Health Informatics 2014: A Clinical View
Professor Iain Carpenter and Professor Martin Severs
Brighton, 4th June 2014
Our World View• Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity. [WHO1948]– Why important? Because it is inclusive of disability [function]
and handicap [participation] as well as personal components of well being
• Informatics is the study of information and hence includes information processing, information systems and computer science– Why important? Because it includes professional practice
aspects of information, the interactions of professional staff and IT systems and the IT itself
CTO Council
Insight
What is Information – Anthony’s Triangle
Information is the result of processing, manipulating and organizing data. It is the context in which data is taken.
DATA
INFORMATION
KNOWLEDGE
WISDOM
An objective of knowledge management is to ensure that the right information is delivered to the right person just in time, in order to take the most appropriate decision.
Data – raw material for example, numbers, text, images, and sounds, in a form that is suitable for storage in or processing by a computer . Without context or specific meaning
Operational :- Collection, Recording Transactions External inputs
Tactical Planning:- Summarised operational data
Strategic Planning:– Information to support long term decisions
Wisdom is the knowledge and experience needed to make sensible decisions and judgments, or the good sense shown by the decisions and judgments made.
Steady State:- Resource/process Management modelling
Approach to the PresentationThe Citizen
The Patient
The Professional Information Technology [IT]
The Health & Social Care System
Approach to the PresentationThe Citizen
The Patient
The Professional Information Technology [IT]
The Health & Social Care System
Occupational Therapists
Health and Social Care19th Century
Hygiene and Engineers
Clean water
Sewers
Public Health
20th Century
Advances in Medical Science
Medical Cures
21st Century
Allied Health
Systemic disorders of aging; neurodegenerative disorders – balance and gait
Developed from: Dr Jane Tolman, Keynote speaker 7th National Allied Health Conference, Tasmania 20/07/07
Function, Dignity and Independence, Quality of Life
mortality
morbidity
The Citizen[Societal] CHANGE• Autonomy as the
dominant moral force• Personalisation• Choice• Openness and
Transparency• My data*
EFFECT• Stronger information governance,
right to object, privacy notices etc• Greater transparency on what is
happening to data• Transaction as opposed to
information services• Wider access to knowledge• Challenge to Big Data eg Care.data
& Little data the consultation
*The Immortal Life of Henrietta Lacks by Rebecca Skloot
The Patient & Service UserIOM report: Crossing the Quality Chasm: A new Health System for the twenty first millennium. (2001)
• Customisation based on patient needs and values. The system of care designed for the most common needs, but responsive to patient choices and preferences.
• The patient as the source of control. Patients have the necessary information and the opportunity to choose over the health care decisions that affect them. The health system should accommodate patient preferences and encourage shared decision-making.
• Shared knowledge and the free flow of information. Patients should have unfettered access to their own medical information and to clinical knowledge. Clinicians and patients should communicate effectively and share information.
The Patient & Service User
• ‘free flow of information’ & the patient as a source of control
• Do you share your letters with you patient? [DH Policy since 2004]
• Do you give patients record access to OT electronic records?
• How do you practice and record shared decision making?
• Do you enable on line completion of some OT assessments?
WHAT DOES THIS MEAN AS AN OCCUPATIONAL THERAPIST?
www.rcgp.org.uk/clinical-and-research/practice-management-resources/~/media/Files/Informatics/Health_Informatics_Enabling_Patient_Access.ashx
The Patient & Service User
• Customisation based on patient needs and values: new horizons?
• Are OTs the ‘go to’ profession for electronic environmental adaptation to enable people to:– Remember to take their tablets?– Remember to eat?– Sit down when going to loo?– Be helped remotely to take the
right food out of the fridge and prepare it for eating?
– Support distant carers with support and communication devices?
WHAT DOES THIS MEAN AS AN OCCUPATIONAL THERAPIST?
Perceived massive opportunities for OTs in this area both in terms of practice and research. This area of ‘medical device’ technology is poorly developed
The Patient & their care record• Can Citizens and Patients fully participate in their care
without access to their records?• Should (will?) routine and continuous record access
become the clinical and social norm?If so then
• Records must be accurate and contemporaneous and both human & machine readable in order to be
• citizen controlled • linked to knowledge sources and decision support
• Data standards must enable an individual’s health care information to be recorded as accurately and completely as necessary to be both human and machine readable
The Professional• The patient/professional relationship, based on trust, is the central
component of clinical care • Any healthcare system must support the relationship and the trust• Many factors conspire against it
– Time– Loss of tolerance and trust– Excess of expectation– Targets– Securing Trust income from secondary use data sets
• The care record is the core repository of all care information and must be accurate, contemporaneous and trusted or the relationship breaks down.
It is crucial OT informaticians put the patient first and the tax payer second
The Professional & the care record
• Two main topical subjects– Professional standards for record keeping– Sharing Data
www.theprsb.org.uk
Record standardsPatient and professional leadership
Ambulance care records
2. Entry, display and format for printing of content
1.Profession-based Record Standards
3. Electronic represent-ation, storage & transfer of content
Professional standards(also specify requirement for ICT development)
User interface standards
Architecture,archetype, terminology, message etc. standards
Profession-based record standards & IT Standards
Sharing Data• Sharing Personal and Confidential Data with and from
your patients is crucial to the quality of their care– The Information Governance review*: To share or not to
share, 2nd Caldicott Report, p35-49 - direct care– Remember the patient is king so if they give you consent
you are OK– Note you need to have a legitimate relationship to the
patient for direct care ie it does not cover a commissioning duty
– Also see NICE Clinical Guideline 138
* www.gov.uk/government/uploads/system/uploads/attachment_data/file/192572/29 00774_InfoGovernance_accv2.pdf
The Information Technology {IT}• IT in the Health and social care system in
England has evolved over time:– Talk about it being a good thing: 1970’s– Drive it through management information: 1980’s– Set the policy which is so self evident the NHS will
follow: 1990’s– Replace all with new IT [NPfIT]: 2000’s– Connect all in 2010’s [Dependent on Information
Standards]
ITMachines as an actor in care
Human to HumanHuman to Human (through Machine)
Machine as passive conduit
NOW
Human to Machine: NCR =SpineMachine to Machine: MessagingMachine & pt to EPR: Self care/TelecareMachine as actor : Decision Support
FUTURE [is now]
IT & the care record• Health and social care IT record systems MUST have
uniform data standards to minimise risk and ensure safety
• Essential features of data standards cover:Interoperability any data source must be able to
exchange data with any otherComparability meaning of data must be consistentQuality data must be collected consistently,
reliably, etc.
Care records & data standards• Data is only of use if it can be retrieved,
processed, presented, understood then acted on by the user in a timely manner
• Key data standards in the Health and social care include:– NHS (CHI) Number for the unique identifier– ICD 10 coding for statistical use of diagnosis in
mortality– OPCS coding for operations and procedures for
payment– SNOMED coding for clinical terms used in direct care
What does success look like?
Integrated Digital Health
Citizens & Patients
Professions
Health Organisations
Information Technology
Concluding Comments• Occupational therapy focuses on adapting the environment,
modifying the task, teaching the skill, and educating the client/family in order to increase participation in and performance of daily activities, particularly those that are meaningful to the client
• Informatics and IT is now integral to all of those domains• We hope this presentation has given an indication of what
health informatics can bring to your patients and your professional lives, how it can help develop your practice and careers, but more importantly, how it can enhance the care we all aim to give to our patients
THANK YOU