Portugal – 1st International meeting on the electronic health record

** Experience from the UK **

26 November 2010

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

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

Wales

ScotlandX

X

Northern IrelandX

Some highlights of the delivery

NHS network

Secure application

serversEncrypted email

National indexes Data

standards

Technical standards

4 prime contractors

Hospitals GPs Community and Mental Health

PACs SUS

Later reduced to 3 then 2

Two solutionsiSoft

Cerner(replace IDX)

Choice from an approved list

New products developed

100% coverage –saved more than

forecast

Hub to standardise

measurement and transactions

Spine and SCR

Choose and Book

GP to GP transfer

1. Healthcare is never a stable environmentPolicy and medical practice changes are a fact of life

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Pervasive national electronic infrastructure (N3)

2002

1994

1998

IM&T Strategy for the NHS

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Pervasive national electronic infrastructure (N3)

Original Scope Additional ScopeKey:

Commissioning Payment by Results Plurality of provision

2. Remember it’s about improving healthcareFocus on delivering information and improvement not technology

Years ago Today

This gap

injures patients

Knowledge processing capacity

Knowledge processing requirement

“Current medical

practice relies

heavily on the

unaided mind to

recall a great

amount of

detailed

knowledge – a

process which, to

the detriment of

all stakeholders,

has repeatedly

been shown

unreliable”

Crane and Raymond

The Permanente

Journal Winter 2003 Volume 7 No.1

Kaiser Permanente Institute for Health

Policy

Challenge – Clinical Knowledge-Processing Burden

A study published in British Medical Journal in 2004 concluded that:

• 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 ?

[1] 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 fearsMake the benefits argument - the media doesn’t help!

NHS porters and cleaners can snoop on your medical recordsDaily Mail 26-Mar-2010

'Big brother' health databaseDaily Mail 11-Oct-2010

4. Ensure local ownership and build capacityYou can’t nationalise responsibility

5. Deliver clinical functionality earlyWhat’s in it for the clinical staff?

6. Redesign and improve the serviceComputerisation of poor process solves nothing

7. Be rigorous about standardsData, integration and semantics are all important

• Terminology: SNOMED CT http://www.ihtsdo.org/

• Drug Database: dm+d http://www.dmd.nhs.uk/

• https://www.uktcregistration.nss.cfh.nhs.uk/trud/

• Professional Record Keeping: http://www.rcplondon.ac.uk/clinical-standards/hiu/medical-records

• Professionalism: UKCHIP http:www.ukchip.org.uk

• Definitions: i.e. ‘Allergy’ and ‘Current Medication’

• Messaging: HL7 v3 http://hl7.org

• Logical Architecture / Archetypes: http://www.connectingforhealth.nhs.uk/systemsandservices/data/lra

• Knowledge and Knowledge Authorship:

• Device Interoperability: www.continuaalliance.org

• User interface design: www.cui.nhs.uk

• Open Health tools: www.openhealthtools.org

What is the date Wednesday next week?

• It will be the 1st of December 2010• UK 1/12/10• US 12/1/10• Sweden 10/12/1

• So in health it’s 01-Dec-2010and that’s final !

• By doing this I just reduced the number of errors it’s possible to make for 12 days a month.

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 infrastructureYou’ll think of new things to use it for

NHS network

Secure application

serversEncrypted email

National indexes Data

standards

Technical standards

Spine and SCR

Choose and Book

GP to GP transfer

Thousands of NHS medical records lostDaily Telegraph

Central Expertise

9. Use more than one vendorCompetition 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 lessons6. Redesign and improve the service

• Computerisation of poor process solves nothing

7. Be rigorous about standards

• Data, integration and semantics are all important

8. Invest in the infrastructure

• You’ll think of new things to use it for

9. Use more than one vendor

• Competition future proofs your investment

10. Be brave

• This is really hard. Change is hard. The technology is difficult. Can you imagine a health service where we don’t confront this challenge

1. Healthcare is never a stable environment

• Policy and medical practice changes are a fact of life

2. Remember it’s about improving healthcare

• Focus on delivering information and improvement not technology

3. Acknowledge public fears

• Make the benefits argument

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?

** 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

matthew.swindells@cerner.com+44 7961 557556