Clinically Led IT

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Clinically Led IT Nursing Needs for the 21st
Century Barbara Stuttle CBE National Clinical
Lead for Nursing Midwifery NHS Connecting For
Health
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Keep in mind..

• Ageing Population
• 2001 over 60s gt than under 18s
• 2050 4 times as many needing care
• At 4 times the current cost
• Remember hidden costs

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The Big Picture
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Despite Efforts to Date, the Chronic Care
Challenge is Growing

• Over the next 10 years, the global incidence of
  chronic disease is predicted to increase by 17,
  further fueling the global burden of disease.
  Several factors account for this driving force
• The success of modern healthcare in transforming
  formerly lethal diseases, injuries, and
  conditions (e.g., HIV, spinal cord injuries,
  diabetes, tuberculosis, and multiple sclerosis)
  into chronic conditions that require continuous
  treatment
• Reductions in premature mortality and increasing
  longevity resulting in longer-lived chronic
  conditions and health-related dependencies and
• Increases in the behaviors (e.g., unhealthy diet,
  physical inactivity, and tobacco use) that
  significantly contribute to many prevalent
  chronic diseases.
• Cultural and expectation changes

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Paper is no longer fit for purpose
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• Lets consider drivers in other industries

• Thanks to
• John C. Knight
• Department of Computer Science
• University of Virginia

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Windscale (U.K.), 1957

• Fire in reactor 1 resulted in radiation
  discharge.
• Improper fire-fighting caused 2nd discharge.
• 32 deaths, 260 cancer cases from radiation.
• Poor plant design procedures prompted safety
  case regime for nuclear industry.

Windscale reactors 1 2 circa 1950
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Flixborough (U.K.), 1974

• Explosion at chemical plant following pipe
  rupture (maint. error)
• 28 killed, 36 injured
• Rupture attributed to nearby fire
• Incident prompted safety case regime for chemical
  industry

Damage to the plant after the explosion
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Piper Alpha (U.K.), 1988

• Gas explosion subsequent oil fire at offshore
  drill
• 167 killed, 62 rescued
• Maintenance errors, poor evacuation cited
• Cullen report established ALARP
• Safety case regulations introduced for off-shore
  industry 1992

Piper Alpha rig ablaze after the explosion
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Clapham (U.K.), 1988

• Signal failure causes three commuter trains to
  collide.
• 35 killed, 100 injured
• Maintenance introduced wiring fault in signal
  box.
• Public enquiry
• Railway safety case regulations introduced in 1994

Wreckage from the 3-train collision
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In 1965 we said the interim before effective
standardisation should be kept as short as
possible 43 years later.?
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It is unethical to carry on doing what we are
currently doing
Professor Sir Muir Gray 01-Oct-2004
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Implementation of Policy requires the
implementation of standards !
As few as possible... Globally....
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Team Work
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The recording of the National Health Service
number should become a routine practice Roughly
translated Use a unique identifier for the
patient
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There should be a separate drug sheet for
recording prescriptions and their administration
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Design challenges - 5 clinical needs
Clinicians needs
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Hardware solutions fit for purpose working with
Industry..

• Solutions that meet complex requirements for
  clinicians
• Readily portable
• Display complex patient information
• Available all the time
• Cleanable
• Wireless communications
• Supports emerging health technologies
• Camera
• RFID / Barcode reader
• Successful Acute Pilot Nursing / Phlebotomy
• Successful Community Pilot Nursing / Social
  Work
• Ongoing evaluations

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Clinical architecture design challenges
Culture changes are required Healthcare
professionals need new skills
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Prevention is better

• Diseases prevented by Primary and Secondary
  Immunisations
• Chronic disease
• Genetic therapy
• Hospital acquired infection
• Litigation costs
• All require a full multidisciplinary record
  contributed to by everyone involved including a
  vibrant Secondary Uses Service

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Connected Care The new challenge
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In order to achieve consistent high quality care
in chronic disease

• If they (the hospital) had computers, you could
  push a few buttons and it would all come up.
  Instead, I keep having to tell them over and over
  again. - John Brown, Patient

Standards Culture Safety / Clinical Utility /
Quality Common User Interface as a
catalyst Knowledge as a catalyst Healthcare
Acquired Infection as a catalyst Readiness for
demographic and disease challenges Assistive
Technology Integrated Research and Evaluation
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Before 2015.?

• No paper records
• Clinicians using records
• Patients contributing to the same records
• Consent to share
• Genomic and other omic data
• Knowledge Authorship
• Decision support
• Knowledge support
• Profession and Citizen
• Active Patient Partners

• All images
• Automated prompts and warnings
• Wellness as well as sickness addressed
• Background data mining
• Feedback of research and evaluation into the
  service

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