www.ychi.leeds.ac.uk

Leeds Institute of Health SciencesYorkshire Centre for Health Informatics

Informatics

• Informatics includes the science of information, the practice of information processing, and the engineering of information systems

• Informatics studies the structure, behaviour, and interactions of natural and artificial systems that store, process and communicate information

• It also develops its own conceptual and theoretical foundations

• Since computers, individuals and organisations all process information, informatics has computational, cognitive and social aspects, including study of the social impact of information technologies

• Understanding the fundamental nature of information and communication systems, and describing the practices that shape them

• Developing interventions which can improve upon existing information and communication systems

• Developing methods and principles which allow such interventions to be designed

• Evaluating the impact of these interventions on the way individuals and organisations work, or on the outcomes of such work

Enrico Coiera, 2003

Health Informatics

Complexity – systems

Scale

Human factors

Standards

Ownership of data

Data entry

Integration

Ethics

Decision Support

Evaluation

Politics

Broad Themes

• 11% of lab tests repeated– Because result is lost

• 30% of treatment orders are undocumented

• 70% of acutely ill patients get right treatment– 30% get contraindicated treatment

• 500% growth in number of new drugs in a decade

Health Informatics – WHY?

One doctor’s clinic….…one patient’s notes

Images: Mike Bainbridge

One Doctors Clinic……..

……..One patients notes

Health Informatics – WHY?

• Increasing patient expectation and education– Increasing litigation

• Demand for transparent processes– Clinical governance and audit

• Unmanageable Information burden– Approx 100 articles published in 1966 from RCTs – Over 10,000 annually by 1995 (Chassin 1998)– ‘The scarcely tolerable burden of information that is

imposed taxes the memory but not the intellect’ (GMC 1993)

Health Informatics – WHY?

Health Informatics – WHY?

• Spiralling health care costs– Developed world in 2002:

• USD 3 Trillion on 1.2 billion people• 11% of GDP• e.g. $5.5M in 37 Days on one patient (Duke University)

– Per capita health cost inflation: 8% per year• Population expansion • Demographic shift• New advances

• No visible means of control

Systemisation

“There is now consensus that a systematic approach to health informatics – the acquisition, management and use of information in health – can greatly enhance the quality and efficiency of medical care and the response to widespread public health emergencies”

“Health and biomedical informatics encompass issues from the personal to the global, ranging through from medical records for individual patients, to sharing data about disease outbreaks among government and international health organisations. Maintaining a healthy population in the 21st century will require systems engineering approaches to redesign care practices and integrate local, regional, national and global informatics networks.”

‘American Association for the Advancement of Science, 2008’

Systemisation

The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade.

It can prevent and minimise the seven ubiquitous healthcare problems:

• Errors and mistakes• Poor quality healthcare• Waste• Unknowing variations in policy and practice• Poor patient experience• Over-enthusiastic adoption of interventions of low value• Failure to get new evidence into practice

Sir Muir Gray, Director of Knowledge, Process and Safety, NHS CfH, 2005

Health informatics

A History: The 50s & 60s

1959 Ledley “Reasoning foundations of medical diagnosis”

1960’s onward – Barnett “Mumps”First version had 4k core and 1k for each of 4 users. Everything stored on tape (1 per patient).‘Great day’ when got first hard disk, storing 30k

1961 Methods Information Medicine Vol 11964 National Library of Medicine adopts Medlars /

Index Medicus1969 Weed “Problem-oriented medical record”1969 World’s first Electronic Patient Record

Nursing system, Kings College London

Systems predominantly for payroll, or pathology

High volume

Repetitious

Rule-based processing (of numerical data)

Systems predominantly for payroll, or pathology

High volume

Repetitious

Rule-based processing (of numerical data)

Health informatics

A History: The 70s

1970 World’s first real-time GP system(Whipton, Essex)

1972 de Dombal “Computer-aided diagnosis of abdominal pain”. Anderson King’s College Hospital record system.

