Safer by Design ? Clinical Governance and Patient Safety – can eHealth help ?

1. Safer by Design ? Clinical Governance and Patient Safety– can eHealth help ? Dr Brian Robson Clinical Director for eHealth NHS National Services Scotland

2. Patient safety as first priority for eHealth? …….discuss.

3. NHS Airlines – would you fly ? • Flights on time - 100% • Lost luggage – 0% • Excellent food • Complementary drinks NHS • successful landings – 85% !

4. How safe are you with the NHS ? 15% of hospitalisations are complicated by medication errors One in seven hospital admissions occurs because care providers do not have access to previous hospital records. 20% of laboratory tests are requested because the results of previous investigations are not accessible Delivering for Health 1200 patients die in E&W each year as a result of medication errors ….costing the NHS £500mper annum Audit Commission, 2001

5. Patient safety – A global issue

6. Computers really can improve your health, or at least make your doctor less likely to kill you. The Guardian Jan 2006

7. The High Heed Yins….. Working with our partners across the whole spectrum of healthcare, we will place patient safety at the very heart of the NHS, making real, substantial improvement to the safety of patient care. Prof. Harry Burns CMO March 2007 Scottish Patient Safety Alliance launch We have had 5 decades of clinical audit and 10 years of clinical governance. The future will focus on patient safety and reducing harm. Prof. Sir Graham Teasdale Chairman of NHS QIS June 2007

8. The High Heed Yins….. Reliability is the key to patient safety…… ……….our clinicians are key to driving changes in the way we do things to make what we do safer for patients…….. …….this is about changing the culture. Mr Gerry Marr Chief Operating Officer NHS Tayside June 2007

9. The High Heed Yins….. Primum non nocere Hippocrates c.400 BC

10. Clinical governance and patient safety is not just for clinicians. All NHS staff have a role to play in providing high quality care and hence have an active role in clinical governance activities.Adapted from NHS QIS Not just for clinicians

11. National Project Board National Project Board National Project Board Local Project Team Local Project Team Local Project Team Overall Minister Chief Executives Group SEHD Departmental Board NHS Board eHealth Strategy Board Clinical Needs Service Context, Needs and Capacity National eHealth Programme Board Heads of eHealth (NHS Boards) Clinical Change Leadership Group Local eHealth Implementation Board National Clinical Reference Group Patient Care Services Sub-Programme Board Infrastructure & Business Systems Sub-Programme Board Optional Sub- Board level Specify and commission work (in partnership with Head of Programmes) Local Project Board National Project Board Local Project Board National Project Board Local Project Board National Project Board National Project Board NSS Provide expertise, staffing resource and line management National Project Team National Project Team National Project Team National Project Team Local National

12. Not just for clinicians Implementing information technology to reduce medical errors and promote patient safety remains the top priority for healthcare chief information officers (CIO) surveyed in a major US poll. Improving quality of care is single biggest issue facing healthcare suppliers (69%) HIMSS 2007 Healthcare Information and Management Systems Society (US) 360 CIOs, 700 hospitals www.himss.org/2007Survey

13. eHealth and Patient Safety • Changing – the WAY we do things • Using IT to help address current clinical risks • Avoid introducing clinical risk with introduction of new technologies

14. CfH experience (1) • Not identifying safety as a driver • No formal clinical risk assessment • No formal safety management system (rail; aviation; O&G) • Over reliance on clinicians ‘instinctively’ assessing risk NPfIT not addressing patient safety 2004 DoH report on NPfIT

15. CfH experience (2) • NPSA – National Patient safety Officer • Patient safety proposition ( benefit ) • Standardised methodology • Hazard assessment ( clinical risk) • Safety case ( how suppliers address risks) • Clinical Certificate of Authority To Release (CATR) • Incident reporting post launch • Standardised training • 2 day / 200 staff ( 100 clinical ) • Technical staff and supplier staff • International standards • IEC 61508 - • CCCN 0161 – safety in healthcare IT

16. Patient safety …..THE driver for eHealth

17. What does this mean for Scotland ? • Unique opportunity • Build Clinical Governance and Patient Safety into eHealth activities • Benefits criteria • Risk management • Quality criteria

18. Information Governance assessment Patient Safety Assessment E&D Impact Assessment All new eHealth Developments Building in Clinical Governance and Patient Safety…. ……safer by design. Each step has a number of supporting elements Clinical Governance assessment

19. If patient safety were the key driver what would the eHealth programme look like ? • Patient safety assessment on all new developments • ECS would be more widely available • HEPMA would be a priority • GP IT systems would not allow pen V to be printed if allergic • Patient identification tools would be prioritised • CHI • Label printers would be ubiquitous • Radio frequency wrist bands • SPSA goals would drive eHealth programme • Clinical systems support process of care and provide data as a by-product. • Ehealth proposals would major on patient safety benefits • Systems would make it easier to do the right thing and prevent you doing the wrong thing.

20. Who needs to be involved ? • Patients • Professional groups • Doctors/ pharmacists /nurses • Heads of eHealth • NHS QIS • SEHD • eHealth programme and teams….

21. Patient safety as first priority for eHealth? …….discuss.

22. Thank you