combining the role of clinical information leader and patient safety champion, dr ian jackson, ccio,...
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#CCIO
#CCIO
Combining the role of clinical information leader and patient safety champion
Dr Ian JacksonChief Clinical Information Officer
York Teaching Hospitals NHS Foundation Trust
Combining the role of clinical information leader and patient safety champion
Dr Ian Jackson
History1981 MS – DOS & IBM PC1982 Commodore 64 released1983 Lotus 1-2-31984 Apple Mac, DELL founded1985 CAT1 wiring1986 PIXAR founded1987 Windows 2.01988 Motorola 880001989 ASUS founded1990 ARCHIE – first search engine1991 Web launched to public1992 Windows 3.11993 DOOM released1994 Windows NT3.51995 Windows 951996 Google1997 Dancing baby!1998 iMAC, Paypal1999 Blackberry2000 Windows XP
Qualified Woodend terminal/printer for biochemistry results
Consultant Anaesthetist1 IBM PC for database work in departmentSecretaries had electric typewriter
Time out like today but for
clinicians ...............................................…vision
1989 Vision
In 5 years we would be able to• Sit at a desk with our own PC• find patient letters, results etc• find where patients were in hospital• enter details into an electronic record
But we can now and it is important
So how can IT help safety?
• Consider my world..
• We set up preoperative assessment in early 1990’s
• Fragmented process and all based on a separate paper record
ReferringDoctor
SpecialistConsultation
Diagnostics+
Optimisation
PreoperativeAssessment
Schedule&
AdmissionRecovery
SuccessfulDischarge
UnplannedOvernightAdmission
Method to return patientsunsuitable for surgical or medical reasons
Patient Pathway
Paper
Paper
Paper
PaperPaperPaper
Day surgery
• Preoperative assessment run by rotating staff.
• Difficulties supporting them when they found a problem with a patient
• Development of Ian’s Box– Not unusual to find 30-40 forms to review– Patient maybe due in the next day
What about other areas?
• Often remote from theatres
• Even less support for staff
• Problem patients – form photocopied and sent in internal mail to
‘designated anaesthetist’
What about other areas?
• Often remote from theatres
• Even less support for staff
• Problem patients – form photocopied and sent in internal mail to
‘designated anaesthetist’
Perhaps you begin to get the picture?
Big safety issues• No timely review of problems
• Reliance on single individuals
• Reliance on paper trail
• Reliance on internal mail
Lack of timely review
Dependence on single individuals
Reliance on internal mail
Reliance on paper trail
Safety Issues for our patients
Based on model by James Reason
Electronic System
• Not just about the system PROCESS
• Important to engage with those involved to help consider the process
• The high level design and map of information flows can help streamline the clinical process
Preoperative Assessment
Design of system helped drive• Agreement of single assessment process
• Agreement to move towards unified assessment team
• The design of a clinical process to manage patients
So what did we end up with?
• Electronic Preoperative Assessment module
• Integrated so part of developing ICR
• Direct access from Theatres module
• Method to manage ‘problem patients’
Management of problem patients
• Use of Worklists
• Patient can be referred to department for action
• Patient can be referred back to Preassessment staff for action
Improving reliabilityLevel I Intent, vigilance & hard work
Level 2 Design systems for reliability constraints, decision aids, reminders, checklists, bundles
Level 3 Prevent design for reliability Identify make failures visible Mitigate prevent / treat harm due to failures
IT is now integral to patient safety
Reliable Health Care Systems• Prevent failure
• Identify and mitigate failure – identify failure when it occurs and intercede before harm
is caused, or mitigate the harm caused by failures that are not detected
• Redesign process based on critical failures identified
Three tier strategy - Institute for Healthcare Improvement