1974 First Medinfo conference, Stockholm.1976 EMI scanner1979 Founding of IMIA

International Medical Informatics Association

Systems still mainly finance or pathology

Data Processing becomes ‘computer systems’

Early steps to manage and control IT in healthcare

First hints at potential for better information to upset apple cart:Protti told by CEO not to collect prescribing data at physician level

Systems still mainly finance or pathology

Data Processing becomes ‘computer systems’

Early steps to manage and control IT in healthcare

First hints at potential for better information to upset apple cart:Protti told by CEO not to collect prescribing data at physician level

1970: A moment in history…

1970 Delivery of fastranII main backing store for 418/III at The London Hospital: Capacity 132 Mb.

Health informatics

A History: 80s and 90s

1981 BCS PHCSG Founded1982 Micros for GPs scheme1983 READ codes1983 BJHC Launched1984 Korner report, UK1986 HIMMS1986 BMIS Founded

1990 AMIA Founded1990 Wessex IT Scandal (£63M)

1990 HL7 v 2.11991 First steps to HL7 v 3.01991 GP system RFA11992 London Ambulance

Despatch System Disaster1993 Cochrane collaboration1994 UMLS1994 JAMIA1999 Information for Health

1990s1980s

First integrated Hospital Information Systems

Shift to clinical systems

Goal now to improve quality of care

First integrated Hospital Information Systems

Shift to clinical systems

Goal now to improve quality of care

Health informatics

Recent History

• 2000– Electronic Record Development and Implementation Programme

• 2002-2003– Wanless Report

– SNOMED CT (Systematized Nomenclature of Medicine)

– National Programme for NHS IT (CfH)

– Integrated Care Record Service

– UK Council for Health Informatics Professionals (UKCHIP)

• 2005– NHS Faculty of Health Informatics

• 2007– Global eHealth agenda – “one of the 21st century’s greatest challenges”

Health Informatics

Best Practice in 2005

• Denmark– 85% of health sector integrated within single system– 2 million messages a month– Central database of all prescriptions and all lab tests

• New Zealand– 75% of health sector integrated– 3 million messages a month

• Veterans Administration– $21 billion, covering 25 million servicemen & families– Highest score in every category of quality assessment in 2003– Care based on VISTA, enabling Continuous Quality Control– Cost per patient static over last decade (all other US providers 50%)

National Programme for IT

By 11 January 2008, NHS Connecting for Health had delivered the following:

• 431,607 NHS staff registered to use the NHS Care Records Service

• 150,563 Summary Care Records have now been uploaded to the Spine

• 60,032,654 prescription messages transmitted using the Electronic Prescription Service (EPS)

• 6,757,586 bookings made using Choose and Book

• Over 525 million images created and stored using Picture Archiving and Communications Systems (PACS)

• Fast, reliable broadband access provided by N3 for 21,482 NHS locations

supporting over 1.2m staff

• 313,240 NHS staff registered to use the NHSmail email and directory service.

Health Informatics

Into the future

• New Focus– Clinical Data Repositories– Surrounded by rule-based alerts and Decision Support Systems

• New Technologies– Designer Drugs and Bioinformatics– Wearable Computing and RFID– Wireless Connectivity and New portable formats

• New Users– Patient Empowerment and Intelligent Agents

• New Drivers– Patient Safety– Regulation and Accountability of Solutions

Yorkshire Centre for Health InformaticsWhere did we come from?

