performers, publishers, polyphony and the pope what can medicine learn from the music business?
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Performers, publishers, polyphony and the Pope
What can medicine learn from the music business?
To Err is Human (IOM, 1999)
• Up to 97,000 unnecessary deaths p.a. in the US are due to medical error– “even using the lower figure [48,000] deaths due to
medical errors exceed the numbers attributable to the 8th leading cause of death … more than from motor vehicle accidents (43,548), breast cancer (42,297) or AIDS (16,516)
• Total national costs … between $17B and $29B
… and the UK
10% of acute admissions to NHS Hospitals result in adverse events which cause patient harm.
C Vincent et al, BMJ, 322: 517-519, 2001
Perhaps 16,000 lives could be saved if all current knowledge of cancer were properly applied ICRF Vision for Cancer, 1995
Disseminating medical knowhow…
• Cochrane Library of systematic reviews
• Scottish Intercollegiate Guidelines Network
• UK National Institute for Clinical Excellence
• US National Guideline Clearinghouse
• BMJ publishing’s Clinical Evidence
… but
Busy clinicians have little time to read … converting paper to electronic pages may not change this reality.
Even if a clinician has time to read the content may not be correctly absorbed and applied in practice.
Conventional published guidelines do not provide recommendations that are tailored to the needs of individual patients.
A new option?
• IT Support for “best practice”– Electronic patient records– Rapid access to guidelines– Prompts and reminders– Decision support– Scheduling and workflow– Support for communication and coordination
Crossing the quality chasm
"reorganization and reform are urgently needed to fix what is now a disjointed and inefficient (healthcare) system … use of information technology is key … if a substantial improvement in quality is to be achieved over the coming decade.”
US Institute of Medicine, March 2001
Music, a historical precedent
Guido d'Arezzo was a Benedictine monk, musical theorist and teacher.
His name is associated with the most comprehensive rationalisation of the myriad, ad hoc and often imprecise means of musical notation that had developed amongst the monasteries of Europe from around the 7th century onwards.
Representing medical guidelines
• Arden syntax Hripcsak et al
• ASBRU Shahar et al
• EON/Protégé Musen et al
• GLIF Intermed consortium
• GUIDE Pavia
• Prodigy Sowerby Centre
• PROforma ICRF
PROforma process modelling language
Decisions PlansActions Enquiries
A PROforma guideline: management of suspected breast cancer by GPs
Some PROforma performances
Das Alte Werk
Genetic risk assessment and counselling
Breast Cancer screening
Composing and publishing
PROforma
Publet library
Publet technology
Transpositions, arrangementsand instruments
John Kingston’s PROforma browser
InferMed’s MACRO Clinical trials manager
REACT interactive care planner
Polyphony
SIGN, BrCa
• GP referrals• Screening• Triple assessment• Surgey• Radiotherapy• Systemic therapy• Follow-up• Information &
support
Managing the orchestra
• Players– Shared score, common notation
• Voices– Parts as separate but coordinated plans
• Communication and coordination – Conductor, leader or none?
• Performance– Interpretation not execution
The audience
REACT:empowering the patient?
Performers, publishers, polyphony and the Pope
Pope John XIX
“summoned Guido of Arezzo to Rome [In 1028] … and urged him to instruct the Roman clergy in music.”
With thanks to …
Jon Bury, Andrew Coulson, David Glasspool, Michael Humber, Ali Rahmanzadeh, Margarita Sordo, David Sutton, Richard Thomson
Imperial Cancer Research Fund
Paul Taylor UCL CHIMERobert Walton Oxford UJon Emery Cambridge URobert Dunlop, Nicky Johns, Michael Morris, Andrew Newbigging InferMed LtdJohn Kingston Edinburgh USubrata Das CRA Inc.
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