What IM

1
What IMT is required for the provision of an
information and knowledge management service, AKA
the lab?

• Dr WA Bartlett
• Clinical Leader
• Biochemical Medicine
• Ninewells Hospital Medical School

2
Todays Challenges and Drivers for Change -

• Changing models of health care delivery.
• Changes in Funding Increasing workloads.
• Skills shortages.
• Reduced focus on laboratory medicine in the
  medical curricula.
• Exponential rise in medical evidence.
• Increasing demand for information by patients
• Quality and accreditation systems.
• Targets waiting times, NSFs
• Patient choice
• New analytical and information technology.

3
Can existing approaches enable us to face these
challenges or have we reached the end of a line?
4
What is our business today?

• Information Knowledge Management?.
• We answer ask questions
• We investigate
• We educate
• We innovate
• We Communicate

5
Our Product?

• A distillation of information, data, measurement,
  and knowledge.
• Formats -
• Reports
• Papers
• Guidelines
• Handbooks
• Educational Materials
• Presentations

6
Information and Knowledge Management Enables the
Delivery of Key Objectives of a Laboratory
Medicine Service?

• Clinical Effectiveness
• Cost Utility

7
How do We Achieve these Objectives

• Ensure that our services are used appropriately.
• Ensure that apply our resources efficiently and
  effectively.
• Ensure that our outputs are fit for purpose and
  delivered to the right place within the right
  time frame.

8
Achieving the Objectives?
Diagram Courtesy of Dr CG Fraser, Dundee
9
Do current lab IT Systems Help us Achieve These
Objectives ?
10
(No Transcript)
11
Traditionally lab systems have focussed on
laboratory problems.

• New Lab systems may need to do much more.
• Integration across systems
• Integration of POCT
• Clinical Governance
• More management functions
• Features -
• Integrated electronic requesting and enriched
  reporting (hospital medics, GP, ICRS, HPA,
  nurses, labs)
• Management/mining of diverse data sets in cross
  disciplinary/system environments.
• Knowledge management
• Web enabled - multimedia

12
(No Transcript)
13
The technology is there we need to put it in
place to effect!
14
IT Clinical Effectiveness
Requesting Reporting Is Key

• Need to ask the right questions.
• Provide the right inputs.
• Deliver the required outputs to the right place
  within the required time frame.
• Apply the outputs effectively.

15
Computerised Order Comms should provide the
following -

• Improved data quality/integrity/flow
• Intelligence in the interface
• Links to information sources (electronic
  handbooks)
• Force delivery of Critical information
• Rapid transfer of evidence into practice
• Results linked to requests
• Current status of requests
• One stop shop, hiding complexity of our
  organisation from the user.
• Enable arrangement of transport
• Such systems exist (e.g. AHSL ICE)

16
Evidence into practice?

• work with clinicians to turn evidence into
  practice.
• Take the evidence and build it into the
  requesting interface.
• Integrate systems with expert systems

17

• Medic to Medic
• Map of medicine
• Integrated Care pathways
• www.medic-to-medic.com

18
Electronic Handbooks.

• XML/XHTML open up new possibilities.
• Use of XML schemas and style sheets will produce
  flexible availability of content and ability to
  rapidly update many systems.
• Local v national availability.
• Web links to evidence and expert sites
• Reference intervals

19
Pre-analytical and lab processes

• Lean and robust high quality process with low
  error rates -
• Concentrate skills on -
• Quality
• Clinical interface
• Education
• RD

• IT requirements -
• Document control
• SOPs available electronically at the work station
  (e.g. Page Suite).
• IQC packages
• Process mapping
• Simulation software

20
Knowledge Transfer Mediated by Erudite Lab
Professional/Medic
21
Report
22
Pacific Knowledge Systems

• www.pks.com.au.
• Tailors the report to the patient

23
Apply Outputs Effectively.

• Combine information, data and knowledge to
  provide a meaningful report to the point of care.
• Enriched reports to aide medics.
• Disease probabilities based on nosology
• Graphical representations
• Novel reporting formats based on pattern
  recognition?
• Hyperlinks to data sources decision aides.
• Automatic referral to areas of expertise
  (local/national)
• Information for patients.

24
Labs helping evidence into practice
25
55 year old White Female
Creatinine rise from 206 to 227 Change
10.3 95 probability of significant rise eGFR
at baseline 23 mL/min/1.73m2 eGFR now 20
mL/min Change 10 3 mL 90 probability
significant fall in eGFR Patient referral?
26
(No Transcript)
27
Deliver the required outputs to the right place
within the required time frame.

• Paper v electronic
• Local v National
• PC v Laptop v Bedside TVs v Handhelds
• E-mail to Blackberry?
• Authorisation delays complex validation systems
  built into LIS?
• Enriched reports
• Interaction with other databases (e.g. pharmacy/
  prescribing/ radiology)
• Error handling?
• Multidisciplinary reports
• Customisation of reporting/requesting

28
Lab system of the future -

• Supports the desired focus of the business.
• Business management functionality
• Big multidisciplinary data base which is future
  proofed.
• Instrument interfaces handling much of the
  traditional functionality (QC, technical
  validation, stock control).
• Web enabled with integrated messaging.
• Integration with others systems (EPR/pharmacy
  etc)
• Knowledge management and data mining.
• User friendly front ends for all user types.
• Flexible and scalable (modular?).
• Defined by the service rather than defining the
  service.
• Never crashes and makes the coffee.

29
Functionality and Levels of IT Complexity that
Exist in the Modern Lab Environment

• No systems available with all this functionality
• Big lab networks may require support of HR etc
• Web technology and mobile computing provides
  massive opportunities to increase impact of
  outputs.
• Data integrity aided by NPfIT

30
(No Transcript)
31
Steam is Out and Fly by Wire Is In!!!!