• Health Informatics in Leeds since early 1970s(Clinical Information Science Group, Professorial Surgical Unit at LGI and SJH) – Undergraduate teaching and research into clinical decision

support systems (funded by MRC, DH, US Navy)

• 1986-96 Clinical Information Science Unit

(22 Hyde Terrace)

– research into implementing and evaluating CDSS. Multicentre trials in NW Region (6 centres), England (8 centres) and EU (64 centres). International surveys for World Organisation of Gastroenterology (IBD, AAP, UGIB). Project Leader for 3 major EU funded projects

Yorkshire Centre for Health Informatics

• 1997 Yorkshire Institute of Clinical and Health Informatics (26 Clarendon Road)

– Virtual Centre, Foresight Initiative DH&DTI

• 2003 Yorkshire Centre for Health Informatics (24 Hyde Terrace) – SRIF funding (£250,000)– UoL Informatics Project (Computing, Business, Geography, Health)

Informatics BSc and MSc– EU and DH funded projects– NPfIT started

• 2005– HEIF 2 Funding, growth in Knowledge Transfer activities,

• Accenture Health Innovation Centre• Courses for NHS Informatics Professionals and IT Health Industry

YCHI Objectives

• To be a focus for Health Informatics activity, developing partnerships with NHS organisations, industry and other academic disciplines

• To develop knowledge through multidisciplinary research

• To facilitate enterprise and knowledge transfer, bridging the gap between research and healthcare informatics

• To develop agreed 'best practice' and quality assurance within health informatics processes

• To disseminate 'best practice' through education and training

• To enhance the profile of Leeds as a centre for Health Informatics nationally and internationally

YCHI Aspirations• Objectives:

– The leading centre in UK (Europe)– Influence national (international) policy (WUN)– Contribute to local economy

• How:– Informatics literate medical graduates– Health literate technical graduates– Build R&D base for HI – metrics & methods– Multidisciplinary - Health, Computing, Business, Social Science – External partnerships with NHS and Industry

• Connecting for Health (NPfIT)• Yorkshire and the Humber SHA, LTHT, BTHT, C&HT• Innovation Centre – CSC Alliance, Intel, Microsoft

People

• Dr Susan Clamp• Dr Rick Jones • Owen Johnson• Liz King• Ruth Evans• Sue Davis

Student support:• Tom Crocker• Steve Box• Richard Gillott• Mohammad Qasim Hussain

Core Activities• Teaching

– Undergraduate Medicine – informatics in the curriculum– Undergraduate - Computing for Medicine– MSc Health Informatics

• Research– Decision support– Health systems– Health outcomes– Screening

• Knowledge Transfer / Innovation– Industrial links– NHS Policy & Innovation– Spin outs & Proof of concept– CPD – Master class programme for regional informatics directors

Teaching

• Informatics BSc (modules on Computing degree) – ends 2009

• Health Informatics MSc www.ychi.leeds.ac.uk/msc/

• Undergraduate Medics – PPD Year 1(IT Skills Course), Year 2 (Medical Information Management), SSCs Years 1,2,3

• CIS in PC project (£50,000 from Bradford TPCT)

• New UG Curriculum – Informatics major part, Virtual hospital

2010 - Core outcomes of the professional spine

• Underpinned and supported by a virtual health community

• Paralleled with early, integrated clinical exposure (developing behaviours and attitudes)

• Series of core (generic) skills used to blueprint speciality content

• Delivered as individual topics, or integrated throughout the course

• Supported by a spiralling life cycle course

ClinicalReasoning

&DecisionMaking

Consultation,Clinical

&Diagnostic

Skills

IT & Informatics

Virtual Hospital +GP Surgery

Virtual PatientCommunity in

parallel with clinicalexposure

Professionalism,Ethics

&Medico-legal

MedicinesManagement

&Safety

CPD, CareerManagement

&Learning/Teaching

Skills

Research,Critical

Appraisal&

EvaluationSkills

Business,Leadership,

Management &NHS

‘Processes’

SSCProgramme,Intercalation

&LURE

Research Activity: examples• www.ychi.leeds.ac.uk/ychi/res_background.aspx

• Evaluation of use of new technologies in healthcare– Information support for informed decision-making - AAPHelp– Mobile devices in A&E – legacy systems integration– Open architectures in pathology test data exchange– Multimedia presentation & simulation

• Health training– Costs and benefits of electronic health systems– Health systems organisation– Research database links to clinical systems

