Knowledge Driven Care – Realised Through TransformationKnowledge Driven Care – Realised Through Transformation

Dr Simon Wallace

Medical Executive

Cerner UK

Things to take note of…Things to take note of…

Supporting Staff with ready access to information

Shortage of staff

Information available when it will provide most benefit

Changing role of Radiologists

Changing role of Radiographers

Managing Risk

Clinical Governance

Integrated Care Pathways (ICP)

What Clinicians Do NOT WantWhat Clinicians Do NOT Want

Partial information (integration)Duplicate workflows and processes InconvenienceUnreliable ‘evidence’Many ways to do this incorrectly!

Start without integration Shift duties without improving

processes and safety Enable mistakes with greater speed

and scope Create complacency with ‘alert

overload’ Attention deficits due to

overconfidence

Cochrane Library

Medline

NICE

National Electronic Library for Health

University of York – NHS Centre for Reviews and Dissemination NHS Economic Evaluation Database DARE – Database of Abstracts of Reviews and Effects Effective Healthcare Bulletins

Healthcare Needs Assessment – epidemiologically based reviews

RCR protocols guidelines

BNF

Knowledge Resources

Reasons for Transforming Healthcare?Reasons for Transforming Healthcare?

Governments: UK

Modernisation Agency: “For the work [modernising the NHS] to be truly effective, it is essential that the current processes and procedures in the NHS are reviewed and tangibly and sustainably improved through a whole system approach to transformational change”

Wanless Report: “Success or failure [of the NHS Plan] will ultimately depend on how effectively the health service uses its resources.”

United States In the US by 2007, they will be spending nearly 17% of their GDP on

healthcare ($2.1 trillion)

Reasons for Transforming Healthcare?Reasons for Transforming Healthcare?

Healthcare organisations: Provide quality healthcare

Recruitment & Retention

Reduce waiting times – DoH targets

Improve capacity and throughput

Improved efficiency of resources

Meet clinical governance requirements

Provide ‘value for money’ services

Information returns

Reasons for Transforming Healthcare?Reasons for Transforming Healthcare?

Health Professionals

Deliver best practice quality care

Reduce Errors

Medical documentation at time of consultation

Improved Communication

Job Satisfaction

Extended role

Institute of Medicine (IOM) To Err is Human (1999) ; Crossing the Quality Chasm (2000)

During hospitalisation in the US as manyas a third of patients suffer from complications related to their 'care‘

80,000- 180,000 treatment related deaths in hospitals every year Apart from treatment deaths another 1.3 million people will be harmed Between 5% and 13% of hospital admissions result from the adverse effects of diagnosis

or treatment

70% of iatrogenic complications, are preventable Millenson, Demanding Medical Excellence, 1997; Sharpe and Faden, Medical Harm 1998; Leape, L., JAMA July 5, 2000)

Iatrogenic injury

Adverse Drug Reactions: Adverse Drug Reactions:

Bandolier – June 2002 www.ebandolier.com

Adverse drug reactions (ADRs) in hospital patients –

Affects 7% of patients or admissions in England

Responsible for 4 out of 100 hospital bed days

Estimated at 15-20 400-bed hospital equivalents

Consuming 4% of bed days available

Cost the NHS £380 million per year

How to TransformHow to Transform

The first step to take is Workflow Optimisation:

0 15 2

20

Errors are inevitable…Errors are inevitable…

A fundamental philosophy emerges:The most common failures are system errors involving drug knowledge dissemination, drug dosing, patient identity checking and patient information availability, suggesting inadequate systems, rather than individual inadequacy, as causes for error‘Physicians and nurses [healthcare professionals] need to accept the notion that error is an inevitable accompaniment of the human condition, even among conscientious professionals with high standards. Errors must be accepted as evidence of system flaws, not character flaws.’

Leape,L. JAMA, 1994

How can IT support care transformation? How can IT support care transformation?

Error prevention Reduced reliance on memory

Error proofing and constraints (order entry)

Standardisation/simplification (information and process)

Education, feedback, alerts, decision support

Potential error detection

Work-flow, work fulfillment and risk aversion programs

Efficiency with routine jobs Efficiency with routine jobs

Patient summary – A clearer picture!Patient summary – A clearer picture!

Inpatients – all I need………..again!Inpatients – all I need………..again!

Errors are avoidable…Errors are avoidable…

Patient: Seinfeld, Jerry

Diagnosis: Acute Myocardial Infarction

No order for beta-blocker

Evidence: www.zynx.com/zynxprd/cpc.asp?cndID=ami