what’s the obsession with the paper ?

Better Medicine Better Health

What’s the obsession with the paper ?

Dr Paul Southern

Consultant Hepatologist


• Where are we ?– Nationally– Personally

• Where should we be ?– Including the why

• How should we get there ?


Where are we ?


Clinical Five

PAS 216/216 Order com 147/216 Dchg Sum 189/216

Scheduling 116/216 Erx 102/216


Hardware

• Excellent wireless

• Good hardware refresh programme

• Out of hours technical on-call

• Good choice of devices

• Apple compatibility.


I use

• Word / letters directory (Silo)

• PACS

• PAS

• ICE

• Unisoft GI

• Outlook

• SystmOne

• Evolve


Bradford


Maybe…….Things aren’t

too bad at Bradford ????


Where should / will we be ?

• We will have less– Beds– Money– Staff

• We will have more– Patients

• Who are older and sicker

– Expectations


Where should we be ?


• Safe, effective and compassionate medical care for all who need it as hospital inpatients

• High-quality care sustainable 24 hours a day, 7 days a week

• Continuity of care as the norm, with seamless care for all patients

• Stable medical teams that deliver both high-quality patient care and an effective environment in which to educate and train the next generation of doctors

• Effective relationships between medical and other health and social care teams

• An appropriate balance of specialist care and care coordinated expertly and holistically around patients’ needs

• Transfer of care arrangements that realistically allocate responsibility for further action when patients move from one care setting to another.


11 core principles

• Fundamental standards of care must always be met.

• Patient experience is valued as much as clinical effectiveness.

• Responsibility for each patient’s care is clear and communicated.

• Patients have effective and timely access to care, including appointments, tests, treatment and moves out of hospital.

• Patients do not move wards unless this is necessary for their clinical care.

• Robust arrangements for transferring of care are in place.

• Good communication with and about patients is the norm.

• Care is designed to facilitate self-care and health promotion.

• Services are tailored to meet the needs of individual patients, including vulnerable patients.

• All patients have a care plan that reflects their individual clinical and support needs.

• Staff are supported to deliver safe, compassionate care, and committed to improving quality


University Hospitals Birmingham


E-prescribing

• Benefits – Mainly relate to decision support

• Integration of pathology +/- medical record

– Less missed doses– Ability to audit and improve practice

• Disbenefits– False confidence– Errors still happen


• Order Comms– Right test / right time / right patient– Productivity hit ?

• Discharge summaries– Improved comms with community– Legibility / safety / reproducability


Why ?


Francis report

‘failure to put the patient first in everything that is done’

•Culture of secrecy– Informatics tends to expose issues (if the data

is inputted in the first instance !)

•Poor performance– Ie observations (<70% complete with paper

charting – nears 100% with computerised)


How should we get there ?

• What is the gold standard ??

– Multifuctional EPR –• EPIC / Allscripts / Millenium ……….

– Best of breed with interfaces


Best of breed

• Choice of clinicians (at least in our Trust !)

• Everyone is special, so very special. (Some are even more special than others)

• If correct architecture is in place should talk to everything else.

• Requirement for open APIs should improve things


• But– Requires lots of (?) expensive interfaces– Information may be added more than once

• Hierarchy and conflict

– More vendors to deal with– More clinical issues to deal with.


Large EPR

• Everything in one place

• Already integrated

• Designed for decision support etc.

• ? Good for audit


• But…

– Expensive– Big– Huge business change – Clinical acceptance can be challenging.– Throwing out billions of pounds of NHS

investment


What do you need to give your CCIO ??

• A quick win• Friends• ? Everyone a device (??an ipad)

• The clinical information to do their job– Better– Faster– Safer– With the patient at the centre


As quickly as possible

• Get the information out of the silos

• Present the information to the clinical teams

• Make the information useful

• Plan from there.


So….

• I think informatics is going to save the NHS

• I think the only way forward is collaboration – Clinicians & Informatics / IT/IS

• I think we need EPR – and a big, all singing, all dancing one

what’s the obsession with the paper ?

Documents

patients care

seamless care

care setting

clinical care

weekcontinuity of care

compassionate medical

highquality patient

effective environment