The story so far
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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

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The story so far

The story so far

Health Informatics Unit – the first 10 years

John Williams

Director, Health Informatics Unit


Overview

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

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

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 unit1

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.


The story so far

WELSH GOVERNMENT

Hosted by Health Solutions Wales (HSW)


Validity value of hes pedw

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

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

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 unit2

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

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


The story so far

http://www.connectingforhealth.nhs.uk/systemsandservices/clinrecords/24hour


Clinical record standards1

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

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


The story so far

  • 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 story so far

The patient focused record

In-patients

Out-patients

Procedures

Specialist

nurse

telephone

support

MrsJones


In summary

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

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


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