinical

Commissioning Group

• South Tyneside Clinical

Commissioning Group

We also need to make links and join things up

•Ambulance Service

General plan • Work with NHS CB to clarify central support for SCNs

• Integrate and rationalise current funding streams

• Appoint Managing Director: Job Description needed

• Identify secondary/tertiary care delivery networks eg CCN, Neonatal, Trauma: request FT support

• Identify formal networks needing CCG support eg Learning Disability, EOL care

• Present an integrated business plan in September

Clinical Networks Northern England?

Provides a route to shared decision making

Can help to standardise and simplify

Offers economy of scale

Should we embrace N. Cumbria from the outset?

It’s getting very cheap!

Cost per Sequenced Human Genome

2001

2007

http://www.engadget.com/2012/02/20/minion-usb-stick-decodes-dna/

Functional classification of JDW SNPs

SNP Type Known SNPs Novel SNPs

Missense 8967 2421

Nonsense 44 5

Synonymous 9121 2261

UTR 18517 7102

Intron 922048 381924

Hereditary persistence of intestinal lactase Used to be called hereditary lactose intolerance(223100)

Europeans usually have haplotype A

Africans have lots of different haplotypes,

A, B, C, U etc Hollox et al Am J Hum Genet 2001;68:160-172

C -13910

T -13910

The lactase gene

The lactase gene

Ennatah et al 2002 found C allele with lactose

intolerance in 4 different populations and T

with tolerance Nature Genetics 30:233-37

A

Beyond the gene

People who can drink milk belong to 5 haplotype groups

Europeans

Kenyans

Tanzanians

Sudanese

Tishcoff et al Nature Genetics 2007;39:31-40

Where are the variants ?

Patrick Willems 01Sept11

Collaborative Curation of the Variome

Human Variome project will launch in June at UNESCO

a pilot programme of partnership between developing countries

and major Genetics centres to begin to create a worldwide

genomics network

Utility and cost

3.5M euros to develop a

Point of care test for

Malaria: Nanomal

Institute of Genetic Medicine

Newcastle University

Centre for Life, Newcastle UK

DNA genotyping and sequencing on nanowires – “while you wait”

Prof Sir John Burn MD FRCP FRCPE FRCPCH FRCOG FMedSci

Medical Director

International Congress of Human Genetics 2011

All authors are stockholders

Elaine Warburton CEO Sam Whitehouse COO

Jonathan O’Halloran Chief Scientist

The team

DNA Extraction We are extracting 20-50ng/ul

for each chip, from whole blood

samples.

Below are results from 3 blanks

and 3 blood cassettes. Buffer

gives “false positive” at 100ng

level

Automated extraction in 4 minutes

In a disposable cassette

2001

Cui, Y., Wei, Q.Q., Park, H.K. & Lieber, C.M.

Nanowire nanosensors for highly sensitive

and selective detection of biological and

chemical species. Science 293, 1289–1292

(2001).

“Devices based on nanowires are

emerging as a powerful platform

for the direct detection of

biological and chemical species,

including low concentrations of

proteins and viruses.” 1st July

2006 Analytic Chemistry

QMDx Sequencing principles

T

G

G

A

C

C

G

T

T

C

A

A

R

- ve - ve

- ve

- ve - ve

- ve

- ve C

Nanowire


C

T

G

G

A

C

C

G

T

T

C

A

A

- ve - ve

- ve

- ve - ve

- ve

- ve

R

100 Å

Debye Length

Nanowire


C

T

G

G

A

C

C

G

T

T

C

A

A

- ve - ve

- ve

- ve - ve

- ve

- ve

Wash

R

Nanowire

QuantuMDx technology: The QPoc

Prototype

design

Institute of Genetic Medicine, Newcastle upon Tyne, UK

Clinical Networks

• There will be central funding from NHS CB for 14/15

Clinical network teams to cover defined geographical patches

Networks and senates will share the same support team

We can create “local networks” within this structure

Informatics is important!

Institute of Genetic Medicine, Newcastle upon Tyne, UK

Genomics

• Whole genome sequencing is now cheap

• Understanding the outputs needs global partnership

• Delivering effective care needs better informatics

• Point of care genetic testing will offer answers

when and where needed

Free prize draw

iPod Nano – EMIS

Hamper – INPS

Kindle - Trisoft


forum

Facing the future

3.45 pm

Concluding remarks and presentation


North East Clinical Health

Informatics Forum

• A body of health informatics focused clinicians who

will act as a specialist resource for organisations,

present and future.

• Assistance in consultation and delivering

recommendations

• A forum of clinicians to share best practice.

• where clinicians can find out about current local

and national information initiatives.

• An opportunity to promote clinical involvement

in IT enabled transformational change.

• An open, supportive environment for clinicians

to discuss issues and concerns.

Future

Approach

Sociotechnical principles

• ‘moving away from a too-narrow focus on IT

• developing a better balance between national

requirements and local flexibility for grassroots

adaptability

• establishing the capacity and capability to support

effective handling of critical human and organisational

issues

• undertaking systematic reviews and evaluations’

Ref Peltu et al How a Sociotechnical approach can help NPfIT deliver better NHS patient care May 2008

RiO Mobile Pilot

• 2 Mobile Solutions / BlackBerry and PC laptop &

notebook devices

• RiO Store & Forward helps maintain existing assets

• Can work with RiO5 and later software releases

• Working with CSE to beta test RiO mobile for Blackberry

and RiO store and forward.

• Issues

• Standards e.g. content of the mental health electronic

patient record, national care plan.

• Clear recommendations on the functionality of systems

e.g. system usability scale.

• Payment by results in mental health e.g. meaningful

clinical outcomes.

• Opportunities

• Patient/Carer involvement.

• Facility to share information e.g. assessment documents,

care plans, procurements documents.

• Clinical Leadership e.g. Clinical Directors and Chief Clinical

Information Officer.

Informatics Committee

https://www.iwantgreatcare.org/

Social media

• ‘It took 100 years from invention of the telephone for it to reach 50% of UK households in the mid-1970s. Has the telephone radically changed medical practice?

• Facebook reached 50% of the UK population in 5 years. Will it be a more powerful disruptor?’

• http://www.gmc-uk.org/guidance/10900.aspDr Anne-Marie Cunningham (@amcunningham), a GP and Clinical Lecturer at Cardiff University

Chief Clinical Information Officer

Summary

• Information

• Communication

• Documentation

• Integration

• Continuous improvement

• Transparent

Acknowledgments

1. NE SHA informatics team


forum

Facing the future

Thank you for coming

Book now for the next meeting

e-health Insider CCIO workshop on 19 June 2012

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