Safer IT Systems for the NHS

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Safer IT Systems for the NHS

• Dr. Maureen Baker CBE DM FRCGP
• Special Clinical Adviser NPSA
• Clinical Safety Officer CfH

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Overview

• Patient safety in Connecting for Health
• NPSA commissioned study
• Safety Management Requirements
• IT solutions to patient safety problems
• Process re-design

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National Programme for IT (NPfIT) in NHS

• AIMS
• To deliver a 21st Century health service that is
  better for patients, citizens, clinicians and
  people working in the NHS through the efficient
  use of ICT
• To improve the convenience, quality and SAFETY of
  patient-centred care by ensuring that those who
  give and receive care have the right information,
  at the right time

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Why do we need it?

• Medical and clinical knowledge continually
  expanding
• Patients want more involvement in their care
• Traditional paper-based recording and storage
  systems can no longer provide effective support
  for NHS
• Many hospitals and most general practices now
  have some form of electronic patient record that
  cannot easily be shared
• Data and information not easily shared across NHS

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Why is this important to NPSA?

• Huge potential to support clinicians in
  practising safely prescribing, transfer of
  information, clinical decision support
• Platform to enable NPSA solutions work right
  patient right care, transfer of care
• Opportunity to exert major influence for safety
  on 6B programme

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Maximising safety in primary care systems

• NPSA funded study (55,000) from University of
  Nottingham
• Conducted during 2003
• Emerging findings conveyed to NPSA while study
  on-going and influenced programme of work

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Objectives of study

• Identify the most important safety issues
  regarding GP computer systems
• Assess GP computer systems in terms of these
  safety features
• Determine GPs knowledge, views and training
  needs in relation to computerised safety features
• Work with stakeholders to produce specifications
  for GP computer suppliers and for training
  practice staff

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Primary care contacts

• 1 million consultations with GPs in UK every
  working day (NHS Plan, 2000)
• 100,000 home visits by community nurses every
  day (NHS Plan, 2000)
• 617 million prescriptions dispensed by community
  pharmacists in year 2002-3 in England (source
  PPA)
• 50 million prescriptions dispensed in dispensing
  practices in year 2002-3 in England (source PPA)

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Medication errors - English general practice

• Medication error rate between 1 and 10 of all
  prescriptions generated
• From lower estimate could be 6,500,000 medication
  errors
• Estimated 1 of medication errors in general
  practice are clinically significant
• Could be 65,000 cases of harm in England annually
  

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Results from NPSA funded study (University of
Nottingham)

• Allergy alert may not be generated
• Hazard alert generated every third prescription
• Single keystroke to over-ride alert
• No audit trail
• Not all safety functionality activated (eg
  contra-indications)
• Hazards generated by drop-down menus
• GPs unsure of safety functionality on systems
• Some think functionality is present when it isnt
  (eg contra-indications)

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Development of Safety Management Approach in NPfIT

• DCMO requested NPSA to conduct high-level risk
  assessment of NPfIT
• NPSA Risk Adviser conducted assessment early
  summer 2004
• Report delivered to NPSA and NPfIT June 2004

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Report findings

• NPfIT currently not
• Formally incorporating safety as a benefit to
  drive the programme
• Formally risk assessing systems and processes
• Formally risk assessing solutions to ensure no
  new risks introduced
• Relying on those involved to instinctively
  address patient safety

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Conclusion

• NPfIT not addressing safety in an explicit,
  proactive, structured and robust manner and.
• Other industries would!

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NPfIT Action

• Work in partnership with NPSA to address safety
  concerns
• Safety Management Approach evolved in workshops
  Autumn 2004
• Based on IEC 61508 (international standard for
  safety critical software)
• Agreed with and supported by NPSA
• Implemented January 2005

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Aims of Safety Management Approach

• To deliver IT systems which improve clinical
  safety.
• To provide suppliers with an easy to use and
  robust safety management system.
• To provide Trusts with assurance and clear
  guidance on the actions they need to take to
  ensure systems are deployed in an effective and
  safe manner.

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Safety Management Requirements

• Every CfH product, and every product that
  connects over the spine to have
• End-to-end hazard assessment
• Safety justification case
• Safety closure report
• When closure report signed off, then
  certificate of authority to deploy issued

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Responsibilities

• The Director of Clinical Safety, Professor Muir
  Gray, Chairs the CfH Monthly Safety Committee.
• The National Patient Safety Authority (NPSA) have
  seconded Dr Maureen Baker as the Clinical Safety
  Officer.
• Muir and Maureen will ensure liaison with the CfH
  Programme Development Board and RIDs

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IT solutions to patient safety problems

• Right patient right care
• Clinical Hand-offs
• Interface issues
• Management of investigations and results

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Process design

• Poor processes can lead to patient safety
  incidents
• Automating poor processes still yields poor
  results for patient safety
• Clinicians need to feed into development of
  systems
• Change in working processes should be determined
  by clinical requirements, not by the way in which
  IT systems have been designed

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Safety Principles

• Systems designed to deliver safer patient care
• Patient safety embedded at every level
  specification design testing and quality
  assurance implementation and use in clinical
  setting
• Structured risk assessment incorporated into
  development processes
• Aim for inherently safe systems

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ANY QUESTIONS?

• www.npsa.nhs.uk
• maureen.baker_at_npsa.nhs.uk