Electronic medical records and personal digital assistants:
ensuring patients get the right treatment
David Morgan
ENT Consultant
Heart of England Foundation Trust and Founding Director of Safe Surgery
Systems
EMRs and PDAs – Ensuring patients get the right treatment
Technology in HealthcareTechnology in Healthcare
Improve patient safetyImprove patient safety Improve hospital efficiencyImprove hospital efficiency Save time and easy to use (2 clicks)Save time and easy to use (2 clicks) Not tied to hardwareNot tied to hardware Integrate with other systems (HL7)Integrate with other systems (HL7) Practical examplesPractical examples
eHealth Award Winner 2005
It’s a matter of It’s a matter of Patient Safety…Patient Safety…Public confidences of ‘wrong’ failures can be devastating for all involved, (patients, professional, organisational and personal reputations)
Systems failures or communication breakdowns
Adverse Events – NPSA DataAdverse Events – NPSA Data
Currently 60-80,000 per monthCurrently 60-80,000 per month Total in NPSA database > 1,000,000Total in NPSA database > 1,000,000 Between Feb 06 and Jan 07 more than Between Feb 06 and Jan 07 more than
24,000 reports received of patients 24,000 reports received of patients misidentified and mismatched with caremisidentified and mismatched with care
Nearly 3,000 related to wristbands and Nearly 3,000 related to wristbands and their usetheir use
Incidence in USAIncidence in USA
3 reports every 2 days 3 reports every 2 days 40% errors ‘reached’ patient40% errors ‘reached’ patient 20% completion of WSS20% completion of WSS No reduction in WSS since publication ofNo reduction in WSS since publication of
Joint Commission’s guidelines Joint Commission’s guidelines
VTE ProphylaxisVTE Prophylaxis
PreventablePreventable Risk assessmentRisk assessment AuditAudit
Responsibility for Patient SafetyResponsibility for Patient Safety
Common Law offence within the criminal court Common Law offence within the criminal court structures and non-insurable.structures and non-insurable.
Incident referred to Police and staff interviewed Incident referred to Police and staff interviewed under cautionunder caution
If gross failure in health and safety management If gross failure in health and safety management found – Trust board risk criminal prosecutionfound – Trust board risk criminal prosecution
CEO assumes overall responsibility; however, all CEO assumes overall responsibility; however, all directors have a 'collective responsibility'directors have a 'collective responsibility'
Corporate Manslaughter and Corporate Homicide Act 2007 Corporate Manslaughter and Corporate Homicide Act 2007 comes into effect on 6 April 2008comes into effect on 6 April 2008
Patented system using combination of Smart wristband tags and Patented system using combination of Smart wristband tags and digital photographs to:digital photographs to:
Improve safety, prevent misidentification and Improve safety, prevent misidentification and reassure patientsreassure patients
Improve Theatre efficiency and reduce waiting Improve Theatre efficiency and reduce waiting times by managing patients and beds bettertimes by managing patients and beds better
Save Clinicians’ time by reducing manual input Save Clinicians’ time by reducing manual input and coding workload.and coding workload.
