Better Medicine Better Health What’s the obsession with the paper ? Dr Paul Southern Consultant Hepatologist

Better Medicine Better Health

Where are we ? –Nationally –Personally Where should we be ? –Including the why How should we get there ?

Better Medicine Better Health

Where are we ?

Better Medicine Better Health

Clinical Five PAS 216/216 Order com 147/216Dchg Sum 189/216 Scheduling 116/216Erx 102/216

Better Medicine Better Health

Hardware Excellent wireless Good hardware refresh programme Out of hours technical on-call Good choice of devices Apple compatibility.

Better Medicine Better Health

I use Word / letters directory (Silo) PACS PAS ICE Unisoft GI Outlook SystmOne Evolve

Better Medicine Better Health Bradford

Better Medicine Better Health

Maybe……. Things aren’t too bad at Bradford ????

Better Medicine Better Health Where should / will we be ? We will have less –Beds –Money –Staff We will have more –Patients Who are older and sicker –Expectations

Better Medicine Better Health Where should we be ?

Better Medicine Better Health Where should we be ?

Better Medicine Better Health Safe, effective and compassionate medical care for all who need it as hospital inpatients High-quality care sustainable 24 hours a day, 7 days a week Continuity of care as the norm, with seamless care for all patients Stable medical teams that deliver both high-quality patient care and an effective environment in which to educate and train the next generation of doctors Effective relationships between medical and other health and social care teams An appropriate balance of specialist care and care coordinated expertly and holistically around patients’ needs Transfer of care arrangements that realistically allocate responsibility for further action when patients move from one care setting to another.

Better Medicine Better Health Safe, effective and compassionate medical care for all who need it as hospital inpatients High-quality care sustainable 24 hours a day, 7 days a week Continuity of care as the norm, with seamless care for all patients Stable medical teams that deliver both high-quality patient care and an effective environment in which to educate and train the next generation of doctors Effective relationships between medical and other health and social care teams An appropriate balance of specialist care and care coordinated expertly and holistically around patients’ needs Transfer of care arrangements that realistically allocate responsibility for further action when patients move from one care setting to another.

Better Medicine Better Health 11 core principles Fundamental standards of care must always be met. Patient experience is valued as much as clinical effectiveness. Responsibility for each patient’s care is clear and communicated. Patients have effective and timely access to care, including appointments, tests, treatment and moves out of hospital. Patients do not move wards unless this is necessary for their clinical care. Robust arrangements for transferring of care are in place. Good communication with and about patients is the norm. Care is designed to facilitate self-care and health promotion. Services are tailored to meet the needs of individual patients, including vulnerable patients. All patients have a care plan that reflects their individual clinical and support needs. Staff are supported to deliver safe, compassionate care, and committed to improving quality

Better Medicine Better Health 11 core principles Fundamental standards of care must always be met. Patient experience is valued as much as clinical effectiveness. Responsibility for each patient’s care is clear and communicated. Patients have effective and timely access to care, including appointments, tests, treatment and moves out of hospital. Patients do not move wards unless this is necessary for their clinical care. Robust arrangements for transferring of care are in place. Good communication with and about patients is the norm. Care is designed to facilitate self-care and health promotion. Services are tailored to meet the needs of individual patients, including vulnerable patients. All patients have a care plan that reflects their individual clinical and support needs. Staff are supported to deliver safe, compassionate care, and committed to improving quality

Better Medicine Better Health University Hospitals Birmingham

Better Medicine Better Health E-prescribing Benefits –Mainly relate to decision support Integration of pathology +/- medical record –Less missed doses –Ability to audit and improve practice Disbenefits –False confidence –Errors still happen

Better Medicine Better Health Order Comms –Right test / right time / right patient –Productivity hit ? Discharge summaries –Improved comms with community –Legibility / safety / reproducability

Better Medicine Better Health Why ?

Better Medicine Better Health

Francis report ‘failure to put the patient first in everything that is done’ Culture of secrecy –Informatics tends to expose issues (if the data is inputted in the first instance !) Poor performance –Ie observations (<70% complete with paper charting – nears 100% with computerised)

Better Medicine Better Health How should we get there ? What is the gold standard ?? –Multifuctional EPR – EPIC / Allscripts / Millenium ………. –Best of breed with interfaces

Better Medicine Better Health Best of breed Choice of clinicians (at least in our Trust !) Everyone is special, so very special. (Some are even more special than others) If correct architecture is in place should talk to everything else. Requirement for open APIs should improve things

Better Medicine Better Health But –Requires lots of (?) expensive interfaces –Information may be added more than once Hierarchy and conflict –More vendors to deal with –More clinical issues to deal with.

Better Medicine Better Health Large EPR Everything in one place Already integrated Designed for decision support etc. ? Good for audit

Better Medicine Better Health But… –Expensive –Big –Huge business change –Clinical acceptance can be challenging. –Throwing out billions of pounds of NHS investment

Better Medicine Better Health What do you need to give your CCIO ?? A quick win Friends ? Everyone a device (??an ipad) The clinical information to do their job –Better –Faster –Safer –With the patient at the centre

Better Medicine Better Health As quickly as possible Get the information out of the silos Present the information to the clinical teams Make the information useful Plan from there.

Better Medicine Better Health So…. I think informatics is going to save the NHS I think the only way forward is collaboration –Clinicians & Informatics / IT/IS I think we need EPR – and a big, all singing, all dancing one