The Knowledge Management Contribution to the e-Health Strategy Dr Kenneth J Robertson Clinical Lead, IM&T

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 Clinical Information Group CMO led, focus on clinical information development CHI-based identification, clinical aspects Clinical leadership Clinical dataset development Key clinical systems Clinical knowledge/ decision support Confidentiality policy Patient Information Group CNO led, focus on patient information development Single gateway to information for patients NHS 24 Online Information sharing platform Local services information IM&T Infrastructure Group NHS Board Chief Executive led, focus on information delivery CHI-based identification, technical aspects Telecommunications Integrated architecture and key strategic systems Information Security IM&T training Business systems and Shared Services including IT support for GMS and Community Pharmacy contracts Information publication to NHS Support services and IM&T staffing IM&T investment eHealth in Practice Group Centre for Change & Innovation, focus on information use CHI-based identification, organisational aspects eHealth working practices Sustainable implementation eHealth innovation NHS Board Clinical IM&T Leads SEHD Clinical IM&T Lead NHS Board IM&T Service Leads SEHD IM&T Strategy

Power of Knowledge 2004 Three pronged approach A.Core standards B.National procurement C.Compliance with standards: –Technical –Medical

Power of Knowledge 2004 Core Standards CHI Number SCI Store SCI Gateway N3 SNOMED-CT

Power of Knowledge 2004 National Procurement A&E PACS e-prescribing/dispensing / e-pharmacy Generic Clinical System

Power of Knowledge 2004 National Clinical Datasets Development Programme Cancer CHD Stroke Diabetes Mental health Child and Maternal Health ‘Core’

Power of Knowledge 2004

Medication errors Frustration Confusion Morbidity Mortality

Power of Knowledge 2004 Step 1 Shared 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)

Power of Knowledge 2004 Electronic transfer of prescriptions Support for prescribing in community Creation of ePharmacy Store Step 2 ePharmacy Programme

Power of Knowledge 2004 Secondary care Full knowledge support –Passive Electronic formularies and knowledge base –Active Interactions Antibiotic prescribing linked to sensitivities Step 3 Hospital Electronic Prescribling and Medicines Administration

Power of Knowledge 2004 Generic Clinical System Generic shell Library of ‘forms’ Direct links to Clinical Data Dictionary Opportunity to build information links

Power of Knowledge 2004 Passive links One button access to information resources –Textbooks (context passing?) –Formularies –etc

Power of Knowledge 2004 Active links Algorithm driven information provision –Reminders to perform tests with rationale –Recognition of patterns of symptoms/signs/laboratory values

Power of Knowledge 2004 Risks Wrong ‘advice’ Irritation ‘Big Brother syndrome’

Power of Knowledge 2004 Sources of information Traditional texts Internet Home-grown

Power of Knowledge 2004 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

Power of Knowledge 2004 Care Pathways Gradually appearing Often in conjunction with Managed Clinical Networks Widening of clinical teams in numeric and geographical terms necessitates better knowledge management

Power of Knowledge % of American students use rather than books 20% drop in use of paper libraries in US What about putting search tools into clinical records?

Power of Knowledge 2004 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

Power of Knowledge 2004 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

Power of Knowledge 2004 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

Power of Knowledge 2004 Accessibility

Power of Knowledge 2004 ‘Exhaustion’

Power of Knowledge 2004 Two into one don’t go…

Power of Knowledge 2004 Two into one don’t go…

Power of Knowledge 2004 SNOMED-CT

Power of Knowledge 2004 Hardware

Power of Knowledge 2004 N3 and Telemedicine Telemedicine no longer stand-alone Role for NES in managing learning resources for broadband links