You’ll make breakthroughs You’ll make breakthroughs The Architect’s Solution: Clinical Solutions for eHealth Gary Mooney Healthcare Architect
Aug 15, 2015
You’ll make breakthroughsYou’ll make breakthroughs
The Architect’s Solution:Clinical Solutions for eHealth
Gary MooneyHealthcare Architect
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• Ageing population with increasing multiple chronic conditions
• Flat-line or decreasing funding
• Increased complexity and sophistication of clinical interventions
• Increased demand to report upon clinical effectiveness and outcomes
• Increasing public expectation for service quality and responsiveness
• Healthcare services need to deliver initiatives to improve:– Clinical performance– Healthcare outcomes– Operational efficiency– Fiscal performance
The Challenge
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• Can facilitate radical transformations for healthcare delivery
• ULSS4 Alto Vincentino Healthcare Service, Thiene, Italy:– Public service– Three facilities merged into a single new-build hospital– Patient centric clinical and operational workflows– Paperless environment, comprehensive EPR– Enterprise platform & integration architecture– Architectural building design to promote patient experience and wellbeing
Clinical Solutions Driving Organisational Change
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• Increasing range of clinical solutions now available in the market
• Healthcare challenges and technological evolution driving innovation– Mobile– Cloud– Consumer– Telematics
• Different models for clinical solutions architecture– Single supplier ‘all encompassing’ solution– ‘Best of Breed’ & Portal integration– Core platform & specialist integration
Clinical Solutions for eHealth
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Clinical Solutions Architecture
Enterprise Solutions
Specialist Solutions
Clinical Decision Support
Clinical Content
Performance Management
Access & Sharing
OCRR Clinical Docs CLMM ObservationsDocument
Management
ED Theatres Anaesthesia ICU Maternity
Oncology Labs Radiology Cardiology Paediatrics
Medicines Management
Clinical Workflow
Medicines Formulary
Evidence Base
Order Catalogues
Reference Sources
Analytics Reporting
Portal Interfacing Integration
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Single Supplier SolutionClinical Solutions Architecture
Enterprise Solutions
Specialist Solutions
Clinical Decision Support
Clinical Content
Performance Management
Access & Sharing
OCRR Clinical Docs CLMM ObservationsDoc
Management
ED Theatres Anaesthesia ICU Maternity
Oncology Labs Radiology Cardiology Paediatrics
Medicines Management
Clinical Workflow
Medicines Formulary
Evidence Base
Order Catalogues
Reference Sources
Analytics Reporting
Portal Interfacing Integration
You’ll make breakthroughs
Best of Breed / PortalClinical Solutions Architecture
Enterprise Solutions
Specialist Solutions
Clinical Decision Support
Clinical Content
Performance Management
Access & Sharing
OCRR Clinical Docs CLMM ObservationsDoc
Management
ED Theatres Anaesthesia ICU Maternity
Oncology Labs Radiology Cardiology Paediatrics
Medicines Management
Clinical Workflow
Medicines Formulary
Evidence Base
Order Catalogues
Reference Sources
Analytics Reporting
Portal Interfacing Integration
You’ll make breakthroughs
Enterprise Platform & IntegrationClinical Solutions Architecture
Enterprise Solutions
Specialist Solutions
Clinical Decision Support
Clinical Content
Performance Management
Access & Sharing
OCRR Clinical Docs CLMM ObservationsDoc
Management
ED Theatres Anaesthesia ICU Maternity
Oncology Labs Radiology Cardiology Paediatrics
Medicines Management
Clinical Workflow
Medicines Formulary
Evidence Base
Order Catalogues
Reference Sources
Analytics Reporting
Portal Interfacing Integration
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Does Installing a Clinical Software Solution Deliver an eHealth Solution?
