Workshop at the RCPI St Lukes Symposium on themes of; 21st Century Healthcare Need for Medical Leadership The Challenge of Complex Systems The Promise of Open Platforms

1. Medical Leadership,
Complex Systems,
Open Platforms
Dr Tony Shannon
16th October 2015

2. Tony Shannon
M.B. B.Ch. B.A.O. UCD, Ireland
Fellow of College of Emergency Medicine England
Fellowship in Informatics USA
MSc 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 Hospitals
Chief Clinical Information Officer, Leeds TH/Leeds NHS & Social Care
Director, Frectal Ltd

3. 21st Century Healthcare
• Healthcare:
• Leadership:
• Complexity:
• Platforms:
• Change:

5. • Pics x 2

7. Medical Leadership

11. • Ts 3rd UCD grad

18. Complex Systems
1908

20. Languages- Tower of Babel
• Medical
• Management
• Technical
• Cartoon... Very been confused in meeting?
• Or
• Who?

21. Cynefin Framework
Snowden, D., Boone, M. (2007). "A Leader's Framework for Decision Making".
Harvard Business Review: November 2007, pp 69–76.

22. Complex Probe
10000 1000
Inate 10
Complicated Analyze
Chaos Act Simple Categorize

23. 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

25. 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

26. NHS National Programme for IT
Thinking in silos Process versus IT Closed solutions

27. NHS EDs – after 4 hour std

28. Value = Quality ↑
Risk↓ Cost↓ Time↓
ATLS = People + Process + Tech

29. Nebraska, 1976

31. Open Platforms
1987

32. Chamerlan 17th-18th C

35. Leeds TH
200+
Enterprise
Wide
System x
Common Web UI
Integration Engine
ESB
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

36. Healthcare Change: State of the Ecosystem
Standards: Vendors: Innovators: Disconnect
International Standards
Local Innovators
eHealth Bodies
& Vendors

37. The Future

38. 5 Key Features of The Platform
• Usability
• Integration
• Clinical Kernel
• Code & Community
• Governance & Leadership

39. #1 UI & Usability

40. Leeds TH
200+
Enterprise
Wide
System x
Common Web UI
Integration Engine
ESB
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

41. #3 Clinical Kernel
• Clinically oriented
• Reusable list of
clinical statements
• Maximal dataset
• Can be coded with
terminologies
e.g.
Pulse, BP
Leeds Care Record dataset
End of Life
Key contacts
etc
• Computable

42. #4: Code & Community

43. # 5 Governance & Leadership

44. NHS England 2011

45. 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

46. Development
Clinically Led
User Centred
Agile Development

47. The beginning...

48. 3 Key Levels
Single Patient
Multiple Patients
Clinical Intelligence View

49. Single Patient View

50. Multi-Patient View

51. Aggregated Data View

53. Single Patient View

54. Single Patient View

55. Virtual Ward View

56. Collaborate : Innovate : Open
Towards an open health & care platform
@RippleOSI www.RippleOSI.org

58. Six components
Foundation layer
Open Requirements
Open Governance
Open Citizen
Technical Platform
Open Viewer
Open Integration
Open Architecture

66. # Clinical Kernel- Archetype
• Clinically oriented
• Maximal dataset
– Can be coded with
terminologies
e.g.
Pulse, BP
Key contacts
etc
• Computable
• Reusable

67. Story re VA
• Ken Kizer pic & Best case anywhere

70. 21st Century Healthcare
International Standards
Local Frontline Innovators
National eHealth Bodies
& Vendors
Regional

71. 21st Century Healthcare
• Healthcare: Leadership Required
• Leadership: Doctor: Nurse: Manager
• Complexity: People: Process: Technology
• Platform: Open: Source : Standards
• Change: Think Smarter

72. Thank you
tony.shannon@frectal.com
tony.shannon@frectal.com
www.frectal.com
@frectally