Rachel HodsonGibbons

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• Rachel Hodson-Gibbons
• Head of eProcurement

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NHS process
Effective healthcare provision requires effective
information provision across the network.
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Patient journey
Primary care
Tertiary
Secondary care
sector
sector
care
Independent
Primary
NHS Trusts
contractors
Care Groups
(and Trusts)
District
NHS Direct
General
Comm
Hospital
health
Practice
services
Diagnostic
staff
Specialist
services
GP
and
Outpatient
referral
services
Non
-
emergency
centres
PATIENT
Inpatient
Emergency
services
Accident
Ambulance
emergency
service
I m GP
8000
33,000
5.3 m
25,000
visits
journeys
OP visits
admissions
operations
per day
per day
per year
per day
per day
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The NHS
The NHS employs 1.2 million staff The NHS
provides 1 million treatments every 36 hours
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Fragmented and complex supply network
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Healthcare data silos
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Ineffective information
Up to 1bn of the bills hospital trusts sent
primary care trusts last year could be wrong,
tests by the Audit Commission have
suggested. Faulty coding by trusts led to 9 per
cent of bills sent to PCTs in 2007-08 being for
the wrong type of procedure on the NHS tariff,
according to the commission's first full-year
audit of payment by results bills.
The Audit Commission's exposure of a high error
rate in clinical coding has an impact far beyond
payment by results. - coding errors mean
commissioners are making decisions based on
flawed information about what clinical work is
being performed.
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The context errors in healthcare

• In the UK, about 10 of inpatient episodes result
  in errors of some kind, of which half are
  preventable
• Of 8 million admissions to hospital in England
  each year, about 850,000 result in patient safety
  incidents which cost the NHS about 2 billion in
  extra hospital days.
• Ref C Vincent, G Neale and M Woloshynowych
  (2001), Adverse Events in British Hospitals
  Preliminary retrospective record review, BMJ
  322517-19

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eSystems

• Electronic and communication technologies
• Join up data silos, automate and remove errors
• Significant benefits available..
• patient safety
• supply chain
• Require - common data standards
• hence adoption of GS1 by NHS..

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NHS and GS1

• DH published Coding for Success in February
  2007, confirming policy support for auto-id and
  GS1.
• Recommendations
• All new coding applications in the NHS should be
  evaluated fully and the lessons shared widely to
  facilitate further development
• All supplies to the English NHS should have a
  product code following the GS1 bar code format,
  and manufacturers of medicinal products and
  medical devices should adopt this approach
• GS1 System should be used for coding
  applications in the NHS

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AIDC can reduce errors

• Key applications
• Verification confirming the identity of a
  person, item or procedure
• Data capture using AIDC to capture serial or
  reference numbers eliminates transcription errors
• Supply chain issues effective track and trace
  for stock control (right product, right place,
  right time) and product recall

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The Vision
Manufacturer

• Verify products
• through supply chain

Finance Stock control

• Verify right patient
• right intervention

Audit
Intervention

• Update patient
• record, stock control
• and audit

Wholesaler
Patient Record
Healthcare Provider (stores)
Clinician
Key
Patient
Flow of items or people
Flow of data
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Evidence patient safety

• Combined electronic prescribing, automated
  dispensing and bedside verification reduces
  prescribing (3.8 to 2) and administration
  errors (7 to 4.3) and patient ID checks
  increase from 17 to 81 (Charing X)
• Bar coding use in blood transfusions associated
  with reduced transfusion errors (Oxford)
• Vaccines use of batch no or expiry date in code
  form associated with reduced immunisation errors.
  (Canada)

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The vision patients
Pathology/ Radiology
Pharmacy
Diagnostics
Medication

• Patient
• ID encoded on wristband
• Electronic Patient Record

Surgical procedures
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Decontamination of sterile surgical instruments
Issue

• NHS National Decontamination Project is
  establishing 18 decontamination super centres,
  which require track and trace of surgical
  instruments.
• Track and trace a generic requirement for all
  NHS organisations

Action

• With the National Project
• Ensure AIDC requirements are fully assessed.
• GS1 application guidelines available
• GS1 coded instruments now available
• Case studies being developed from early adopters
  (Nov 2007)

• For organisations outside the National Project
• NHS and industry workshops
• Consultation with solution providers upgrade
  of systems to GS1

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Medicines manufacturing (and associated pharma)
Issue

• Production and over-labelling of medicines in
  hospital pharmacy units
• Robotic dispensing becoming more common so
  demand for coding of locally manufactured or
  over-labelled products is increasing.

Action

• Establish current procedures and practices
  through visits and survey
• Develop case studies
• Identify best practice (with National and
  Regional Steering Boards)
• Develop 10 step guide
• Workshops and other dissemination to facilitate
  uptake

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Patient identification
Issue

• Around 25,000 reports of patients being
  mismatched with care Feb 2006 to Jan 2007. gt2900
  of these associated with use of wristbands
• Wristbands are an ideal carrier for
  machine-readable verification of patient ID

Action

• NPSA Safer Practice Notices
• Standardising wristbands improves patient safety
  (July 2007)
• Your guide to implementing standard wristbands
  (July 2007)
• GS1/CfH team now working with hospitals to
  develop patient ID solutions for various
  applications.
• Case studies and workshops

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NHS procurement and commercial benefits
Improved healthcare provision
Traceability
Robust processes, reduction of waste
Partnership
Reduces Risk
Automation of processes
Consolidation, strategic sourcing
Compliance
Interoperability of systems and processes
Visibility of demand and expenditure
Common NHS data and business message standards
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Whole system benefits
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NHS Procurement eEnablement Programme

• Implements Procurement eEnablement in the NHS
  June 2007
• Strategy to drive forward adoption of
  procurement eEnablement technologies across the
  NHS supply chain
• Achieve interoperability - via common data
  standards
• Increase awareness and understanding
• Exploit once-only opportunities NHS data pool,
  pre-qualification for tendering

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Suppliers need to..

• Ensure participation in NHS procurement
  eEnablement is on the corporate agenda.
• Implement GS1 coding standards GTINs priority
  will be on high risk areas for patients pharma,
  med tech
• NHS GS1 migration plans
• NHS terms and conditions
• Ensure awareness about procurement eEnablement
  technologies within the organisation
• Participate in NHS once-only systems

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Contacts NHS Procurement eEnablement Programme
eenablement_at_nhs.net www.pasa.nhs.uk Rachel
Hodson-Gibbons 0789 999 5045 rachel.hodson_at_pasa.nh
s.uk