Take Medicines Management as an Example…
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The Problem
• 10% of hospital patients are known suffer an adverse drug error
• 1,200 lives could be saved per year
• Each adverse error can extend patient stays by 8.5 days
• Direct costs to the NHS > £500m
• Significant year on year increase in reported adverse drug errors
• c. 76% attributable to acute care
Sources:A Spoonful of Sugar | Audit Commission (2001)Safety in Doses | NPSA (2009)
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Common Problems
• Illegible, ambiguous, incomplete drug charts
• Time wasted locating charts and deciphering information
• Missed / late doses of critical medications
• Poor and inconsistent allergy recording / checking
• Poor communication between clinicians regarding changes or additional doses (e.g. stat meds)
• Medication charts not re-written in a timely manner
• Poly-pharmacy complexities
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An Age Old Problem
‘He wrote in a doctor’s hand, which from the beginning of
time has been so disastrous to the pharmacist and so
profitable to the undertaker’
Mark Twain 1835 -1910
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Solution Orientated Approach
Solution Intervention
The Complexity of Errors
•Processes
•Workload
•Staffing levels
•Lack of support for junior staff
•Busy ward
•Lack of supervision
•Poor medication chart design
•Communication difficulties
•Slip
•Lapse
•Rule-based mistake
•Knowledge-based mistake
•Inadequate
•Unavailable
•Missing
DefencesError Producing
ConditionsActive Failures
Latent Conditions
Adverse Drug Error
Source: GMC EQUIP Study (2009)
Software Intervention
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Lack of knowledge
Didn’t know about formulation/routes of admin 65,16
First few weeks into FY1 post 68,65,47,26,16,10,6, new ward
56, first on call 58
Didn’t ask for help or check: Not wanting to
look stupid 56,6,47,30
Reading quickly 56,29
Busy 58,56,30,
18, 29
Lack of senior support or poor support/communication given
68,65,56,18,17,43
Unaware of pharmacy
services 65,17
No calculator 43
Workload (extra wards/oncall) 56,
18
BNF unclear/ insufficient 17,10
Pressure from pt relative 26
Knowledge-based mistakes (18)
Knowledge-based mistake
Pharmacist 74, 58,48,47,43, 29, 26,17,16, 4
Nurse 30,29
Self 65,18
Senior Dr 56,10,6, 5
Patient 68
Didn’t know CD regulations 48, 4
Tired/not eaten 43
Didn’t know dose 74,56,47,43,29,26,18,6
Didn’t know how to treat 68,30
Didn’t know interaction 58
Don’t know what time of day to rx 10
Errors always picked up: make error repeatedly-
Violation 29, 17
Attitude that didn’t matter 10,
4
Didn’t know drug was penicillin 5
Didn’t recognise as ‘illin’ used brand
name in guidelines 5
Prescribed by previous Dr 5
Never prescribed before 74,68,65,58, 56,47,48,43,30,26, 18,16,10, 6, 5, 4
(29, 17 repeated errors)
Don’t know duration of treatment 17
Not checkinginteraction/dose 58,26
Start
Start
ePMA
Some Risks and Errors Addressed
Different and Poorly Understood Risk Profiles Introduced
Reported Examples• Pre-ePMA Error Rate : 14.6% (general wards)• Post ePMA Error Rate : 17.3% (general wards)
• Pre-ePMA Error Rate : 12% (MAU)• Post ePMA Error Rate : 31% (MAU)
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• Increased nursing time for direct patient care
• Reduction in adverse clinical events
• Decreased LOS and re-admission rates
• Improved clinical outcomes
• Proactive avoidance of clinical issues
• Improved patient experience
• Improved performance visibility
• Compliance with defined best practices with reduced practice variation
Solutions Orientated Results…
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• Clinical solutions can provide the foundations to deliver sustainable and significant improvements for healthcare services
• The solution architecture should reflect local requirements and capabilities:– Required clinical / operational / fiscal benefits and outcomes– Capability to absorb and manage change– Fiscal limitations
• Architecture needs to be Agile to adapt to respond to future demands:– Technology Infrastructure– Software solution(s) / supplier(s)– Organisational change capacity
• ‘How’ clinical solutions are implemented ultimately determines success:– Clinician adoption– Benefits and outcomes– Long-term sustainability
Conclusion