Portugal – 1st International meeting on the electronic health record ** Experience from the UK ** 26 November 2010 Matthew Swindells Chair of the British Computer Society, Health Visiting Professor, Surrey University School of Management Vice President Global Consulting, Cerner Limited Former CIO for the English National Health Service
Disclaimer and Declaration• This is a personal view• I am not representing policy on behalf of: – The NHS or NHS Connecting for Health – Any other government body UK or otherwise – Cerner – BCS• I now work as Vice President for Cerner Limited, a global health IT Supplier
An English Project X Scotland XNorthern Ireland X Wales
Some highlights of the delivery Secure National application Encrypted indexes Data servers email standards NHS network Spine Choose GP to GP Technical and SCR and Book transfer standards 4 prime Hospitals GPs Community and PACs SUS contractors Mental HealthLater reduced to Two solutions Choice from an New products 100% coverage – Hub to 3 then 2 iSoft approved list developed saved more than standardise Cerner forecast measurement (replace IDX) and transactions
1. 1998 1994 2002 Provide Prescriptions Service IM&T Strategy for the NHS Provide Bookings Service Pervasive national electronic infrastructure (N3) Build Life-long Provide Prescriptions Health RecordKey: Service Service Provide Bookings Service Original Scope Build Life-long Health Record Service Commissioning Patient Choice Digital ImagingAdditional Scope Pervasive national electronic infrastructure (N3) Secondary Uses Service Payment by Results NHS Email System Policy and medical practice changes are a fact of life Transfer of records between GPs Quality Management Analysis System NHS Numbers for Babies Healthcare is never a stable environment Plurality of provision Bowel Cancer Screening
2. Remember it’s about improving healthcare Focus on delivering information and improvement not technology Challenge – Clinical Knowledge-Processing Burden“Current medicalpractice reliesheavily on the Knowledge processing requirementunaided mind torecall a greatamount ofdetailedknowledge – a This gapprocess which, to injures patientsthe detriment ofall stakeholders, Knowledge processing capacityhas repeatedlybeen shownunreliable”Crane and RaymondThe Permanente Years ago Today A study published in British Medical Journal inJournalWinter 2003 Volume 7 No.1Kaiser Permanente Institute for Health 2004 concluded that:Policy • 1 in 16 hospital admissions are the result of an adverse drug reaction – 76% avoidable. • This equates to 4% of hospital bed capacity At any one time 7 x 800 bed hospitals are occupied by patients admitted with ADRs. Cost = £466m annually – • Patient harm and £354m expenditure avoidable by putting in place e-prescribing ?  Pirmohamed, M. et al: Adverse drug reactions as a cause of admission to hospital: prospective analysis of 18,820 patients: BMJ 2004; 329: 15-19
3. Acknowledge and confront public fears Make the benefits argument - the media doesn’t help!NHS porters and cleaners cansnoop on your medical recordsDaily Mail 26-Mar-2010 Big brother health database Daily Mail 11-Oct-2010
4. Ensure local ownership and build capacity You can’t nationalise responsibility
5. Deliver clinical functionality early What’s in it for the clinical staff?
6. Redesign and improve the service Computerisation of poor process solves nothing
7. Be rigorous about standards Data, integration and semantics are all important• Terminology: SNOMED CT http://www.ihtsdo.org/ What is the date Wednesday next week?• Drug Database: dm+d http://www.dmd.nhs.uk/• https://www.uktcregistration.nss.cfh.nhs.uk/trud/ • It will be the 1st of December 2010• Professional Record Keeping: • UK 1/12/10 http://www.rcplondon.ac.uk/clinical-standards/hiu/medical-records • US 12/1/10• Professionalism: UKCHIP http:www.ukchip.org.uk • Sweden 10/12/1• Definitions: i.e. ‘Allergy’ and ‘Current Medication’• Messaging: HL7 v3 http://hl7.org • So in health it’s 01-Dec-2010• Logical Architecture / Archetypes: and that’s final ! http://www.connectingforhealth.nhs.uk/systemsandservices/data/l ra• Knowledge and Knowledge Authorship: • By doing this I just reduced the number of errors it’s possible to make for 12 days• Device Interoperability: www.continuaalliance.org a month.• User interface design: www.cui.nhs.uk• Open Health tools: www.openhealthtools.org How many times do these need to be invented globally ? Adopt what’s already there and be rigorous about enforcing it. No competition on standards!
8. Invest in the infrastructure You’ll think of new things to use it for Secure National application Encrypted indexes Data servers email standards NHSnetwork Spine Choose GP to GP Technical and SCR and Book transfer standards Thousands of NHS medical records lost Daily Telegraph Central Expertise
9. Use more than one vendor Competition future proofs your investment
10. Be Brave“Culture eats strategy for breakfast” Some times you feel as if you are fighting 100 years of operational practice on your own!
Ten lessons1. Healthcare is never a stable 6. Redesign and improve the service environment • Computerisation of poor process • Policy and medical practice changes solves nothing are a fact of life 7. Be rigorous about standards2. Remember it’s about improving • Data, integration and semantics are healthcare all important • Focus on delivering information and 8. Invest in the infrastructure improvement not technology • You’ll think of new things to use it for3. Acknowledge public fears 9. Use more than one vendor • Make the benefits argument4. Ensure local ownership and build • Competition future proofs your investment capacity • You can’t nationalise responsibility 10. Be brave5. Deliver clinical functionality early • This is really hard. Change is hard. The technology is difficult. Can you • What’s in it for the clinical staff? imagine a health service where we don’t confront this challenge
** Experience from the UK ** Questions Matthew Swindells Chair of the British Computer Society, HealthVisiting Professor, Surrey University School of Management Vice President Global Consulting, Cerner Limited Former CIO for the English National Health Service email@example.com +44 7961 557556