The future is not a destination like the Isle of Wight, waiting for our arrival; it is something

we have to create

The future is like the Great Western Railway, an idea that

became a plan that was realised

The future is here; it is just not evenly distributed

Professional centred Patient centred

Effectiveness & efficiency Value

Opinion based Evidence based

Event Pathway

Organisation Network

Structure System

Clinical practice peripheral Clinical practice central

Money driven Knowledge driven

Research findings Systematic reviews

2006----------------------2011

Most patients in 2011 will•Feel responsible for their own record •Know their NHS number•Read and think about the quality assured knowledge sent to them before the consultation•Enter their own data before the consultation•Use a decision aid before taking the decision to have an operation •Know where they are on a care pathway•Accept that medical knowledge is of variable quality

Most consultations in 2011 will•Focus on the human factors and personal issues•Be face to face •Be a process, including patient preparation before and information therapy after, the face to face•Last no longer than in 2005•Include a computer •Require at least ninety seconds of data input

•Remember the date of the previous consultation and provide

appropriate reminders

Most decisions in 2011 will be

•Based on best current evidence

•Based on the patient’s values and clinical condition

•Shared in a manner determined by the preferred decision making style of the patient

•Recorded clearly

•Made over a period of time

Knowledge in 2011 will be •Derived from the experience of clinicians and patients as well as from research •Based on a common core, updated annually•Hallmarked for quality & never based on peer review alone•Always available digitally•Presented in forms which allow wide access and minimise misunderstanding•Delivered instantly where and when needed, and available 24/7

“Risk of death after upper gastrointestinal haemorrhage…

has not decreased despite modern endoscopic methods of

stopping haemorrhage in high risk patients”

Douglass A,Bramble MG & Barrison I (2005)

National survey of UK emergency endoscopy units

BMJ,doi:10.1136/bmj.38379.662616.F7

“Half of all hospitals have no emergency rota for patients with

acute upper gastrointestinal haemorrhage, and, often, emergency

gastroscopy was in unfamiliar surroundings helped by staff unfamiliar with endoscopy”

Douglass A,Bramble MG & Barrison I (2005)

National survey of UK emergency endoscopy units

BMJ,doi:10.1136/bmj.38379.662616.F7

84 “hospitals have no emergency

rota for patients with acute upper gastrointestinal haemorrhage, and, often, emergency gastroscopy was

in unfamiliar surroundings helped by staff unfamiliar with endoscopy”

Douglass A,Bramble MG & Barrison I (2005)

National survey of UK emergency endoscopy units

BMJ,doi:10.1136/bmj.38379.662616.F7

“mortality in hospitals with a dedicated bleeding unit is almost half the national average,indicating that

at least 40% of the deaths associated with gastrointestinal

bleeding are preventable ”

Douglass A, Bramble MG & Barrison I (2005)

National survey of UK emergency endoscopy units

BMJ,doi:10.1136/bmj.38379.662616.F7

Shared Aim

Hypertext organisation Bureaucratic Organisation(Nonaka & Takeuchi OUP 1995 ; The Knowledge Creating Company

A National IBD Service would have A National set of objectives, criteria and

standards A nationally agreed templates of a care pathways

expressed using the Map of MedicineA National DatasetA single specification for all information system providersA National knowledge base updated annually

A National community of practice, including patientsA single web site

X local services, where X is >1 and <150

The National IBD Service has A National set of objectives, criteria and

standards - the BSG guidelinesA nationally agreed templates of a care pathway

expressed using t he Map of MedicineA National Dataset - from Do Once and ShareA single specification for all information system providers- from Do Once and ShareA National knowledge base updated annually by the National Library for Gastrointestinal Disease

A National community of practice, including patientswww.ibd.nhs.uk

X local services, where X is >1 and <150

The National IBD Service

For patients

Quality and safety

Local services

National Library for IBD

Statistics & Information systems

Professional development

Key documents

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Inflammatory bowel disease is one of the most important conditions managed by the NHS. It is common and serious. Important progress has been made in the last decade and steps have been taken both through commissioning and through Connecting for Health, and all other national agencies, to get knowledge into practice and raise the standards of all services, in particular help those providing services of poorest quality learn, adopt and adapt more quickly. In some parts of the country also it is more difficult for clinicians to provide high quality care because of resource constraints.

What is clear, however, is that by applying what we know, care can improve and this web site pulls together the knowledge about inflammatory bowel disease:

NHS IBDS

34 cardiac32 cancer 140 antenatal22 Renal14 genetics 9 Cleft palate? Epilepsy?IBD ?Stroke

The Three Counties IBD service

•A Community of practice, supported by a web space

•Localised version of the national pathway using the Map of Medicine eg

with local phone numbers

•An annual Report

•Clinicians involved from a number of Trusts

Let’s stop making bits of Lego; we need to decide what we

want to build

Let’s move from visions to plans

Muir Gray has familial hypercholesterolaemia

Every six months he receives an email reminder from the lab to have a blood test

He receives 2 SMS reminders if no blood sample is received within 2 weeks

If no specimen is received his GP receives a copy email

If there is a result is sent to the GP and to his Healthspace where it is stored in sequence

Appropriate advice and support is automatically generated

Mrs A is worried about familial breast cancer and phones for a GP appointment

The healthcare assistant asks if Mrs A would like to tell her the nature of her problem

On learning it, she

1. Ascertains her access to NHS Direct

2. identifies the relevant page on NHS Direct

3. Sends it to Mrs A

Mrs A consults the site which1. Ascertains her preferred reading level 2. Ascertains her knowledge of genetics eg the meaning of the term mutation3. Offers information about genetics and familial breast cancer including the experience of other women in DIPEX4.Allows her to complete a family risk assessment5. Stores all this information on her Healthspace

Guidance in long esoteric documents can be embedded

in lab request and report forms

“The false positive rate [for Hepititis C] is especially

important in low prevalence settings where the number of false positives may exceed

the number of true positives”Booth JCL et al (2001)

Gut 49 (Suppl 1) i4 column 1 Section 3.1 lines 23-27

What it really looks like

Royal Cornwall Lab Service

Muir Gray 21/06/1944 NHS number 400 186 6897

ELISA25.5Hepatitis C is of low prevalence in Cornwall. National guidance is that diagnosis should be confirmed by PCR test in low prevalence populations

For PCR test click here For access to full text of guidance click here To test your knowledge in one minute click here

“Recently,measurement of serum procollagen III (every

three months during treatment) has been adopted as a surrogate marker of liver

toxicity”BMJ 333;381-384

What it really looks like