Transcript Health Informatics: A Clinical View

Health Informatics 2014:
A Clinical View
Professor Iain Carpenter and
Professor Martin Severs
Brighton, 4th June 2014
Our World View
• Health is a state of complete physical, mental and
social well-being and not merely the absence of
disease or infirmity. [WHO1948]
– Why important? Because it is inclusive of disability
[function] and handicap [participation] as well as
personal components of well being
• Informatics is the study of information and hence
includes information processing, information
systems and computer science
– Why important? Because it includes professional
practice aspects of information, the interactions of
professional staff and IT systems and the IT itself
What is Information – Anthony’s Triangle
CTO Council
Strategic Planning:–
Information to support long
term decisions
Tactical Planning:Summarised
operational data
Steady State:Resource/process
Management
modelling
Operational :Collection,
Recording
Transactions
External inputs
Insight
WISDOM
KNOWLEDGE
INFORMATION
DATA
Wisdom is the knowledge and
experience needed to make sensible
decisions and judgments, or the good
sense shown by the decisions and
judgments made.
An objective of knowledge management is to
ensure that the right information is delivered to
the right person just in time, in order to take the
most appropriate decision.
Information is the result of processing,
manipulating and organizing data. It is
the context in which data is taken.
Data – raw material for example,
numbers, text, images, and sounds, in a
form that is suitable for storage in or
processing by a computer . Without
context or specific meaning
Approach to the Presentation
The Citizen
The Patient
The Professional
The Health & Social
Care System
Information Technology [IT]
Approach to the Presentation
The Citizen
The Health & Social
Care System
The Patient
Occupational
Therapists
The Professional
Information Technology [IT]
Health and Social Care
19th Century
Hygiene and
Engineers
20th Century
21st Century
Advances in
Medical Science
Allied Health
Medical Cures
Clean water
Sewers
Systemic disorders of
aging;
neurodegenerative
disorders – balance and
gait
Public Health
morbidity
mortality
Function, Dignity and
Independence, Quality of Life
Developed from: Dr Jane Tolman, Keynote speaker 7th National Allied Health Conference, Tasmania 20/07/07
The Citizen
[Societal] CHANGE
• Autonomy as the
dominant moral force
• Personalisation
• Choice
• Openness and
Transparency
• My data*
EFFECT
• Stronger information
governance, right to object,
privacy notices etc
• Greater transparency on what
is happening to data
• Transaction as opposed to
information services
• Wider access to knowledge
• Challenge to Big Data eg
Care.data & Little data the
consultation
*The Immortal Life of Henrietta Lacks by Rebecca Skloot
The Patient & Service User
IOM report: Crossing the Quality Chasm: A new Health System
for the twenty first millennium. (2001)
• Customisation based on patient needs and values. The system of
care designed for the most common needs, but responsive to
patient choices and preferences.
• The patient as the source of control. Patients have the necessary
information and the opportunity to choose over the health care
decisions that affect them. The health system should accommodate
patient preferences and encourage shared decision-making.
• Shared knowledge and the free flow of information. Patients
should have unfettered access to their own medical information
and to clinical knowledge. Clinicians and patients should
communicate effectively and share information.
The Patient & Service User
WHAT DOES THIS MEAN AS AN OCCUPATIONAL THERAPIST?
• ‘free flow of • Do you share your letters with you
information’
patient? [DH Policy since 2004]
& the patient • Do you give patients record access
as a source
to OT electronic records?
of control
• How do you practice and record
shared decision making?
• Do you enable on line completion of
some OT assessments?
www.rcgp.org.uk/clinical-and-research/practice-management-resources/~/
media/Files/Informatics/Health_Informatics_Enabling_Patient_Access.ashx
The Patient & Service User
WHAT DOES THIS MEAN AS AN OCCUPATIONAL THERAPIST?
• Customisation
based on patient
needs and values:
new horizons?
• Are OTs the ‘go to’ profession for
electronic environmental
adaptation to enable people to:
–
–
–
–
Remember to take their tablets?
Remember to eat?
Sit down when going to loo?
