To what does this refer When

1
To what does this refer?When?

• That it will ever come into general use,
• notwithstanding its value, is extremely
• doubtful
• because its beneficial application requires
• much time and gives a good bit of trouble,
• both to the patient and to the practitioner

2
Positioning Front Line Connect in NHS
Connecting for Health
E-COMS
Digital TV
E-Gif
My Health Space
nhs.net

• Front Line Connect

Coordination of Initiatives and Impact

• Meeting Expectations

Frontline Staff
Evidence Base
Quality
Care Delivery
Patient Journey / Expectations
3
Here is Edward Bear,coming downstairs now, bump,
bump, bump, on the back of his head,
behind Christopher Robin. It is, as far as he
knows, the only way of coming downstairs,
A.A. Milne 1926 Illustration E.H.Shepard
192614
4
Best Practice Patient Pathway
Performance management information to be
communicated to all staff
Introduce scheduling to get the right
Call patients close to appointment to remind
them confirm medication details
Stagger lists stream patients flows Lower
patient wait time
people right equipment
Post op information inc pain management
in the right place, at the right time.
live, real-time data/systems for theatres
Generic Referrals
Nurse led discharges Discharge Lounge
Surgery
Patient and Staff Surveys feed back ideas and
suggestions into patient pathway
Pre Peri Post
Admission
Screen patients at referral
Discharge
Pool Wait lists where possible
and Pre-Assess
Follow Up
Outpatients

• All DS patients should walk to theatre
• Dedicated day surgery lists where possible if
  not schedule day cases first
• Mixed lists (IP, DC) can cause problems with
  productivity and cancellations
• session
• LAs often before GAs does not accommodate
  recovery time for same day discharge

Flexible opening hours supported by an
operational policy Ensure quality and consistency
of information Management of Post-OperativePain
Stagger admissions Dedicated admissions area
changing, locker facilities consulting
rooms All patients admitted on day of surgery

• Within 13 weeks of referral
• One stop shop one nurse-led pre assessment for
  all elective surgery, partial booking, consent
  begun
• Patient Fully briefed prepared

Streamline process Pre assess then list for
surgery Pre assess facilities could be based in
OP Agree patient selection criteria for DS based
on National Guidance IT to support staff
Post-op information Emergency contact
details Follow up telephone call
Design Day Surgery model for patient pathway
move away from the IP model
5
Challenge for the NHS

• ..is to harness the information revolution and
  use it to benefit patients.
• Rt. Hon. Tony Blain
• All our tomorrows conference, July 2 1998

6
Drivers for Change

• Empowerment of the patient
• Globalisation of Healthcare
• Alternative financing models
• Political commitment to modernisation and reform

7
The NHS

• What are we to
• Become?

8
Improved Accessto All Services

• Better emergency care
• Reduced waiting
• Increased booking
• More choice for Patients

9
Improving Services and Outcomes

• In
• Cancer Care
• Coronary Heart Disease
• Mental Health
• Older People
• Improving life chances for children

10
Focus on

• Improving overall experience for patients
• Reducing health inequalities
• Access
• Services
• Outcomes
• Contributing to cross-government tackling of drug
  misuse

11
The Context

• NHS Blueprint
• NHS Plan
• NHS Improvement Plan
• Accountability
• Healthcare Commission
• Clinical Standards
• Healthcare Standards Unit
• Population Health and Disease Management
• National Service Frameworks
• Information
• NHS Information Centre
• NHS Connecting for Health
• National Programme for IT

12
Obstacles to progress

• Territorialism
• Tribalism
• Traditionalism
• Tunnel vision
• Timidity
• Terror
• Toolopoenia atoolia
• Targetitis
• Tiredness, exhaustion and cynicism

13
The Innovation and Diffusion Cascade (Modified
from Don Berwick)

• Innovators - 2
• Early adapters - 5
• Spreaders/disciples - 15
• Followers - 58
• Agnostics and recalcitrants - 15
• Saboteurs and wreckers - 5
• Which species are you?

