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Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
Development And Implementation Strategies - Roy Harper
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Development And Implementation Strategies - Roy Harper

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  • Introduction
  • No surprises here – the solution is to move to computerized clinical information systems. Much better.. Have a good IT infrastructure. We have computing power right up to the bed-side now. We just don’t have the clinical information systems as yet but we need to be freed to work on these! We need to move away from the big bulky inflexible systems from large usual suspect suppliers who provide lousy solutions at inflated costs.
  • That’s what I am passionate about. I believe …. Seeing it already….. exemplars locally in teleneurology and in paediatric cardiology … time now for diabetes and other chronic diseases. Pilots up and running. Looking at integrating these new approaches into routine clinical care… privelege to be heavily involved in improving on what is already out there … in developing and testing new ‘prototype’ technological solutions.
  • Introduction
  • Second problem is the way we store our information. Paper charts. Not working now. One copy. Hard to transport and store. Not available when needed in acute situations. 1 in 6 chance will not be available at clinic. Information hard to find. No longer complete as not enough clerical staff now to file everything. No way to search, analyze or learn from the information recorded. We need a better solution asap.
  • Paperwork overload. Bit of an exaggeration – frontline HSC staff don’t have desks! Spending so much time documenting the care we give that it is seriously eating into the time we have for direct patient bed-side care. Well meaning folks from patient safety side, infection control, medicines management side, governance side are coming up with very valid new processes but what that usually means for staff on the frontline is another page or two of an A4 form to fill out!
  • No surprises here – the solution is to move to computerized clinical information systems. Much better.. Have a good IT infrastructure. We have computing power right up to the bed-side now. We just don’t have the clinical information systems as yet but we need to be freed to work on these! We need to move away from the big bulky inflexible systems from large usual suspect suppliers who provide lousy solutions at inflated costs.
  • What I have discovered is that a lot of the key information we need as clinicians to support patient care is already available in lots of different clinical computer systems spread across the service. Some are good some are not. Some we have access to some we don’t but there is information in there that is really valuable – allergies, medication lists, letters, laboratory results, x-ray reports and images, and lots more. Hard to get at as you can imagine. We need to bring it all together.
  • Collapse – world today - What is this attempting to convey? Regions are not sharing emr, ehr or domain data?
  • An this is the answer - …… this is a key step in improving how we use our clinical information . We have seen it elsewhere. In various parts of the word. Very different approach to that taken in England which has been a disaster. I am sure you are aware of this ….
  • Instead of talking about it we are doing it now.
  • I do not have time to do a live demo but hear are a few screenshots of what the pilot ECR looks like. Amazing information. Looks complex but for clinicians easy – takes a few minutes training to get up to speed.
  • All the documents I need at the click of a button
  • Lab results collated from various laboratories
  • X-ray reports and images
  • Up to date medication lists. Some people are on a lot of pills!! No longer have to ring GP surgery and ask them to fax through list of medications!!
  • Collapse – world today - What is this attempting to convey? Regions are not sharing emr, ehr or domain data?
  • ECR VISION - is achievable
  • DW - Changed wording
  • DW - Changed wording
  • Introduction
  • Transcript

    • 1. Development and Implementation Strategies A Clinician’s Perspective Dr Roy Harper Consultant Physician & Endocrinologist The Ulster Hospital Visiting Professor, School of Mathematics and Computing The University of Ulster
    • 2.  
    • 3. Heading to a place where?
      • ICT is used to support patients , healthcare personnel and healthcare delivery
      • - making it better
      • - making it easier
      • - making it safer
      • For me - potential is being realised
    • 4. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Diamond Diabetes ECR installed HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ Emergency Care Record Pilot Goes Live ECCH set up Start of H&C Number roll out Wireless Carts NI BCS Health set up First COM 723 at UUJ Local PACS Tablet PCs and remote access Regional EHR Research Group Established 2009 PatientCentre [email_address] Appointed as Physician in UCHT RPA Roll out of PCs in all OPD Consulting Rooms Pilot ECR NIPACS
    • 5.  
    • 6.  
    • 7.
