the knowledge management contribution to the e-health strategy dr kenneth j robertson clinical lead,...
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The Knowledge Management Contribution to the e-Health Strategy
Dr Kenneth J RobertsonClinical Lead, IM&T
Power of Knowledge 2004
Power of Knowledge 2004
e-Health Key Elements
Power of Knowledge 2004
eHealth/ IM&T Programme Board
chaired by Minister for Health & Community Care,overarching vision and direction
NHS Board Clinical IM&T Leads
SEHD Clinical IM&T Lead
NHS Board IM&T Service Leads
SEHD IM&T Strategy
Clinical Information Group
CMO led, focus on clinicalinformation development
Patient Information Group
CNO led, focus on patient information development
IM&T Infrastructure Group
NHS Board Chief Executive led, focus on information delivery
eHealth in Practice Group
Centre for Change & Innovation, focus on information use
CHI-based identification,clinical aspects
Clinical leadership
Clinical dataset development
Key clinical systems
Clinical knowledge/ decisionsupport
Confidentiality policy
Single gateway to information for patients
NHS 24 Online
Information sharing platform
Local services information
CHI-based identification,technical aspects
Telecommunications
Integrated architecture and key strategic systems
Information Security
IM&T training
Business systems and Shared Servicesincluding IT support for GMS and Community Pharmacy contracts
Information publication to NHS
Support services and IM&T staffing
IM&T investment
CHI-based identification,organisational aspects
eHealth working practices
Sustainable implementation
eHealth innovation
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Three pronged approach
A. Core standardsB. National procurementC. Compliance with standards:
– Technical– Medical
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Core Standards
• CHI Number• SCI Store• SCI Gateway• N3• SNOMED-CT
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National Procurement
• A&E• PACS• e-prescribing/dispensing / e-pharmacy• Generic Clinical System
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National Clinical Datasets Development Programme
• Cancer• CHD• Stroke• Diabetes• Mental health• Child and Maternal Health• ‘Core’
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Medication errors
• Frustration• Confusion• Morbidity• Mortality
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Step 1Shared Access to Medication/Problem List
• High priority for OOH care– Primary Care– Ambulance– A&E– NHS 24
• Needed to reduce risk
• Move to NHS Drug Dictionary (Previously UKCPRS)
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• Electronic transfer of prescriptions• Support for prescribing in community• Creation of ePharmacy Store
Step 2ePharmacy Programme
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• Secondary care• Full knowledge support
– Passive•Electronic formularies and knowledge base
– Active•Interactions•Antibiotic prescribing linked to sensitivities
Step 3Hospital Electronic Prescribling and Medicines Administration
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Generic Clinical System
• Generic shell• Library of ‘forms’• Direct links to Clinical Data Dictionary
• Opportunity to build information links
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Passive links
• One button access to information resources– Textbooks (context passing?)– Formularies– etc
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Active links
• Algorithm driven information provision– Reminders to perform tests with
rationale– Recognition of patterns of
symptoms/signs/laboratory values
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Risks
• Wrong ‘advice’• Irritation• ‘Big Brother syndrome’
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Sources of information
• Traditional texts• Internet• Home-grown
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Doing a lot already
• ECCI Programme– Referrals supported by local/national
guidance
• Primary Care systems supported by prescribing advice
• SCI-DC and SCAN– Managing supporting information including
patient advice
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Care Pathways
• Gradually appearing• Often in conjunction with Managed
Clinical Networks• Widening of clinical teams in numeric
and geographical terms necessitates better knowledge management
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• 70% of American students use rather than books
• 20% drop in use of paper libraries in US
• What about putting search tools into clinical records?
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Intuitively
• Require more interplay between traditional ‘hoover and vomit’ approach to clinical information and true information management
• Need modern ‘librarian’ skills built in with the bricks
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Funding
• Follows from the above that current financial model is inappropriate
• Traditional separation of IT from Statistics from Library and Knowledge won’t work
• However, can’t change everything overnight
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Legacy problem
• Much of the software in the NHS is old and written in such a way that it is inflexible and expensive to alter
But
• ‘Portal’ approach e.g. via SCI-Store could allow value-added element
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Accessibility
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‘Exhaustion’
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Two into one don’t go…
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Two into one don’t go…
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SNOMED-CT
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Hardware
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N3 and Telemedicine
• Telemedicine no longer stand-alone• Role for NES in managing learning
resources for broadband links