Download - Ten Lessons from NPfIT
Portugal – 1st International meeting on the electronic health record
** Experience from the UK **
26 November 2010
Matthew Swindells
Chair of the British Computer Society, HealthVisiting Professor, Surrey University School of Management
Vice President Global Consulting, Cerner Limited
Former CIO for the English National Health Service
Disclaimer and Declaration
• This is a personal view
• I am not representing policy on behalf of:
– The NHS or NHS Connecting for Health
– Any other government body UK or otherwise
– Cerner
– BCS
• I now work as Vice President for Cerner Limited, a global health IT Supplier
An English Project
Wales
ScotlandX
X
Northern IrelandX
Some highlights of the delivery
NHS network
Secure application
serversEncrypted email
National indexes Data
standards
Technical standards
4 prime contractors
Hospitals GPs Community and Mental Health
PACs SUS
Later reduced to 3 then 2
Two solutionsiSoft
Cerner(replace IDX)
Choice from an approved list
New products developed
100% coverage –saved more than
forecast
Hub to standardise
measurement and transactions
Spine and SCR
Choose and Book
GP to GP transfer
1. Healthcare is never a stable environmentPolicy and medical practice changes are a fact of life
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Pervasive national electronic infrastructure (N3)
2002
1994
1998
IM&T Strategy for the NHS
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Pervasive national electronic infrastructure (N3)
Original Scope Additional ScopeKey:
Commissioning Payment by Results Plurality of provision
2. Remember it’s about improving healthcareFocus on delivering information and improvement not technology
Years ago Today
This gap
injures patients
Knowledge processing capacity
Knowledge processing requirement
“Current medical
practice relies
heavily on the
unaided mind to
recall a great
amount of
detailed
knowledge – a
process which, to
the detriment of
all stakeholders,
has repeatedly
been shown
unreliable”
Crane and Raymond
The Permanente
Journal Winter 2003 Volume 7 No.1
Kaiser Permanente Institute for Health
Policy
Challenge – Clinical Knowledge-Processing Burden
A study published in British Medical Journal in 2004 concluded that:
• 1 in 16 hospital admissions are the result of an adverse drug reaction – 76% avoidable.
• This equates to 4% of hospital bed capacity At any one time 7 x 800 bed hospitals are occupied by patients admitted with ADRs. Cost = £466m annually –
• Patient harm and £354m expenditure avoidable by putting in place e-prescribing ?
[1] Pirmohamed, M. et al: Adverse drug reactions as a cause of admission to hospital: prospective analysis of 18,820 patients: BMJ 2004; 329: 15-19
3. Acknowledge and confront public fearsMake the benefits argument - the media doesn’t help!
NHS porters and cleaners can snoop on your medical recordsDaily Mail 26-Mar-2010
'Big brother' health databaseDaily Mail 11-Oct-2010
4. Ensure local ownership and build capacityYou can’t nationalise responsibility
5. Deliver clinical functionality earlyWhat’s in it for the clinical staff?
6. Redesign and improve the serviceComputerisation of poor process solves nothing
7. Be rigorous about standardsData, integration and semantics are all important
• Terminology: SNOMED CT http://www.ihtsdo.org/
• Drug Database: dm+d http://www.dmd.nhs.uk/
• https://www.uktcregistration.nss.cfh.nhs.uk/trud/
• Professional Record Keeping: http://www.rcplondon.ac.uk/clinical-standards/hiu/medical-records
• Professionalism: UKCHIP http:www.ukchip.org.uk
• Definitions: i.e. ‘Allergy’ and ‘Current Medication’
• Messaging: HL7 v3 http://hl7.org
• Logical Architecture / Archetypes: http://www.connectingforhealth.nhs.uk/systemsandservices/data/lra
• Knowledge and Knowledge Authorship:
• Device Interoperability: www.continuaalliance.org
• User interface design: www.cui.nhs.uk
• Open Health tools: www.openhealthtools.org
What is the date Wednesday next week?
• It will be the 1st of December 2010• UK 1/12/10• US 12/1/10• Sweden 10/12/1
• So in health it’s 01-Dec-2010and that’s final !
• By doing this I just reduced the number of errors it’s possible to make for 12 days a month.
How many times do these need to be invented globally ?
Adopt what’s already there and be rigorous about enforcing it.
No competition on standards!
8. Invest in the infrastructureYou’ll think of new things to use it for
NHS network
Secure application
serversEncrypted email
National indexes Data
standards
Technical standards
Spine and SCR
Choose and Book
GP to GP transfer
Thousands of NHS medical records lostDaily Telegraph
Central Expertise
9. Use more than one vendorCompetition future proofs your investment
10. Be Brave
“Culture eats strategy for breakfast”
Some times you feel as if you are fighting 100 years of operational practice on your own!
Ten lessons6. Redesign and improve the service
• Computerisation of poor process solves nothing
7. Be rigorous about standards
• Data, integration and semantics are all important
8. Invest in the infrastructure
• You’ll think of new things to use it for
9. Use more than one vendor
• Competition future proofs your investment
10. Be brave
• This is really hard. Change is hard. The technology is difficult. Can you imagine a health service where we don’t confront this challenge
1. Healthcare is never a stable environment
• Policy and medical practice changes are a fact of life
2. Remember it’s about improving healthcare
• Focus on delivering information and improvement not technology
3. Acknowledge public fears
• Make the benefits argument
4. Ensure local ownership and build capacity
• You can’t nationalise responsibility
5. Deliver clinical functionality early
• What’s in it for the clinical staff?
** Experience from the UK **
Questions
Matthew Swindells
Chair of the British Computer Society, HealthVisiting Professor, Surrey University School of Management
Vice President Global Consulting, Cerner Limited
Former CIO for the English National Health Service
[email protected]+44 7961 557556