1. The benefits from standardised terminology for NHS England The view from NHS Connecting for Health Dr Mike Bainbridge Clinical Architect October 2006

2. First…perhaps some perspective

3. Martini

4. Clinician Citizen Health Social Care

5. Citizens Needs The distinction between citizen and patient is artificial There are only met and unmet needs A credible health society should focus on meeting the needs of its citizens A credible citizen should be an active partner in this process Health, social care and education records are currently artificially separated if the focus is on meeting unmet needs

6. These are challenges to any of the member states. Why reinvent wheels ?

7. Total health expenditure as a percentage of Gross Domestic Product in EU - UK ONS Website

8. English IT spending will represent 4% of total health budget by 2008 Wanless Report

10. €1€10€100€1,000€10,000 0% 100% Healthy, Independent Living Chronic Disease Management Doctor’s Office Community Clinic HOME CARE Assisted Living Skilled Nursing Facility RESIDENTIAL CARE Community Hospital ICU Specialty Clinic CLINICAL CARE COST of CARE/DAY QUALITY of LIFE The Past Traditional HIT Focus

11. Terminology Advantage #1 Unambiguous machine to machine communication for distributed (cross boundary) care workflow

12. From Genetics to Ergonomics New Challenges

13. Telecare Technology Vision Elderly living independently WWW Home Hub Appliance Glucose Sensor Pedometer Blood- pressure Cuff Cholesterol Monitor Medication Tracking Single Assessment Protocol Database, Housing Record, Social Care Record Home Automation Security Wireless Network Lights Doors windows Motion / Activity Bed Drawers Kitchen Bathroom Sensor networks Care Professionals Family, friends and volunteers NHS Care Record NHS Direct Telecarer Care Response Service, Warden etc Emergency Services e.g. Text alerts The English View

14. Consent Confidentiality Privacy Identity management for citizens Trust, truth and provenance

15. From Paper to Electronic Records

16. Paper records Ubiquitous 350 year old paradigm Incomplete is expected Knowledge support is more paper or ‘book paradigm’ Decision support is rudimentary or disruptive Therefore is it unethical to continue to use paper records to pretend to deliver ‘joined-up’ care in the 21 st Century ?

17. Terminology Advantage #2 Navigation of large records –20 years of medical records as GPs now have are difficulty in navigation on ‘small’ computer screens. –Context specific views are needed during care, coded records essential for this –Agreement on headings or even the need for headings would be useful –Not a unique problem

18. Paper is no longer fit for our purposes

19. Terminology Advantage #3 Decision support. –Machine understandable records are essential. –Even basic medication DSS requires coded diagnoses, coded allergies, coded drugs coded patient preferences –AND DEFINITIONS !

21. “we can see that from 1948-1994 there have been 7 doublings in real research expenditures, plus 3 doublings in real research productivity, which implies a total of 10 doublings in total medical knowledge, or roughly a 1000-fold increase in medical knowledge (The exact figure is 1342 times).” Robert A. Freitas Jr http://leitl.org/sci.nano/5165.html

22. Stop pretending all of medicine can be remembered by humans, however clever.

24. “It is unethical to carry on doing what we are currently doing” Professor Sir Muir Gray NHS Head of Knowledge Management 01-Oct-2004

25. Terminology Advantage #4 Electronic care pathways/ guidelines. –Particularly in case of long term condition management and cross care boundary care, –Positioning of patient within the pathway is only effective if you have a machine understandable record Requires all your professions to be aligned and believing that this work is necessary

29. Terminology Advantage #5 Secondary uses –Surveillance –Audit –Research –Screening –‘Classification’ –Payment of GPs though their new contract

30. Grown-up secondary use

33. And Finally Choosing a terminology has multiple advantages Most important is that it acts as a catalyst for all other enterprise-wide essentials which have been needed for 40 years in the UK ever since the first implementations in the late 1970s

34. Messages –Interoperability –Citizens as active partners –Industry engagement –Clinical Engagement –Innovative contracting –Common User Interface –Standards –Partnerships –Let’s try and not invent the same wheels ! –Let’s work in partnership on common areas

35. In 2015….across the EU No paper records Clinicians using records Consent to share Genomic and other “omic” data Decision support Knowledge support Active Patient Partners All images Automated prompts and warnings Background data mining Feedback of research and evaluation into the service

36. Demonstrations Common User Interface –Care pathways –Medicines management –Terminology demonstrator –‘Notional Clinical Application’ –Standards for interface design Choose and Book Radiology PACS

37. The benefits from standardised terminology for NHS England The view from NHS Connecting for Health Dr Mike Bainbridge Clinical Architect October 2006