      • Disease specific EMR
      • Comprehensive
      • Based on Microsoft Access
      • Used by all HCP
      • Modified as required for NI
      • Used by almost all hospital diabetes units
      Diamond
    • 8. Development and Implementation Strategies
      • Something about
      • Bottom up / peer-to-peer
    • 9. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Diamond Diabetes ECR installed HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ Emergency Care Record Pilot Goes Live ECCH set up Start of H&C Number roll out Wireless Carts NI BCS Health set up First COM 723 at UUJ Local PACS Tablet PCs and remote access Regional EHR Research Group Established 2009 PatientCentre [email_address] Appointed as Physician in UCHT RPA Roll out of PCs in all OPD Consulting Rooms Pilot ECR NIPACS
    • 10. Development and Implementation Strategies
      • Something about
      • Bottom up / peer-to-peer
      • Good foundation (infrastructure)
    • 11.
      • “ Information technology is no longer perceived as just a supporting tool, but has become a strategic necessity for developing an integrated healthcare IT infrastructure that can improve services and reduce medical errors”
      • Source: Le Rouge, Mantzana & Wilson, European Journal of Information systems (2007) 16, 669-671
    • 12.
      • Systematic Review: Impact Of Health Information Technology on Quality, Efficiency, and Costs of Medical Care.
      • Chaudhry et al., Ann Intern Med 2006;144:742-52.
      • Improving Safety with Information Technology
      • Bates and Gawande. N Engl J Med 2003;348:2526-34.
    • 13. Development and Implementation Strategies
      • Something about
      • Bottom up / peer-to-peer
      • Good foundation (infrastructure)
      • Disseminate and build ‘evidence’
    • 14. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Diamond Diabetes EMR installed HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ Emergency Care Record Pilot Goes Live ECCH set up Start of H&C Number roll out Wireless Carts NI BCS Health set up First COM 723 at UUJ Local PACS Tablet PCs and remote access Regional EHR Research Group Established 2009 PatientCentre [email_address] Appointed as Physician in UCHT RPA Roll out of PCs in all OPD Consulting Rooms Pilot ECR NIPACS
    • 15. Ongoing Information & Support Regular Feedback on Progress Patients increasingly need (and demand) ready access to feedback on their progress with advice from HCPs
    • 16. Effective ‘ Connected Health ’ approaches
      • Copy letters to patient
      • Use the telephone
      • Use SMS
      • E-mail
      • On-line contact … .via a web-portal
    • 17. DI@L-log Architecture Schematic VoiceXML Interpreter Primary / Secondary Care Provider Intranet Patient Enters Information At Home Or On The Move Regular Health Report Print-Outs Sent To Patient PSTN Secure Firewall Electronic Patient Record (EPR) Data Repository
      • Data Management
      • Visualisation
      • Trend Analysis
      • Decision Support/
      • Evidence Based Medicine
      PDA Clinical Workstation Doctor / Nurse On The Move
      • Patient Details
      • Clinical Targets
      • Protocols
      [email_address]
      • Weight
      • Blood Sugar
      • Blood Pressure
    • 18.
      • ECCH launched January 2008
      • To promote health improvement through the use of new technologies
      • First project is to establish a large-scale remote monitoring service
    • 19.  
    • 20. Remote telemonitoring
      • Patients record data on an agreed set of parameters at a remote location
      • Data is routinely communicated to a monitoring centre
      • Data is analysed and feedback given as appropriate to support patient self-care
      • Incoming data outside of ‘limits’ triggers an alert and ‘response’
      • Data is used to support ongoing clinical decision making
    • 21. Transformation from Industrial Age Medicine to Information Age Healthcare Source: Adapted from Malaysian Telemedicine Blueprint Industrial Age Medicine Information Age Medicine Transformation Through Cost-Effective Use of Information & Communication Technologies Person Community Primary Secondary Tertiary Individual Self-Care Friends and Family Community Networks Professionals as Facilitators Professionals as Partners Professionals as Authorities
    • 22. Home (self) monitoring technologies can transform episode driven health services into a relationship based continuum of care E A Balas 1999 Does it work in diabetes care?
    • 23.  
    • 24.  
