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Medical Leadership, Complex Systems, Open Platforms
Dr Tony Shannon16th October 2015
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Tony ShannonM.B. B.Ch. B.A.O. UCD, IrelandFellow of College of Emergency Medicine England
Fellowship in Informatics USAMSc in IT Management England
(Clinical Lead, NHS Connecting for Health – National Programme for IT)
(Chair, Clinical Review Board, openEHR Foundation)
Consultant in Emergency Medicine, Leeds Teaching HospitalsChief Clinical Information Officer, Leeds TH/Leeds NHS & Social Care
Director, Frectal Ltd
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21st Century Healthcare
• Healthcare:
• Leadership: • Complexity: • Platforms:
• Change:
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• Pics x 2
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Medical Leadership
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• Ts 3rd UCD grad
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Complex Systems
1908
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Languages- Tower of Babel
• Medical• Management• Technical
• Cartoon... Very been confused in meeting?• Or • Who?
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Cynefin Framework
Snowden, D., Boone, M. (2007). "A Leader's Framework for Decision Making". Harvard Business Review: November 2007, pp 69–76.
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Complex Probe
10000 1000
Inate 10
Complicated Analyze
Chaos Act Simple Categorize
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Complex Adaptive Systems
• Many parts, Many interactions• Perpetual novelty
• Identify Patterns– e.g., Weather, Internet, Human Body, Healthcare– Self-organise
• Iterative, Evolutionary Change– Golden Spiral
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Referral in
Assessment
Plan CareDeliver Care
Referral Out
Operational (1 patient)
Strategic (++ patients)
Tactical ( > 1 patient) Resource management
Performance management
Key Patterns in Health Care
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NHS National Programme for IT
Thinking in silos Process versus IT Closed solutions
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NHS EDs – after 4 hour std
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Value = Quality ↑ Risk↓ Cost↓ Time↓
ATLS = People + Process + Tech
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Nebraska, 1976
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Open Platforms
1987
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Chamerlan 17th-18th C
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Leeds TH 200+
Enterprise Wide
System x
Common Web UI
Integration EngineESB
A B C
1
2
3
4
5
Core Process
Core Process
Core Process
Core Process
Core Process
Modular
SOA
Enterprise wide
System Y
Access/SQL
Current State of the HIT Market
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Healthcare Change: State of the EcosystemStandards: Vendors: Innovators: Disconnect
International Standards
Local Innovators
eHealth Bodies
& Vendors
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The Future
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5 Key Features of The Platform
• Usability• Integration• Clinical Kernel• Code & Community• Governance & Leadership
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#1 UI & Usability
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Leeds TH 200+
Enterprise Wide
System x
Common Web UI
Integration EngineESB
A B C
1
2
3
4
5
Core Process
Core Process
Core Process
Core Process
Core Process
Modular
SOA
Enterprise wide
System Y
Access/SQL
# 2 Integration
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#3 Clinical Kernel
• Clinically oriented• Reusable list of clinical
statements
• Maximal dataset• Can be coded with
terminologies
e.g. Pulse, BPLeeds Care Record datasetEnd of LifeKey contactsetc
• Computable
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#4: Code & Community
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# 5 Governance & Leadership
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NHS England 2011
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Leeds
Flickr.com/photos/62766743@n07
• 1 million population served• £800 million budget• 200,000 ED attendances• 14,000 staff• 600+ consultants• 300+ information siloes
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DevelopmentClinically LedUser CentredAgile Development
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The beginning...
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3 Key Levels
Single Patient Multiple PatientsClinical Intelligence View
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Single Patient View
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Multi-Patient View
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Aggregated Data View
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Single Patient View
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Single Patient View
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Virtual Ward View
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Collaborate : Innovate : Open Towards an open health & care platform
@RippleOSI www.RippleOSI.org
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Six componentsFoundation layer
Open Requirements
Open GovernanceOpen Citizen
Technical Platform
Open ViewerOpen IntegrationOpen Architecture
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# Clinical Kernel- Archetype
• Clinically oriented
• Maximal dataset– Can be coded with
terminologies
e.g. Pulse, BPKey contactsetc
• Computable
• Reusable
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Story re VA
• Ken Kizer pic & Best case anywhere
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21st Century Healthcare
International Standards
Local Frontline Innovators
National eHealth Bodies
& Vendors
Regional
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21st Century Healthcare
• Healthcare: Leadership Required
• Leadership: Doctor: Nurse: Manager• Complexity: People: Process: Technology• Platform: Open: Source : Standards
• Change: Think Smarter