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