1. Penfield Virtual Hospital InContext Denise Downs Director of Research & Enterprise

2. OpenHealth Tools December 2008 1 … And now for something completely different

3. OpenHealth Tools December 2008 2 Delivering Improved Health Care Current work with local trusts around patient documentation – identified skills gaps in staff that allows recording to the required level of precision Some current resistance regarding new IT systems that doesn’t add value to patient care experience – more about MIS Need to help future professionals understand what new information will be able to get from new systems.

4. OpenHealth Tools December 2008 3 Agenda: Products –Penfield Virtual Hospital –InContext Community of Current Users University Future Interests An exploration ???

5. OpenHealth Tools December 2008 4 University of Huddersfield Context Health courses provided for: –Nursing –Midwifery –Operating Dept Practice –Occupational Therapy –Physiotherapy –Podiatry –Primary Healthcare –Social Work –Counselling Research also determining recognised practice in such areas and providing additional teaching materials

6. OpenHealth Tools December 2008 5 Wards Patients Staff Patient Records Time based simulation Keith Ward http://www.penfieldvirtualhospital.info

7. OpenHealth Tools December 2008 6 Penfield VLE Penfield Virtual Hospital represents on a computer screen the week in the life in an acute hospital. Penfield is populated with real patients case notes drawn from the InContext project. The case notes viewed through Penfield Virtual Hospital provide the individual Clinical Context to SNOMED concepts in support of Direct Care. Penfield Virtual Hospital provides the Service Delivery Context to support Indirect Care functions e.g. aggregation functionality, resource management, research, epidemiology, administration and management information etc. Penfield has its own learning management system that enables multiple choice, list sort and essay type questions to be raised in the context of activity users are currently doing. Multiple choice and list sort questions are graded on submission with immediate feedback given to users.

8. OpenHealth Tools December 2008 7 Types of content Admissions details Care Plans Investigation results –Lab reports –Ultrasound –X-Ray –ECG Medical Notes Correspondence and reports Observations Prescriptions Fluid intakes …

9. OpenHealth Tools December 2008 8 InContext http://incontext.intrica.net http://incontext.intrica.net The InContext web site contains 261 examples of real anonymised patients case notes drawn from a broad range of medical specialities including Med/surgical, Ophthalmic, ENT, Obstetrics and Gynaecology, Paediatrics, Mental Health, Learning Difficulties etc. Case note collection process started in 2004 and continues year on year. Every year new case notes are collected and added to the web site; equal to at least 10% of total stock. In 2009 we aim to collect 26 new case files. This methodology ensures that the case files reflect changes to treatment modalities, drugs etc. Each year we extend collections into new areas e.g. in 2009 We are extending into primary care areas. Currently twenty-three UK, three Australian, one New Zealand, three Irish and one south African HE institutions subscribe to the InContext web site contributing 1936 individual registrants.

10. OpenHealth Tools December 2008 9 InContext Ethical approval until 2012 for current activity Provides for case based learning Fully transcribed verbatam Many cases have tutor notes, highlighting learning points but also referencing QAA benchmark statements Held in pdf’s and fully bookmarked Incontext site allows users to search for relevant case notes and then download the full pdf’s Can get real care plans, fluid balance sheets, X- Rays, discharge summaries etc

11. OpenHealth Tools December 2008 10 Sample case bookmarked content Care Plans Ward round reports Medical notes Multi-discipline notes Pressure sore assessments Nutritional assessment Weight chart TPR Chart ECG Biochemisrty Haemotology Microbiology Radiology Prescription ……………

12. OpenHealth Tools December 2008 11 InContext Currently 60% of the case notes have a discharge summary based on the UK medical colleges discharge summary template and include full SNOMED codes in the clinical narrative section [and other sections]. By April 2009 all case notes will have a completed discharge summary and also an admissions summary based on the UK medical colleges template and fully SNOMED classified. Two sets of case files have been fully mapped to SNOMED codes as exemplars and saved in xml file format. Exploring with clinicians how SNOMED process contributes to Direct Care functions of decision support, documentation, case reporting and case summaries is likely to be a key determinant of a successful uptake. In the absence of this authentic clinical context there is a tendency that SNOMED education and training becomes features led rather than benefits led.

13. OpenHealth Tools December 2008 12 Penfield VLE When combined the InContext case materials and Penfield Virtual Hospital provides an in depth patient data base broadly representative of medical specialities that can be exploited to support SNOMED training of clinicians.

14. OpenHealth Tools December 2008 13 Current Business Model Currently have a community of users via license –37 institutions –Approx 2000 users Countries licensing: –Australia –New Zealand –Ireland –South Africa 16 Countries using exemplars 6855 active sessions in August this year Refresh the case studies at rate of 10% per year License fee supports resource to maintain and deliver the system, and to develop new case studies Community help determine priorities for new case development Income around installation and training Visibility globally – visiting lectures, conferences etc

15. OpenHealth Tools December 2008 14 University Priorities & Interests Research –Around current practice and issues –Around future practice and challenges Education of existing professionals Education of future professionals Accreditation of learning In UK very close relationship with Trusts, interchanges of staff Collaboration globally is increasingly key Research Funding often linked to collaboration models OHT can influence funding opportunities and help facilitate collaborative networks Open curriculum models already developing UK Government pressure to change HE models

16. OpenHealth Tools December 2008 15 What other applications for such data? Working with NHS UK on using our case notes to provide real data to help illustrate SNOMED CT usage to supplier base –Used that to enhance the discharge notes within Penfield to put SNOMED CT data in front of the professionals we are currently training Approached by one software supplier around extracting data from Penfield to help in testing cycle A wider role for Penfield around educating healthcare professionals in areas of interest for the OHT community ? … ? Role for HE in OHT???