Be helped remotely to take the right
food out of the fridge and prepare it
for eating?
– Support distant carers with support
and communication devices?
Perceived massive opportunities for OTs in this area both in terms of practice and
research. This area of ‘medical device’ technology is poorly developed
The Patient & their care record
• Can Citizens and Patients fully participate in their care
without access to their records?
• Should (will?) routine and continuous record access
become the clinical and social norm?
If so then
• Records must be accurate and contemporaneous and
both human & machine readable in order to be
• citizen controlled
• linked to knowledge sources and decision support
• Data standards must enable an individual’s health
care information to be recorded as accurately and
completely as necessary to be both human and
machine readable
The Professional
• The patient/professional relationship, based on trust, is
the central component of clinical care
• Any healthcare system must support the relationship and
the trust
• Many factors conspire against it
–
–
–
–
–
Time
Loss of tolerance and trust
Excess of expectation
Targets
Securing Trust income from secondary use data sets
• The care record is the core repository of all care
information and must be accurate, contemporaneous
and trusted or the relationship breaks down.
It is crucial OT informaticians put the patient first and the tax payer second
The Professional & the care record
• Two main topical subjects
– Professional standards for record keeping
– Sharing Data
www.theprsb.org.uk
Record standards
Patient and professional leadership
Ambulance care records
Profession-based record standards &
IT Standards
1.Professionbased Record
Standards
Professional
standards
(also specify
requirement for ICT
development)
2. Entry,
display and
format for
printing of
content
User interface
standards
3. Electronic
representation, storage
& transfer of
content
Architecture,
archetype,
terminology,
message etc.
standards
Sharing Data
• Sharing Personal and Confidential Data with and
from your patients is crucial to the quality of their
care
– The Information Governance review*: To share or not
to share, 2nd Caldicott Report, p35-49 - direct care
– Remember the patient is king so if they give you
consent you are OK
– Note you need to have a legitimate relationship to the
patient for direct care ie it does not cover a
commissioning duty
– Also see NICE Clinical Guideline 138
* www.gov.uk/government/uploads/system/uploads/attachment_data/file/192572/29
00774_InfoGovernance_accv2.pdf
The Information Technology {IT}
• IT in the Health and social care system in
England has evolved over time:
– Talk about it being a good thing: 1970’s
– Drive it through management information: 1980’s
– Set the policy which is so self evident the NHS will
follow: 1990’s
– Replace all with new IT [NPfIT]: 2000’s
– Connect all in 2010’s [Dependent on Information
Standards]
IT
Machines as an actor in care
NOW
Human to Human
Human to Human (through Machine)
Machine as passive conduit
FUTURE [is now]
Human to Machine: NCR =Spine
Machine to Machine: Messaging
Machine & pt to EPR: Self care/Telecare
Machine as actor : Decision Support
IT & the care record
• Health and social care IT record systems MUST have
uniform data standards to minimise risk and ensure
safety
• Essential features of data standards cover:
Interoperability
Comparability
Quality
any data source must be able to
exchange data with any other
meaning of data must be consistent
data must be collected consistently,
reliably, etc.
Care records & data standards
• Data is only of use if it can be retrieved,
processed, presented, understood then acted on
by the user in a timely manner
• Key data standards in the Health and social care
include:
– NHS (CHI) Number for the unique identifier
– ICD 10 coding for statistical use of diagnosis in
mortality
– OPCS coding for operations and procedures for
payment
– SNOMED coding for clinical terms used in direct care
What does success look like?
Citizens &
Patients
Information
Technology
Integrated
Digital
Health
Health
Organisations
Professions
Concluding Comments
• Occupational therapy focuses on adapting the
environment, modifying the task, teaching the skill,
and educating the client/family in order to increase
participation in and performance of daily activities,
particularly those that are meaningful to the client
• Informatics and IT is now integral to all of those
domains
• We hope this presentation has given an indication of
what health informatics can bring to your patients and
your professional lives, how it can help develop your
practice and careers, but more importantly, how it can
enhance the care we all aim to give to our patients
THANK YOU