Portugal 1 st International meeting on the electronic health record ** Experience from the UK **

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1 Portugal 1 st International meeting on the electronic health record ** Experience from the UK ** 26 November 2010 Matthew Swindells Chair of the British Computer Society, Health Visiting Professor, Surrey University School of Management Vice President Global Consulting, Cerner Limited Former CIO for the English National Health Service

2 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

3 An English Project X Northern Ireland X Scotland X Wales

4 Some highlights of the delivery Encrypted Secure application servers National indexes Data standards NHS network Spine and SCR Choose and Book GP to GP transfer Technical standards 4prime contractors Hospitals GPs Community and Mental Health PACs SUS Later reduced to 3 then 2 Two solutions isoft Cerner (replace IDX) Choice from an approved list New products developed 100% coverage saved more than forecast Hub to standardise measurement and transactions

5 1. Healthcare is never a stable environment Policy and medical practice changes are a fact of life IM&T Strategy for the NHS Provide Prescriptions Service Provide Bookings Service Build Life long Health Record Service Pervasive national electronic infrastructure (N3) Provide Prescriptions Service Provide Bookings Service Build Life long Health Record Service Patient Choice Digital Imaging Secondary Uses Service NHS System Transfer of records between GPs Quality Management Analysis System NHS Numbers for Babies Bowel Cancer Screening Commissioning Payment by Results Plurality of provision Pervasive national electronic infrastructure (N3) Key: Original Scope Additional Scope

6 2. Remember it s about improving healthcare Focus on delivering information and improvement not technology Challenge Clinical Knowledge Processing Burden 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 Knowledge processing capacity Years ago Knowledge processing requirement Today This gap injures patients 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

7 3. Acknowledge and confront public fears Make the benefits argument the media doesn t help! NHS porters and cleaners can snoop on your medical records Daily Mail 26 Mar 2010 'Big brother' health database Daily Mail 11 Oct 2010

8 4. Ensure local ownership and build capacity You can t nationalise responsibility

9 5. Deliver clinical functionality early What s in it for the clinical staff?

10 6. Redesign and improve the service Computerisation of poor process solves nothing

11 7. Be rigorous about standards Data, integration and semantics are all important Terminology: SNOMED CT Drug Database: dm+d Professional Record Keeping: standards/hiu/medical records Professionalism: UKCHIP Definitions: i.e. Allergy and Current Medication Messaging: HL7 v3 Logical Architecture / Archetypes: ra Knowledge and Knowledge Authorship: Device Interoperability: User interface design: Open Health tools: What is the date Wednesday next week? It will be the 1 st of December 2010 UK 1/12/10 US 12/1/10 Sweden 10/12/1 So in health it s 01 Dec 2010 and 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!

12 8. Invest in the infrastructure You ll think of new things to use it for Encrypted Secure application servers National indexes Data standards NHS network Spine and SCR Choose and Book GP to GP transfer Technical standards Thousands of NHS medical records lost Daily Telegraph Central Expertise

13 9. Use more than one vendor Competition future proofs your investment

14 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!

15 Ten lessons 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? 6. 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

16 ** Experience from the UK ** Questions Matthew Swindells Chair of the British Computer Society, Health Visiting Professor, Surrey University School of Management Vice President Global Consulting, Cerner Limited Former CIO for the English National Health Service

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