1. Can Complimentary IT Provide Some of the Solutions? Dr Mark Tidmarsh Consultant Anaesthetist North Cumbria Acute Hospitals NHS Trust 2004

2. Current Service:Carlisle Integrated Hospital/Community Centralised Preassessment Unit Nurse led ( Organised as a ‘Clinical Sieve’ ) Directed by Anaesthetics Standardised Assessment Format (Custom Patient Questionnaire/Complimentary IT Preassessment tool) Named Community Preassessment Contacts Preassessment Social Worker

3. Surgical Preassessment A Clinical Communication System Managing A Complex Integrated Patient Event Component Elements Clinical Social Care Integrated Admin Capability Effective Data Management/Responsibility Joint Working with Multiple Care Groups (Within both hospital and community )

4. Assessment Shortfalls ‘Surgical Model Starting point’ Surgical Perspective Non-standardised Proformas/’Tick Box’ mentality Inappropriate Assessment Tool Limited Senior Supervision/Direction ‘One Size Fits All’ Limited Opportunity for Directed Management

5. Process Shortfalls ‘Surgical Model Starting point’ Secondary Care Perspective Fragmented/Duplicated (Expensive to Provide) Poorly Coordinated Lack of Data Responsibly Failure to Define Information Flows Failure to Collate/Use All Collected Information No Proactive Use of Waiting List Time

6. Development Approach Establish links/Pathways Process Mapping Exercise Patient flows Information flows Necessary Care Groups Case Management Model Patient the Primary Care Focus Emphasis on Service Integration Support the ‘Whole’ Patient Pathway (Referral to Discharge)

7. IT Advantages Assessment Standardise Theme (‘Simple for the uncomplicated…..) Format (‘Clinical sieve’) Content (Risk Assessment/Stratification) Training/Education Auto prompts/Web links/Integrated Teaching Material Portable Peripheral clinics (Space/Scattered population/GP) Clinical Research (Real Time Data Collection)

8. IT Advantages Process Information Management Improved Data Storage/Security (EPR) Coordinate Care (Hospital/Community) –Defined Information Flows –Custom Outputs System Interface (Auto-populate or Data viewing/sharing ) Clinical Audit ‘ House Keeping Reports’

9. Potential Problems

10. System Development Options In-House Restricted Vision Limited Development Resource Technical Support Public/Private Partnership Development Attitude/Commercial Approach IT Development Resource Future Utility/Compatibility

11. Public/Private Partnership Chameleon Information Management Services (CIMS) Infoflex Generic Tool Set Information Standard in Carlisle 18 systems implemented with over 350 users Used in over 90 Trust across the UK Has been sponsored for Spine Compliance CIMS is talking to the LSPs Uses Latest Technology Conforming to the messaging standards (eg. XML, HL7)

17. Future Opportunities Assessment Data Entry (OMR/Copy and Paste) Audit (Local/National) Peripheral Clinics Data Viewing (‘Read Only Out of Hours’) Process Common Surgical Pathway Parallel Management Opportunities System Interface (Community/Hospital) E-mail

18. Summary Complementary IT Define Assessment and Process Support Custom Changes Risk Assessment (Medical/Surgical Risk Stratification) Defined Information Flows ( Auto-Generated Outputs) Use of Available Clinical Time Effective Data Management Service Integration (Hospital and Community) Directed Management (‘ Match Need With Resource’ ) Preassessment Education/Training Potential

19. Questions?