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The story so far. Health Informatics Unit – the first 10 years. Overview. Where we are now: A brief review of the work of the RCP HIU Where we are going: A look to the future. RCP Health Informatics Unit: our mission.
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The story so far Health Informatics Unit – the first 10 years John Williams Director, Health Informatics Unit
Overview • Where we are now: • A brief review of the work of the RCP HIU • Where we are going: • A look to the future
RCP Health Informatics Unit: our mission • To improve and develop the recording and communication of information about patients so that this effectively and safely supports a wide variety of purposes • These purposes include • support for patient care (primary purpose) • source of data for aggregate analysis (secondary uses) • This mission applies to both paper and electronic patient records and communications
RCP Health Informatics Unit • 2001-3: Reviewed quality of data derived from records (Literature review) Williams JG, Mann RY. Hospital Episode Statistics: time for clinicians to get involved? Clinical Medicine 2002;2(1):34-7. Mann R, Williams J. Standards in medical record keeping Clinical Medicine 2003;3:329-32.
RCP Health Informatics Unit • 2001-3: Reviewed quality of data derived from records (Literature review) Williams JG, Mann RY. Hospital Episode Statistics: time for clinicians to get involved? Clinical Medicine 2002;2(1):34-7. Mann R, Williams J. Standards in medical record keeping Clinical Medicine 2003;3:329-32. • 2004-7: Worked with consultants in England &Wales to improve the quality and use of clinical data (iLab Project) Croft GP, Williams JG Breaking the cycle of poor data quality Clinical Medicine 2005;5:47-49. Croft GP, Williams JG, Mann RY, Cohen D, Phillips CJ. Can hospital episode statistics support appraisal and revalidation? Randomised study of physician attitudes. Clinical Medicine 2007;7:332-8.
WELSH GOVERNMENT Hosted by Health Solutions Wales (HSW)
HES PEDW Validity/value of HES/PEDW • HES/PEDW are inappropriate for ‘clinical’ purposes at alocallevel • Missing or incorrect episodes, diagnoses and procedures Williams JG & Mann RY Hospital Episode Statistics: time for clinicians to get involved? Clinical Medicine 2002;2(1):34-7. • Poor timeliness – long delay before the data are available • Poor attribution of data to individual professionals • Insufficient clinical depth – only diagnosis & procedures Croft GP et al The RCP Information Laboratory: breaking the cycle of poor data quality Clinical Medicine 2005;5: 47-9 Croft GP et al Can hospital episode statistics support appraisal and revalidation? Clinical Medicine 2007;7:332-8 • HES/PEDW are not useful for national audit • Roberts SE et al Feasibility of using routinely collected inpatient data to monitor quality and inform choice: a case study using the UK Inflammatory Bowel Disease audit. Frontline Gastroenterology 2011;2:153-9. • HES/PEDW are of value at a populationlevel • Roberts SE et al Hospital admission for ulcerative colitis and Crohn’s disease in England: comparison of mortality with and without colectomy. BMJ 2007;335:1033-36. • Button LA et al Hospitalised incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: A record linkage study. Alimentary Pharmacology & Therapeutics 2011;33:64-76
Why these problems? • Data is recorded in poorly structured paper records • Clinical content is not standardised • Clinical terms are not defined • Haphazard scrutiny of record content by seniors • No requirement for clinical validation before returns are made • Coding rules are inappropriate – eg‘impression’ • Data is coded in classifications that lack clinical granularity (ICD-10 & OPCS-4) • Information Departments are focused on meeting the needs of the organisation rather than clinicians • Dataset is too limited from a clinical perspective: only diagnosis and procedures; no clinical data on out-patients
Can HES/PEDW be improved? • Yes, in the short-term, with greater attention to clear documentation of diagnoses and procedures • No, in the long-term, without radical changes to the current dataset and process for collection
RCP Health Informatics Unit • 2007-9: Developed standards for structure and content of medical records (Admission records, handover & discharge) Carpenter I, Bridgelal-Ram M, Croft G, Williams J. Medical records and record-keeping standards. Clinical Medicine 2007;7:328-31. Carpenter I, Bridgelal-Ram M, Williams JG. A Clinician’s Guide to Record Standards Parts 1 and 2. Royal College of Physicians, London 2008.
Clinical Record Standards • Evidence and consensus based standards for the structure and content of admission records, handover & discharge communications • Endorsed by the Academy of Medical Royal Colleges; DH; GMC; CQC; NICE; NHSLA; Medical Schools Council; Postgraduate Deans • http://www.rcplondon.ac.uk/resources/clinical-resources/standards-medical-record-keeping
http://www.connectingforhealth.nhs.uk/systemsandservices/clinrecords/24hourhttp://www.connectingforhealth.nhs.uk/systemsandservices/clinrecords/24hour
Clinical Record Standards • Current work is addressing ambulatory care: • Scoping the contexts in which contact with hospitals occur • Identifying the information needs of these contacts • Developing generic standards for the structure and content of the record • Other work • Refining the standards for the admission record • Developing editorial principles to ensure sustainability • Consulting on a core set of common data items http://www.rcplondon.ac.uk/policy/improving-healthcare/health-informatics
The long-term vision...... • To achieve, in ten years • Patient focused electronic records • Nationally standardised structure and content • Primary source of valid data for aggregate analysis • Appropriate patient access to personal information • This vision has been • Endorsed by RCP Council • Adopted by Academy of Medical Royal Colleges • Acknowledged by DH • Supported by statutory bodies http://tinyurl.com/AoMRCVisionStatement
Adam Fujinon • Ascribe Scorpio • Endosoft • KeyMed (Olympus) • Unisoft • Endoeasy • GI-Trac • Weblogik EMS • Locally developed solutions Diabetes Hypertension GORD Diabetes Hypertension GORD Arthritis Diabetes Hypertension GORD
The patient focused record In-patients Out-patients Procedures Specialist nurse telephone support MrsJones
In summary • A 10 year vision for hospital patient records • Electronic records focused on the patient, not the disease, intervention or context • Clinical data conforming to national standards for structure and content • Data captured at the point of care used as primary source of aggregate information for many purposes • Greater patient access and control • Endorsed by the Academy of Medical Royal Colleges • Supported by a broad spectrum of national organisations http://tinyurl.com/AoMRCVisionStatement
A big thank you to all who HIU staff who have contributed to this work over the last ten years • Robin Mann • Valerie Porter • Janis Huston • Shaibal Roy • David Warmate • John Ramage • Sean Preston • Giles Croft • Caroline Brooks • Lucy Payne Mala Bridgelal Ram Iain Carpenter Helen Fogarty Jibby Medina Darren Wooldridge .. and of course to all those individuals and organisations who have supported or worked with us