• Antenatal health screening– Biochemistry – risk modelling and performance prediction– Ultrasound biometrics – QA systems

• Renal medicine– System design and formalisation of patient pathways– Systematizing of control of anaemia in renal failure– AMIE – decision support for EPO therapy

Ongoing Research

• National Pathology Benchmarking for primary Care

• Screening - Decision Support/ Risk analysis/ Quality Assurance

• A&E Clinical Decision Unit AAP Project - LTHT

• Evaluation of the pilot implementation of an IT specification for a blood tracking system – NHS Connecting for Health

• Training and Education for Research Database Developers – application to Wellcome

• Research Students -– Tom Crocker– Narmadha Damodaran – Claudia Malic– Julius Awakame

• Student projects– Mobile A&E– Lab Handbook– Ultrasound QA

Collaborations

LIHS• Health and Social Care

– Justin Keen, Mary Godfrey

• Psychiatry– Louise Bryant,

Bridgette Bewick,Jenny Hewison

• Public Health– Lai Fong Chiu

University

• Healthcare

• School of Computing

• Electronic Engineering

• School of Design

• LUBS – Technology & Innovation Group (TIGr)

Knowledge Transfer

• YCHI has a proven track record in applied research, with many and diverse successful KT activities, including:

– development and evaluation of decision support systems– evaluation of NHS programme of Electronic Health Records– prenatal and antenatal screening programmes– pathology service reorganisation– electronic Networks in Primary Care– Spin-out activity

Knowledge Transfer Courses

Understanding the Business of the NHS• IT suppliers• NHS Informatics staff

CPD in Health Informatics – www.cpd4it.org.uk • Informatics Master Classes• New technology days – mobile medicine, digital pens, voice

recognition• Topic focused workshops – maternity systems, information

governance

Spin out activity

• AAPHelp - http://www.aaphelp.leeds.ac.uk/aaphelp/

• X-Lab – proof of concept, spin out company

• Elipse Antenatal Screening - Perkin Elmer www.elipse.org.uk

• Ultrasound Quality Assurance – proof of concept

NHS / DH Links

National Library for Health

Yorkshire and the Humber

Industrial Links

X-Lab Ltd

Leeds Teaching Hospitals Trust• Largest in Europe

– 4000 beds– 8 hospital– £700m turnover

• Example Projects– Digital Emergency Department

• Welch Allyn partnership• Intel / Dell• EMED

– Pathology Systems• Intelligent orders• Interpretation automation• Management dashboards• Virtual microscopy

– Renal Medicine• Intelligent prescribing

– Clinical Genetics• Cancer risk triage support

Future Development

• Teaching – Medical Undergraduate, Health Informatics MSc

• Research Collaboration – HI projects– HI in your projects

• Knowledge Transfer– Quality CPD courses for NHS (Clinical, Informatics, Management)

• Professional accreditation, RSM, UKCHIP, BCS

• People– Chair, research support, visiting Profs & lecturers (industry & NHS)

SpecialistCare

Secondary Care

YCHI Strategy PlanT

each

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Kno

wle

dge

Tra

nsfe

rR

esea

rch

Business Computing Medicine and HealthHealth Informatics

MSc Health InformaticsMSc Projects

LIHS - Sharing Modules SSCs

Informatics in Undergraduate Medical Curriculum

SSC Projects

Health software industry

Health technology

industry

Primary Care

Patient centred

Health Informatics Managers

Connecting for Health

Certificate & DiplomaProgrammes

CPD Courses

Master classesWorkshops

PhDs

Journals

Conferences

CPD4IT

National agenda

Consultancy work

ResearchGrants

Collaborations- within LIHS- with LUBS, Computing, Medicine- with other Informatics Centres- International

International agenda

Leeds Institute of Health SciencesCharles Thackrah Building101 Clarendon RoadLeedsUnited KingdomLS2 9LJTel. +44 (0) 113 3434961

www.ychi.leeds.ac.uk