    • 25. Remote telemonitoring JB JMcM
    • 26. And so RTM may help those:
      • With diabetes (and co-morbidities) experiencing repeated hospital admissions
      • With type 2 diabetes starting on injection therapy
      • Pregnant or preparing for a pregnancy
      • With type 2 diabetes and suboptimal blood sugar or blood pressure control
      • Preparing for major surgery
      • With type 1 diabetes
    • 27.  
    • 28. Remote home-based telemonitoring – what have we learn’t
      • Useful for a wide range of patients
      • Patients like it
      • Amazing amount of incoming data
      • Positive outcomes
      • Initial triage by someone else is helpful
      • Safety limits (4-16) are not always relevant
      • Software could be better
      • Requires a dedicated weekly virtual clinic session
      • Permits frequent treatment adjustments
      • Promising in terms of improving blood sugar control
    • 29. Conclusions
      • Home-based remote telemonitoring (RTM) can be used to support and motivate patients with diabetes improve their self-management skills and their diabetes.
      • Clinically relevant improvements in HbA1c were seen in patients using RTM for 12 weeks.
      • Patients readily accept RTM. Significant changes to working patterns and a redeployment of resources will be required for RTM to become widely used and accepted by clinicians.
    • 30. And so ‘connected health’
      • Has little evidence in our health economy
      • Limited potential
      • Increases workload
      • Lots of ancillary (superfluous) data which is hard to interpret and out of context
      • Not another system!
      • And so little clinical engagement
    • 31. Development and Implementation Strategies
      • Something about
      • Bottom up / peer-to-peer
      • Good foundation (infrastructure)
      • Disseminate and build ‘evidence’
      • Careful if little clinical engagement
    • 32. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Diamond Diabetes ECR installed HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ Emergency Care Record Pilot Goes Live ECCH set up Start of H&C Number roll out Wireless Carts NI BCS Health set up First COM 723 at UUJ Local PACS Tablet PCs and remote access Regional EHR Research Group Established 2009 PatientCentre [email_address] Appointed as Physician in UCHT RPA Roll out of PCs in all OPD Consulting Rooms Pilot ECR NIPACS
    • 33. Problems around the way we record and use clinical information
    • 34. Still very much a paper-based world
    • 35.  
    • 36.  
    • 37.  
    • 38.  
    • 39. Before ECR PAS A&E PACS South Eastern Labs Renal G P Comm H&C Others Belfast Northern Southern Western Western GP’s
    • 40.
        • Valuable time and resources wasted every day searching and waiting for clinical information needed for effective, fast and safe decision making.
        • Reliance on notes, fax, post, porters, phone calls, taxis to obtain relevant clinical information.
        • Significant duplication of effort due to multiple unconnected information systems across the service – limited sharing of information.
        • Personal experiences - lack of information increases clinical risk & reducing efficiency.
    • 41. The problem is in accessing key information
      • Many disparate clinical systems
      • Multiple log-on’s to lots of different password protected systems
      • Only access to a single clinical domain or service
      • Ever increasing amounts of clinical time devoted to locating information
      • Preventing effective and timely decision-making
    • 42. The answer – a NI-wide ECR
      • Key information from various disparate legacy clinical information systems brought together effectively and collated within a secure regional electronic care record (ECR)
      Feasible ?
    • 43. Here’s what’s happening
      • Research group – learnt from others
      • HSC supported a proof of concept study
      • Pilot ECR is up and running
      • Running for >18 months
      • Very positive evaluation
      • Moving now to a regional ECR
    • 44.  
    • 45.  
    • 46.  
    • 47.  
    • 48.  
    • 49. Before ECR PAS A&E PACS South Eastern Labs Renal G P Comm H&C Others Belfast Northern Southern Western Western GP’s
    • 50. With ECR Patient Access to Personal Health Records Belfast Western Northern Southern Southeastern Single sign-on, Security, Auditing, Business rules GP’s
    • 51.
      • 97% of users were very satisfied or satisfied with the ease of use
      • 97% of clinicians surveyed found the PoC system useful and 100% would recommend the system to a colleague
      • 74% of doctors surveyed reported that the ECR use helped them to make the right diagnosis quicker and 84% agreed ECR use had contributed to a better clinical outcome at least once during the evaluation period.
