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Will informatics deliver integrated care? SIHI Conference 10th September 2014
Martin Severs, Clinical Professional Lead and Caldicott Guardian
HSCIC:
Who are they?
Are they part of the NHS?
2
August 2014: Work by MORI on behalf of NHS England
What we do
We set standards that protect
patient’s confidential information, reduce
bureaucracy and improve data quality
We operate essential technology services
that support the health and care system
We collect, analyse and publish
national data and statistical information
that helps inform decision making
We develop the next generation of
national data and information systems
Who we are
What we do
NHS Mail
600,000 registered
users
GP2GP
89% of clinicians
agree it improves
patient experience
The Spine
Contains 80
million records
NHS Choices
Handles 29 million
enquiries a month
Electronic
Prescription
Service
Potential to save the
NHS £179M a year
Informing public
discussion
3,000 news stories
used our statistics
What we do
GP Payments
Service
Calculates and pays
over £7.2 billion
annually
Choose and Book
50 million patients
referrals reached
Statistical
reports
220 statistical
reports published
Screening
Helps to detect over
13,500 invasive
cancers
National Back
Office
Manages accuracy
of 6.3 million
transactions
What is health informatics?
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• Health Informatics in the UK is defined as:
• … the knowledge, skills and tools, which
enable information to be collected, managed,
used and shared to support the delivery of
healthcare and promote health” (‘Making
Information Count’,
• A Human Resources Strategy for Health
Informatics Professionals, Department of
Health 2002)
What is integrated care?
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• Integrated care – also known as integrated health, coordinated care, comprehensive care, seamless care and transmural care – is a worldwide trend in health care reforms and new organizational arrangements focusing on more coordinated and integrated forms of care provision. Integrated care may be seen as a response to the fragmented delivery of health and social services being an acknowledged problem in many health systems
• Ref: Wikipedia
What is integrated care?
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• WHO gives the following definition:
• Integrated care is a concept bringing together inputs, delivery, management and organization of services related to diagnosis, treatment, care, rehabilitation and health promotion. Integration is a means to improve services in relation to access, quality, user satisfaction and efficiency
• Gröne, O & Garcia-Barbero, M (2002): Trends in Integrated Care – Reflections on Conceptual Issues. World Health Organization, Copenhagen, 2002, EUR/02/5037864
Will health informatics deliver integrated care?
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• Necessary but not sufficient
• Discuss 7 additional considerations that will make it more likely that health informatics will be able to deliver integrated care – Autonomy
– Commercial sector
– Person as an actor
– Small data
– Big data
– Standards particularly data standards
– Finance
Autonomy
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• Autonomy is the dominant moral force in
westernised society
– Policy: Choice, openness, transparency
– ‘Me’ and ‘my’: health, record, body, decisions
– Control: When and where I need it
• Major Impacts
– Record access ► patient recording
– Complex IG rules ► national consent system
– General choice ► Choice for my situation
Autonomy
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Commercial sector
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• Commercial Sector produce useful products
and services for you and me
– Apps
– Medical devices [with embedded software]
– Analysis services
– Data processor services
• Major impacts
– Them & us ►rich ecosystem
– Public provision ► enabling Public and private
– Relative stagnation ► Dynamic innovation
3rd Party Dependency What else is required?
• Education – Implementors
– End users
• Tools
• Knowledge / Rule bases
• Data Acquisition – User interfaces
– Quality measures and CQI activities
• Localisation – Translation
– Cultural adaptation / extension
Terminology
Tools
Education
Localisation
Person as an actor
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• Person as an actor – Improving health
– Managing illness
– Reducing health and social care costs [direct and indirect]
• Major impacts – Prescribed education & rise of apps/medical devices
with software embedded
– Compelling cases [time, access, convenience etc]
– Shift in data source and control and Doctor-Patient relationship
Small data
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• Small data [the forgotten component]
– About data about each of us as individuals
– About our direct care and the staff that care for us
– About letters, discharge summaries, etc
– About decision and knowledge support for front line
staff
• Major impacts
– Focus on quality of care via quality of record
– ICT as a tool for clinicians not a master
– Major socio-technical revolution in usability in real life
to support better care not divert clinicians away from it
Big data
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• Big data – find more effective ways of preventing or managing
illnesses;
– advise local decision makers how best to meet the needs of local communities;
– promote public health by monitoring risks of disease spread
– map out pathways of care to streamline inefficiencies and reduce waiting times
– determine how to use NHS resources most fairly and efficiently
– Open up a whole new stream of research around complex medical conditions or simple conditions and complex treatments or both!
– Ascertain new and important relationships between genomics and illness & outcomes
Standards
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• Standards especially data standards – All talk and no action
– Failure of decisions associated implementation is costing too much
– Value from investment is impaired and failure prevents a stable platform for innovation
• Major impacts – Consensus to consortium standards
– Local idiosyncratic to international
– Push to pull [Professions, Policy, Finance, IT]
– Crucial for integration of service
Clinical Terminologies & other data standards:
Who are they for?
Human to Human
Human to Human (through Machine) Machine as passive conduit
NOW
eMachine as active agent : DSS
EPR as Knowledge Representation
Terminology as software component
FUTURE
Finance
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• Finance
– Gaining better value from investment
– Reduce costs [NHS consuming GDP by 2030]
– Reduce waste of needless duplication
• Major impacts
– ICT to improve care performance
– ICT to shift activity from staff to patients
– ICT to deliver health promotion to reduce long terms costs
– Invest now to save later
Good information is an important part of making sure people stay healthy and get the best care
The Power of Information, Department of Health