Theatre Efficiency – 1Theatre Efficiency – 1stst 3/12 3/12
SurgeonSurgeon BeforeBefore After After IncreaseIncrease
AA 84.4%84.4% 98.5%98.5% 16.6%16.6%
BB 76.2%76.2% 95.7%95.7% 25.6%25.6%
CC 83.4%83.4% 87.2%87.2% 4.6%4.6%
DD 77.2%77.2% 80%80% 6.2%6.2%
ALLALL
AverageAverage 69.3%69.3% 79.6%79.6% 14.9%14.9%
HEFT Implementation 2007+HEFT Implementation 2007+(4 theatres and 4 wards)(4 theatres and 4 wards)
Non RFID theatres – 6 WSS in 3/12Non RFID theatres – 6 WSS in 3/12 RFID theatres – 4 WSS cases preventedRFID theatres – 4 WSS cases prevented Usability feedback – DVT assessmentUsability feedback – DVT assessment Patient feedback (5,000+)Patient feedback (5,000+) Correctly codes - PBRCorrectly codes - PBR Hospital promotion – patient choiceHospital promotion – patient choice ROI – 6/12ROI – 6/12
Electronic Patient Record FormElectronic Patient Record Form
Electronic Patient Record FormElectronic Patient Record Form
Rugged Tablet PCRugged Tablet PC
Mobile wireless connectionMobile wireless connection
Simple Touch Screen ‘buttons’Simple Touch Screen ‘buttons’
Data entered in any orderData entered in any order
Prompts for data relevant to incidentPrompts for data relevant to incident
Configure to meet Service needsConfigure to meet Service needs
Patient Record FormPatient Record Form
On trial with Air AmbulanceOn trial with Air Ambulance
Warwickshire Air Ambulance Warwickshire Air Ambulance connecting to Heartlands and Walsgrave Hospitalsconnecting to Heartlands and Walsgrave Hospitals
Electronic Patient Record FormElectronic Patient Record Form
Call DataCall Data Incident DataIncident Data Clinical DataClinical Data Diagrams of injuries, Diagrams of injuries,
site and vehiclesite and vehicle Decision SupportDecision Support ““Attack Alert” buttonAttack Alert” button
A&E Workstation ViewA&E Workstation View
1st Responders & Paramedics at scene
Ambulance or Staging area
Control Rooms
A&E Departments
Tagged Triage Cards
Award 2005Award 2005
ClinicalClinical Decision SupportDecision Support Portable Access to Medical InformationPortable Access to Medical Information Suitable for PDA / Laptop / Tablet PCSuitable for PDA / Laptop / Tablet PC Piloted at Birmingham Heartlands Piloted at Birmingham Heartlands 50 Tools & Calculators50 Tools & Calculators 60 ECG Trace Library60 ECG Trace Library 30 Heart & Lung Sounds30 Heart & Lung Sounds Departmental GuidelinesDepartmental Guidelines
CalculatorCalculator
Coroners Study Findings – 2005Coroners Study Findings – 2005
30 HEFT Juniors in 4 Specialties30 HEFT Juniors in 4 Specialties Time allocated: Time allocated:
50% said ‘None’ 50% said ‘None’ 50% said ‘30min’50% said ‘30min’
Official time allocated: Official time allocated: 2 of the 4 specialties said ‘None’2 of the 4 specialties said ‘None’
Written handover:Written handover: 23% said ‘Yes’23% said ‘Yes’
Patient list handover:Patient list handover: 50% said ‘Most of the time’50% said ‘Most of the time’
Is practice satisfactory?Is practice satisfactory? 33% said ‘No’33% said ‘No’
Coroners Study/HEFT SurveyCoroners Study/HEFT Survey
Uses PDA / Laptop / Tablet PCUses PDA / Laptop / Tablet PC Linked wirelessly to Server based applicationLinked wirelessly to Server based application Process manages Handover of Tasks and PatientsProcess manages Handover of Tasks and Patients Maintains Audit trailMaintains Audit trail
Lord Darzi (Our NHS-Our Future)Lord Darzi (Our NHS-Our Future)
Fair – equally available to allFair – equally available to all Personalised – tailored to needs of Personalised – tailored to needs of
individualindividual Effective- focused on delivering outcomesEffective- focused on delivering outcomes Safe – giving patients confidenceSafe – giving patients confidence
Care in Chair SystemCare in Chair System
End-to-end prescribing and monitoring solutionEnd-to-end prescribing and monitoring solution Tailored to each patients’ monitoring needsTailored to each patients’ monitoring needs Deployed on mobile platformDeployed on mobile platform Bluetooth Device OptionBluetooth Device Option Clinically ValidatedClinically Validated Data analysis using ANN optionData analysis using ANN option
Prescribing Tele-monitoring Prescribing Tele-monitoring PackagePackage
Mobile ComponentMobile Component
Tele-monitoring resultsTele-monitoring results
Lack of Adoption of TechnologyLack of Adoption of Technology
NHS historically poor at adopting NHS historically poor at adopting technology vs HCWtechnology vs HCW
Strategic/Tactical/Operational viewsStrategic/Tactical/Operational views CfH programme – contracts NOT solutionsCfH programme – contracts NOT solutions Finance – rule of thirdsFinance – rule of thirds Decision making process flawedDecision making process flawed Procurement processProcurement process
Email: [email protected]: www.safesurgerysystems.com
