1. Knowledge Driven Care – Realised Through Transformation Dr Simon Wallace Medical Executive Cerner UK

2. Things to take note of… Supporting Staff with ready access to information Shortage of staff Information available when it will provide most benefit Changing role of Radiologists Changing role of Radiographers Managing Risk Clinical Governance Integrated Care Pathways (ICP)

3. What Clinicians Do NOT Want Partial information (integration) Duplicate workflows and processes Inconvenience Unreliable ‘evidence’ Many ways to do this incorrectly!  Start without integration  Shift duties without improving processes and safety  Enable mistakes with greater speed and scope  Create complacency with ‘alert overload’  Attention deficits due to overconfidence

4. Cochrane Library Medline NICE National Electronic Library for Health University of York – NHS Centre for Reviews and Dissemination  NHS Economic Evaluation Database  DARE – Database of Abstracts of Reviews and Effects  Effective Healthcare Bulletins Healthcare Needs Assessment – epidemiologically based reviews RCR protocols guidelines BNF Knowledge Resources

5. Reasons for Transforming Healthcare? Governments:  UK  Modernisation Agency: “For the work [modernising the NHS] to be truly effective, it is essential that the current processes and procedures in the NHS are reviewed and tangibly and sustainably improved through a whole system approach to transformational change”  Wanless Report: “Success or failure [of the NHS Plan] will ultimately depend on how effectively the health service uses its resources.”  United States  In the US by 2007, they will be spending nearly 17% of their GDP on healthcare ($2.1 trillion)

6. Reasons for Transforming Healthcare? Healthcare organisations:  Provide quality healthcare  Recruitment & Retention  Reduce waiting times – DoH targets  Improve capacity and throughput  Improved efficiency of resources  Meet clinical governance requirements  Provide ‘value for money’ services  Information returns

7. Reasons for Transforming Healthcare? Health Professionals  Deliver best practice quality care  Reduce Errors  Medical documentation at time of consultation  Improved Communication  Job Satisfaction  Extended role

8. Institute of Medicine (IOM)  To Err is Human (1999) ;  Crossing the Quality Chasm (2000) During hospitalisation in the US as many as a third of patients suffer from complications related to their 'care‘ 80,000- 180,000 treatment related deaths in hospitals every year  Apart from treatment deaths another 1.3 million people will be harmed  Between 5% and 13% of hospital admissions result from the adverse effects of diagnosis or treatment 70% of iatrogenic complications, are preventable  Millenson, Demanding Medical Excellence, 1997;  Sharpe and Faden, Medical Harm 1998;  Leape, L., JAMA July 5, 2000) Iatrogenic injury

9. Adverse Drug Reactions: Bandolier – June 2002 www.ebandolier.com Adverse drug reactions (ADRs) in hospital patients –  Affects 7% of patients or admissions in England  Responsible for 4 out of 100 hospital bed days  Estimated at 15-20 400-bed hospital equivalents  Consuming 4% of bed days available  Cost the NHS £380 million per year

10. How to Transform The first step to take is Workflow Optimisation:

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12. Errors are inevitable… A fundamental philosophy emerges: The most common failures are system errors involving drug knowledge dissemination, drug dosing, patient identity checking and patient information availability, suggesting inadequate systems, rather than individual inadequacy, as causes for error ‘Physicians and nurses [healthcare professionals] need to accept the notion that error is an inevitable accompaniment of the human condition, even among conscientious professionals with high standards. Errors must be accepted as evidence of system flaws, not character flaws.’ Leape,L. JAMA, 1994

13. How can IT support care transformation? Error prevention  Reduced reliance on memory  Error proofing and constraints (order entry)  Standardisation/simplification (information and process)  Education, feedback, alerts, decision support  Potential error detection  Work-flow, work fulfillment and risk aversion programs

14. Efficiency with routine jobs

15. Patient summary – A clearer picture!

16. Inpatients – all I need………..again!

17. Errors are avoidable… Patient: Seinfeld, Jerry Diagnosis: Acute Myocardial Infarction No order for beta-blocker Evidence: www.zynx.com/ zynxprd/cpc.asp?cndID=ami