planning to practice knowledge-driven healthcare solutions, rcp, 2007

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Planning to Practice

Knowledge-driven healthcare solutions, RCP, 2007

Dr. Mike Stein – Medical Director

October 2007


•Framework for sharing clinical knowledge across care settings

•Evidence based care pathways available to clinicians at the point of care

•Localizable benchmark for clinical processes


Outline

The Doctor’s journey – 2 min

The Patient’s journey – 2 min

A tool to mediate many dialogues – 5 minDemonstration and integration with clinical systems

Lessons learnt to date – 3 min

Current and future developments – 2 min

Q & A


The Doctor’s Journey


• Information and technology overloadGrowing information base

• Specialty silos

Communication issues

• Clinical governancePlethora of guidelines, no standard format

Trainees, locum and agency staff

• Increasing patient safety issues Less patient time, more referralsMedical errorsRising cost of claims

PROBLEMS IN HEALTHCARE

* Guidelines in general practice: the new Tower of Babel? BMJ 1998;317:862-863 ** Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment. BMJ 1998;316:509-513


The Patient’s Journey


Courtesy of Professor Bill Runciman, APSF; Data extracted from AHRQ 2006 report


UK and Australia

Wrong plan nearly 50% of the time

Harm patients in 10% of admissions; half preventable

The harm is permanent or severe with 2% of admissions

Death is associated with the harm in 1/300 patients

Data courtesy of The Healthcare Commission Survey (2006), Professor Jeff Richardson, CHE, Monash University, Australia and Harrison W et al. The effectiveness of healthcare systems in the UK – scoping study; Department of Public Health and Epidemiology, University of Birmingham, 2006


Getting evidence into practice – our NHS journey


Power of Evidence – driving more effective and efficient healthcare delivery

80% of physicians changed their care as a result of evidence*

as follows:

– Avoided hospitalisation in 12%

– Reduced overall length of stay in hospital in 19%

– Changed diagnostic tests in 51% and drug choices in 45%

– Avoided additional tests or procedures in 49%

Adhering to evidence-based guidelines for treating hypertension alone could save at least $1.2 billion annually in US**

Sloan-Kettering – most effective and efficient [Risk adjusted mortality from cancer against length of stay for institutions in NY State***]

* Marshall J G. The impact of the hospital library on clinical decision making: the Rochester study. Bull Med Libr Assoc. 1992 April; 80(2): 169–178** Fischer MA, Avorn J. Economic implications of evidence-based prescribing for hypertension: can better care cost less? JAMA 2004;291:1850-6.***BMJ 2005: 330; 530-533 “What can the UK and US health systems learn from each other?” Lois Quam and Richard Smith


MAP OF MEDICINE OVERVIEW


MAP OF MEDICINE HISTORY

1999 2001 2003 2005 200720062004

First pathways created

Graphical Tree display created

South

East &

North East

Wales

mobile Map

2008

MMSMap Display

Integration

North West/

West Midlands

London


Current position


Map Display usage data from a Local Healthcare Community

The user profile chart is based on 2249 users registered on the Map of Medicine from 3 early adopter sites in Wales

Allied Health Professional

Emergency Services

General Practitioner

Health Science Services

Junior Doctor

LibrarianNurse or Midwife

Personal Social Services

Pharmacist

Professional Manager

Senior Doctor

Student AHP

Student Medical

Unknown

Administrative ServicesStudent Nursing

Support Services


ImplementationAll data up to and including September 30th - does not include data from CSC hosted service (approx 3000 users.

Registered Users/Sessions

17

89

19

21

21

80

24

55

27

50

29

99

34

50

40

87

45

69

0

1000

2000

3000

4000

5000

1 2007 2 2007 3 2007 4 2007 5 2007 6 2007 7 2007 8 2007 9 2007

MonthUser Sessions Total Users


Lessons learnt to date

Cochrane: Over 2,500 studies assessed (1997 – 2007) plus our own experience - take home messages

1. Tools: Localizable guidelines; allow local communities to set priorities; feedback and audit

2. Integrated: Accessible (clinical workflow); system-wide

3. Communications: Local senior clinicians are crucial supporters

4. Leadership: To drive standards and responsive regulation


1. Leadership - senior clinical, administrative and political engagement

CollegesNHS Institute for Innovation and ImprovementIHC WalesNICE National directorsLicensing authorities - GMC, Health CommissionNPfIT and CfH

2 . Communications

Clinician and management channels [about to start]

3 . Integration

Clinicians workflow, enterprise-wide


Systems integration

Integration with clinical systems– Easy access from clinical workflow– Triggering actions within EPR systems

Mobile Map of Medicine:Making the Map of Medicine Mobile– Developing world– UK

Drug information and e-prescribing– Access to drug information– E-Prescribing

Healthcare planning and managementIntegration with profiling and simulation tools


4. Local priorities

Demonstration


Thank you!

[email protected]

planning to practice knowledge-driven healthcare solutions, rcp, 2007

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