14
Positioning IT
Shared Information Common Systems National
Programme
15
Component Parts

• New National Network (N3)
• National Care Record Service (NCRS)
• Choose and Book Service (CAB)
• Electronic Transfer of Prescriptions (ETP)
• Picture Archiving and Communications (PACS)

16
NHS Care Record Service

• What it will do
• Transforms the management of Health and Social
  Care
• Gives health and Care professionals access to
  patient information
• Gives patients access to their own personal
  records
• Over time will show patient health and care
  history
• (Treatments, allergies, interactions, drugs etc.)
• Eventually include scanned paper records
• Local records will be more comprehensive
• Include, Scans, X-rays, operative data

17
Choose and Book

• Phased Implementation
• GPs/Primary care staff to make initial
  appointments
• Patient choice over when and where treatment
  received
• Provides better planning and management of
  information
• E-mail for professionals to discuss a patients
  care pathway
• Reduces incidence of cancelled appointments and
  DNAs
• Improves clinical governance
• Should achieve financial benefits
• Available for all first outpatient appointments
  by end of 2005

18
Electronic Transfer of Prescriptions

• Phased Implementation
• Prescriptions transferred automatically to
  chemist/pharmacist nominated by the patient
• Information sent automatically to the
  Prescription Pricing Authority (PPA)
• Patients can choose where they collect their
  prescriptions
• Cost of managing the payment for prescriptions
  will be reduced
• Increases patient safety by reducing prescription
  errors
• Should reduce dosage errors and adverse drug
  events
• Prescription information forms part of each
  persons NHS care record
• Repeat prescriptions sent directly to
  chemist/pharmacy
• Initial implementation sites followed by wider
  roll-out

19
Changing the Culture Requires

• Political sponsorship
• Public involvement
• Professional leadership
• Organisational ownership
• Patient empowerment

20
Changing the Culture Involves

• Sustained investment at all levels
• Continuous realignment of goals
• Whole systems approach to system redesign
• Placing the patient at the centre
• Common standards and benchmarks
• Continued focus on health improvement

21
Changing the Culture should avoid

• Short-term Expedience
• Professional Disengagement
• Policy Overload
• Planning Blight
• Re-engineering without Reform

22
IT in Health is for

• New and Seamless Models of Care
• Professional Self-Regulation
• Fully Informed Patient Choice
• Improved Population Health
• Targeted and Effective Performance Management

23
IT in Care
Client
Cultural Change to Enable Improved Care
Clinician
Computer
24
Is 99.9 good enough?
If it is then

• 2,700 pieces of mail would be lost by the Royal
  Mail every hour
• 6,200 ATM errors every hour
• 14 unsafe airplane landings every day
• 2 babies given to the wrong parents every day
• One major plane crash every 18 days
• 3,300 incorrect prescriptions annually

• Data from studies indicate
• As many as 30,000 die every year from
• Medical errors in the UK
• (Source BMJ March 2000)
• More people die from medical errors than
• - Breast cancer 12, 930 (2002 Figures)
• - Motor vehicle accidents 3,252 (2002 Figures)
• - AIDS 235 (2001 Figures)

25
IT in the new Paradigm

• Old View
• IT as a driver
• IT for its own ends
• IT competing for scarce implementation resources
• Technology is the priority

• New View
• IT as enabler
• IT as a catalyst
• IT used to assist collaboration between care
  providers
• Care Delivery is the priority

26
NHS Connecting for HealthIn Context
Changing Workforce
Clinical Governance
Agenda for Change
European Working Time Directive
Consultant Contract
National Programme for IT
GP Commissioning
Improving Partnership for Hospitals/National
Patient Safety Agency
27
NHS Connecting for HealthIn Context
E-COMS
My Health Space
Digital TV
E-Gif
nhs.net

• NHS Connecting for Health

Coordination of Initiatives and Impact
Frontline Staff

• ETD and FLC

Evidence Base
Quality
Care Delivery
Patient Journey / Expectations
28
The Stethoscope1834

• That it will ever come into general use,
  notwithstanding its value, is extremely doubtful
  because its beneficial application requires much
  time and gives a good bit of trouble, both to the
  patient and to the practitioner

29
Here is Edward Bear,coming downstairs now, bump,
bump, bump, on the back of his head,
behind Christopher Robin. It is, as far as he
knows, the only way of coming downstairs, but
sometimes he feels that there really is another
way, if only he could stop bumping for a moment
and think of it
A.A. Milne 1926 Illustration E.H.Shepard
192614