      • 33% of clinicians had found at least one occasion where use of the ECR had prevented an adverse event, such as an allergic reaction.
      • In an outpatient audit the ECR avoided unnecessary review appointments in 6.8% of patients seen.
    • 52. Development and Implementation Strategies
      • Something about
      • Bottom up / peer-to-peer
      • Good foundation (infrastructure)
      • Disseminate and build ‘evidence’
      • Careful if little clinical engagement
      • Clinical champions with something to show
    • 53.  
    • 54.  
    • 55.  
    • 56.  
    • 57.  
    • 58. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Diamond Diabetes ECR installed HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ Emergency Care Record Pilot Goes Live ECCH set up Start of H&C Number roll out Wireless Carts NI BCS Health set up First COM 723 at UUJ Local PACS Tablet PCs and remote access Regional EHR Research Group Established 2009 PatientCentre [email_address] Appointed as Physician in UCHT RPA Roll out of PCs in all OPD Consulting Rooms Pilot ECR NIPACS
    • 59. Help clinicians to get involved?
      • Encouragement
      • A leadership role (CCIO campaign)
      • Support (time, resources, peer, IT)
      • Proper Structured Training
    • 60.  
    • 61. Help clinicians to get involved?
      • Encouragement
      • A leadership role (CCIO campaign)
      • Support (time, resources, peer, IT)
      • Proper Structured Training
    • 62.  
    • 63. eHealth Competency Framework
      • Clinical Leadership and Management
      • IT Healthcare Projects
      • Working with Information
      • Clinical Care Records
      • Clinical IT Systems and Technologies
      • Knowledge Management
      • Clinical and Health IT Standards
      • Glossary of Terms
      • Bibliography
    • 64. eHealth Competency Framework
      • Developed by Academy of Medical Royal Colleges and Scottish Government
      • To define knowledge, skills and attitudes required to use healthcare IT to support the delivery of care
      • Suggest a framework for training and education of postgraduate doctors (for all but especially those with an interest in eHealth)
    • 65. eHealth training for clinicians in NI
      • HSC ICT Programme Board supported (bursaries)
      • Collaboration with local Universities (University of Ulster)
      • Certificate, Diploma and MSc programme in Healthcare Informatics
      • Ensure competencies are covered
    • 66. Development and Implementation Strategies
      • Something about
      • Bottom up / peer-to-peer
      • Good foundation (infrastructure)
      • Disseminate and build ‘evidence’
      • Careful if little clinical engagement
      • Clinical champions with something to show
      • Grow informed clinical champions
    • 67. Timeline for Health Computing (Informatics) in Health and Social Care in Northern Ireland (1999 – Present) – A Personal View 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Diamond Diabetes ECR installed HPSS ICT ‘Vision’ HPSS ICT ‘From Vision to Reality’ Emergency Care Record Pilot Goes Live ECCH set up Start of H&C Number roll out Wireless Carts NI BCS Health set up First COM 723 at UUJ Local PACS Tablet PCs and remote access Regional EHR Research Group Established 2009 PatientCentre [email_address] Appointed as Physician in UCHT RPA Roll out of PCs in all OPD Consulting Rooms Pilot ECR NIPACS
    • 68.  
    • 69.  
    • 70.  
    • 71.
      • Recently CE approved Vitalsens VS100 patient monitor from Intelesens Ltd. (Northern Ireland)
      • The product combines disposable electrodes , offering reduced motion artifact for high quality vital sign collection, with a reusable , miniaturized clip-on body-worn device for non-invasive vital signs monitoring.
      • Data sent wirelessly to a web based tool developed by Intelesens Ltd, allowing patient data and medical trends to be viewed via a web browser.
      Intelesens Device
    • 72. Development and Implementation Strategies
      • Something about
      • Bottom up / peer-to-peer
      • Good foundation (infrastructure)
      • Disseminate and build ‘evidence’
      • Careful if little clinical engagement
      • Clinical champions with something to show
      • Grow informed clinical champions
      • Supporting Innovation – and taking a risk
    • 73. Development and Implementation Strategies A Clinician’s Perspective Dr Roy Harper Consultant Physician & Endocrinologist The Ulster Hospital Visiting Professor, School of Mathematics and Computing The University of Ulster

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