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Making IT WorkMaking IT Work

Tom Faichen BSc CSci FIBMS

BMS 3 (Lab. IT Manager)

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TopicsTopics

Personal Background.Why IT is necessaryWhat we want IT to do nowHow to make IT work

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Personal QualitiesPersonal Qualities

IdealistA bit Naïve at timesLike playing devil’s advocateMost importantly I am fully aware that as

well as an employee of the NHS, I am also a PATIENT !!

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Personal BackgroundPersonal Background

35 years in Laboratory MedicineMost specialising in Maternity/Neonatal

Haematology and Blood TransfusionBecame involved in Lab Computer Systems

1985Have played a major role in procurement,

implementation and management of 4 LIMS

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IT Development - WhyIT Development - Why

Government Policy of reform in NHSPatient centred Policy with IT backbonePatients demand fast efficient NHS Providers dependant on efficient data

transfer and presentationLabs and Radiology supply 60-70% of

patient data

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Electronic Patient/Health Electronic Patient/Health RecordRecord

The driving force of these reformsGetting all the data into a single patient

recordAid Patient SafetyAllow Decision Support - allow links to

Guidelines and EBMAid efficiencies and use of scarce resources

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Order Communication Order Communication SystemsSystems

Patient Safety– Positive Patient Identification (Bar Coded

wristbands/RDIF)– Vein to Vein tracking when issuing blood

products– Printing of labels at point of collection

Electronic Transmission of order to Lab. Electronic tracking of order back to patient

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Laboratory Taking ControlLaboratory Taking Control

Electronic/Protocol based orderingSingle EPR across multi-site/sectors

– Reduction in unnecessary duplicate testing– Use of Evidence Based Laboratory Medicine

Transcription Error Reduction– Patient validation– Electronic reporting– Electronic links between Laboratories

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Electronic OrderingElectronic Ordering

Agreed Electronic Protocols– Chest pain, Abdominal pain

Guideline Awareness Hierarchical control of expensive/sensitive tests

– Consultant to authorise before test can be ordered

Duplicate Testing Control– Clinician automatically referred to previous results or

outstanding request status

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HowHow

I.T. is only part of the solutionHow we implement and use I.T. must be

consideredThink about turning Data into useful

information then knowledgeThink as a patient and how you would

expect your information to be used

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Sociological and Cultural Sociological and Cultural IssuesIssues

Major change in working practice across the whole organisation

Development of ‘technical’ system plusDevelopment of ‘users’ working practicesGives ‘best fit’ and successful

implementationKey staff must be involved from beginning

of any project

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Problems

to be overcome.

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Unique Patient IdentifierUnique Patient Identifier

Fundamental to EPR/EHRCurrent Multiple Numbers held in Legacy

systems across sites– Problems importing historical data– Problems keeping disparate records up to date– Problems Identifying patients to avoid multiple

records

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START

AGAIN

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Patient Database CleanupPatient Database Cleanup

Complete download all area patient demographics into new PMS Database

Link to local SCI Store and National CHI Database for updates

Merge matching historical records to new database on presentation

Populate all service systems such as Labs with new Database

Only download minimum historical data into new service database keep all rest in lookup account.

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CommunicationCommunication

Staff Fears– Communication between all

disciplines/departments involved– understanding that there will be disadvantages

as well as advantages to individual groups – Adequate training for all users

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ConfidentialityConfidentiality

Patient Data must be secureStaff access on ‘need to know’Appropriate audit trails on data accessInclude for use in R&D, EBMResource Password maintenance Secure fast logins

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InfrastructureInfrastructure

Investment in infrastructure must include– Ring Fenced finance– Sufficient support to provide 24/7/365 cover– Regular upgrading of supporting equipment

Insufficient investment in above leads to– User stress, user disenchantment– Ultimately system failure.

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Quality IssuesQuality Issues

Variation in use of Standards– Database structure variations– User variation in data entry

Search methods Use of case

System upgrades– Reintroduction of ‘bugs’– Functionality changes

Applying Quality checks

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System Implementation

and

Post Implementation Review

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TrainingTraining

Include overview of whole system Training time must be made availableRefresher training especially in backup

proceduresGeared to individual needs assessment Appropriate training at appropriate time

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Pilot SitesPilot Sites

– Must be representative Include all sites if multi hospital Broad spectrum to cover most eventualities Where possible interface to all systems which will

ultimately be connected

– Must have eager Champion– Must realise there will be pain before gain– Should not be extended beyond pilot until all

major issues are resolved

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System ReviewSystem Review

Pre and post pilot audit of– Length of stay in unit (e.g. ICU)– No of requests with complete dataset– No of duplicate tests– No of clinical incidents reported with patient

ID problems

Publish Findings

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Summary for Making OCS WorkSummary for Making OCS Work

Strong strategic leadership from project board Solve the Patient ID problem Getting the correct system ’champions’ to lead

their area of the project Ensure full understanding of current work practices Ensure new work practices are not slower than

current Ensure adequate training at the right time Publish findings

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ReferencesReferences 1 Strategy for Information; NHS Scotland; Accessed 29/6/2005 2 National eHealth IM&T Strategy 2005-2008 ; NHS Scotland Accessed 30/6/05 3 Information Technology in Complex Health Services Organizational Impediments to Successful Technology

Transfer and Diffusion; Frank Charles Gray Southon, MSc, PhD, MComm, Chris Sauer, PhD, and Christopher Noel Grant (Kit) Dampney, Msc, PhD; J Am Med Inform Assoc. 1997 Mar–Apr; 4(2): Accessed 2/7/05

4 Understanding Implementation: The Case of a Computerized Physician Order Entry System in a Large Dutch University Medical Center; Jos Aarts, MSc, Hans Doorewaard, PhD, and Marc Berg, MA, MD, PhD; American Medical Informatics Association, J Am Med Inform Assoc. 2004 May; http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=14764612 Accessed 2/7/05 

5 Lorenzi NM, Riley RT. Knowledge and change in health care organizations. Stud Health Technol Inform .2000; http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=61464 Accessed 2/7/05 

6 A Consensus Statement on Considerations for a Successful CPOE Implementation; Joan S. Ash, PhD, MLS, P. Zoë Stavri, PhD, MLS, and Gilad J. Kuperman, MD, PhD; J Am Med Inform Assoc. 2003 May–Jun; 10(3): 229–234. Accessed 13/8/05

7 Computerized Clinical Decision Support: From the Classroom to the Patient’s Room –Presentation by 1st MSc graduate, Dr Andy Steele; Health Care Informatics Symposium; 28th June 2005 Royal College of Surgeons Edinburgh 

8 The National Programme for IT: Safer Care for Patients – Dr Paul Whatling, Former Clinical Lead, NHS Connecting for Health;Health Care Informatics Symposium; 28th June 2005 Royal College of Surgeons Edinburgh

9 Reducing costs with computerised order entry Core Informational White Paper accessed 13/8/05 10 Medic to-Medic® and the Map of Medicine® – Dr Enone Honeyman; Health Care Informatics Symposium; 28th

June 2005 Royal College of Surgeons Edinburgh