1115 gary mooney national health-conference-eire-may15

You’ll make breakthroughsYou’ll make breakthroughs

The Architect’s Solution:Clinical Solutions for eHealth

Gary MooneyHealthcare Architect

You’ll make breakthroughs

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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


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


Single Supplier SolutionClinical Solutions Architecture




Clinical Content


Access & Sharing

OCRR Clinical Docs CLMM ObservationsDoc

Management




Clinical Workflow

Medicines Formulary

Evidence Base

Order Catalogues

Reference Sources

Analytics Reporting



Best of Breed / PortalClinical Solutions Architecture




Clinical Content


Access & Sharing


Management




Clinical Workflow

Medicines Formulary

Evidence Base

Order Catalogues

Reference Sources

Analytics Reporting



Enterprise Platform & IntegrationClinical Solutions Architecture




Clinical Content


Access & Sharing


Management




Clinical Workflow

Medicines Formulary

Evidence Base

Order Catalogues

Reference Sources

Analytics Reporting



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Does Installing a Clinical Software Solution Deliver an eHealth Solution?

Take Medicines Management as an Example…


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)


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


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


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


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)


• 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…


• 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