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Planning to Practice Knowledge-driven healthcare solutions, RCP, 2007

Planning to Practice Knowledge-driven healthcare solutions, RCP, 2007 Dr. Mike Stein – Medical Director October 2007. Evidence based care pathways available to clinicians at the point of care. Framework for sharing clinical knowledge across care settings.

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Planning to Practice Knowledge-driven healthcare solutions, RCP, 2007

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  1. Planning to Practice Knowledge-driven healthcare solutions, RCP, 2007 Dr. Mike Stein – Medical Director October 2007

  2. Evidence based care pathways available to clinicians at the point of care • Framework for sharing clinical knowledge across care settings • Localizable benchmark for clinical processes

  3. Outline The Doctor’s journey – 2 min The Patient’s journey – 2 min A tool to mediate many dialogues – 5 min Demonstration and integration with clinical systems Lessons learnt to date – 3 min Current and future developments – 2 min Q & A

  4. The Doctor’s Journey

  5. PROBLEMS IN HEALTHCARE • Information and technology overload Growing information base • Specialty silos Communication issues • Clinical governance Plethora of guidelines, no standard format Trainees, locum and agency staff • Increasing patient safety issues Less patient time, more referrals Medical errors Rising cost of claims * Guidelines in general practice: the new Tower of Babel? BMJ 1998;317:862-863 ** Guidelines on anticoagulant treatment in atrial fibrillation in Great Britain: variation in content and implications for treatment. BMJ 1998;316:509-513

  6. The Patient’s Journey

  7. Courtesy of Professor Bill Runciman, APSF; Data extracted from AHRQ 2006 report

  8. UK and AustraliaWrong plan nearly 50% of the timeHarm patients in 10% of admissions; half preventableThe harm is permanent or severe with 2% of admissionsDeath is associated with the harm in 1/300 patientsData courtesy of The Healthcare Commission Survey (2006), Professor Jeff Richardson, CHE, Monash University, Australiaand Harrison W et al. The effectiveness of healthcare systems in the UK – scoping study; Department of Public Health and Epidemiology, University of Birmingham, 2006

  9. Getting evidence into practice – our NHS journey

  10. Power of Evidence – driving more effective and efficient healthcare delivery 80% of physicians changed their care as a result of evidence* as follows: • Avoided hospitalisation in 12% • Reduced overall length of stay in hospital in 19% • Changed diagnostic tests in 51% and drug choices in 45% • Avoided additional tests or procedures in 49% Adhering to evidence-based guidelines for treating hypertension alone could save at least $1.2 billion annually in US** Sloan-Kettering – most effective and efficient [Risk adjusted mortality from cancer against length of stay for institutions in NY State***] * Marshall J G. The impact of the hospital library on clinical decision making: the Rochester study. Bull Med Libr Assoc. 1992 April; 80(2): 169–178 ** Fischer MA, Avorn J. Economic implications of evidence-based prescribing for hypertension: can better care cost less? JAMA 2004;291:1850-6. ***BMJ 2005: 330; 530-533 “What can the UK and US health systems learn from each other?” Lois Quam and Richard Smith

  11. MAP OF MEDICINE OVERVIEW

  12. Integration mobile Map MAP OF MEDICINE HISTORY Map Display MMS 1999 2001 2004 2006 2007 2008 2003 2005 First pathways created London South Wales Graphical Tree display created East & North East North West/ West Midlands

  13. Current position

  14. Map Display usage data from a Local Healthcare Community The user profile chart is based on 2249 users registered on the Map of Medicine from 3 early adopter sites in Wales

  15. Implementation All data up to and including September 30th - does not include data from CSC hosted service (approx 3000 users.

  16. Lessons learnt to date Cochrane: Over 2,500 studies assessed (1997 – 2007) plus our own experience - take home messages • Tools: Localizable guidelines; allow local communities to set priorities; feedback and audit • Integrated: Accessible (clinical workflow); system-wide • Communications: Local senior clinicians are crucial supporters • Leadership: To drive standards and responsive regulation

  17. 1. Leadership - senior clinical, administrative and political engagement • Colleges • NHS Institute for Innovation and Improvement • IHC Wales • NICE • National directors • Licensing authorities - GMC, Health Commission • NPfIT and CfH 2 . Communications • Clinician and management channels [about to start] 3 . Integration • Clinicians workflow, enterprise-wide

  18. Systems integration Integration with clinical systems • Easy access from clinical workflow • Triggering actions within EPR systems Mobile Map of Medicine: Making the Map of Medicine Mobile • Developing world • UK Healthcare planning and managementIntegration with profiling and simulation tools Drug information and e-prescribing • Access to drug information • E-Prescribing

  19. 4.Local priorities Demonstration

  20. Thank you!mike.stein@mapofmedicine.com

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