The Role of Information Technology in Clinical Governance


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The Role of Information Technology in Clinical Governance. Fernando D. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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The Role of Information Technology in Clinical Governance

  1. 1. Information Technology in Clinical Governance Professor Devaka Fernando Sheffield Hallam University Associate Medical Director Sherwood Forest Hospitals NHS Trust
  2. 2. • ‘A framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’.
  3. 3. Building Block model for CG
  4. 4. • Patient safety • Evidence Based Medicine • Health Technology Assessment • Reflections • Summary
  5. 5. Patient safety • As to disease, make a habit of two things – to help, or at least do no harm- Hippocrates, Epidemics (book I Chapter XI) c 400 BC • Medicine used to be simple, ineffective and relatively safe. It is now complex, effective and potentially dangerous. Professor Cyril Chantler
  6. 6. Patient Safety • Defined as freedom, as far as possible, from harm or risk of harm, caused by medical management (as opposed to harm caused by the natural course of the patients original illness or condition).
  7. 7. Harm to patients • Mostly not deliberate • Not through serious incompetence • Mainly normally competent clinicians working in inadequate systems. • Most harm caused by medical practice is avoidable.
  8. 8. Steps to Patient safety • Build a safety culture (open and fair) • Lead and support staff • Integrate risk management • Promote reporting • Involve and communicate with patients • Learn and share safety lessons • Implement solutions to prevent harm
  9. 9. • Patient safety • Evidence Based Medicine • Health Technology Assessment • Reflections • Summary
  10. 10. On what evidence do we choose technology? • Personal experience • Reasoning and intuition • Colleagues • Endorsement • Published evidence (what type of publication ?)
  11. 11. Evidence based Medicine • The process of systematically reviewing, appraising and using research findings to aid the delivery of optimum clinical care to patients. • Based on strength and weight of scientific evidence on clinical effectiveness when allocating resources.
  12. 12. EBM a multifaceted process of assuring clinical effectiveness. • Production of evidence through research and scientific review. • Production and dissemination of evidence based clinical guidelines. • Implementation of evidence based, cost effective practice through education and management of change. • Evaluation of compliance with agreed practice guidance through clinical audit and outcomes focussed incentives.
  13. 13. Grading evidence: Levels of evidence. High Quality Meta analyses, Systematic reviews or Randomised clinical trials. High quality systematic reviews of case control or cohort studies or well conducted case control or cohort studies Non analytic studies, case reports, case series. Expert opinion.
  14. 14. Critical appraisal • A method of assessing and interpreting the evidence by systematically considering its validity, results and relevance to the area of work considered.
  15. 15. • Patient safety • Evidence Based Medicine • Health Technology Assessment • Reflections • Summary
  16. 16. HTA: The bridge between evidence and policy making. • Provides a range of stakeholders involved in planning, purchasing and investing in healthcare, with accessible, usable and evidence based information that will guide decisions about technology.
  17. 17. Health Technology Assessment : systematically examines effects of application of health technology • Safety • Clinical efficacy • Clinical effectiveness • Cost • Cost effectiveness • Organisational implications • Social consequences • Legal consequences • Ethical considerations
  18. 18. Some HTA related definitions • Clinical effectiveness: How do the health outcomes of the technology compare with available treatment alternatives. • Cost Effectiveness: Are these improvements in health outcomes commensurate with additional costs of the technology?
  19. 19. Health Technology Assessments • Helps policy makers decide which technologies are effective and which are not. • Defines most appropriate indications for their use. • Reduces or eliminates interventions that are unsafe, ineffective or whose cost is too high compared with benefits.
  20. 20. • Patient safety • Evidence Based Medicine • Health Technology Assessment • Reflections • Summary
  21. 21. How does your organisation • Procure Health care technology in general? • Medicines? • Equipment ? • Information technology?
  22. 22. What evidence base do you use to assess IT systems in Health care? What evidence base supports your product?
  23. 23. • Patient safety • Evidence Based Medicine • Health Technology Assessment • Reflections • Summary
  24. 24. Summary • ICT systems are a health care intervention. • Systems for evaluating their efficacy and safety should be as robust as those evaluating other health care technologies. • An integrated approach by consumers of health care technology and providers of technology required. • A corporate culture of evidence based critical appraisal is required • Consequent corporate buy in from developers, providers and purchasers of IT solutions in health care is required.