Specifying clinical IT requirements for pathways: a national perspective

1. Specifying clinical IT requirements for pathways: a national perspective Dr Mark Dancy Consultant Cardiologist National Clinical Lead CHD Collaborative

2. Potential benefits from NPfIT • Readily available information • Patients • Clinicians looking after them • Ease of communication • Combined care • Audit • Health economics & Public Health

3. Current position • Numerous systems • All different • Software • Field definitions • Architectures • Not designed to communicate • Need paper

4. Current position • Many databases designed for audit • Not designed around patient pathway • ‘Minimum dataset’ • Implies majority of mandatory fields • Not suitable for EPR • High cost of data gathering – audit clerks • Integrated care pathways • Within hospitals mostly paper-based • Within primary care – templates

5. Datasets: different according to purpose Clinical processes history, exam, tests, diagnosis, treatment Audit and clinical governance local and national - NSF targets Information for patients general and personal Public health Service planning: demand and capacity Finance

6. Clinical datasets (EPR) • Needs a lot of data – medicine is complex • Choice between free text and defined data items (auditable) • Needs a lot of data items • Many/most will not be mandatory • How much of the requirements for other uses will be met by a good clinical dataset?

7. The ideal system design for clinical input • Intuitive, fast • Follows predicted workflows • Accommodates the majority of clinical needs with minimal need for free text • Data entered at point of care • Supports workforce developments (PwSI) • Platform independent • Organisation independent

8. Potentially difficult areas • Inpatient care • Complex • Changing differential diagnoses • Changing firms • Logistics of the bedside • Multiple pathologies • Systems often arranged around single diagnosis Best test-bed is single disease managed out of hospital

9. Understanding workflows RAPCP Pilot Provisional national dataset Functional specification Dataset development Clinical systems manufacturers National system Local development Pilot sites Maximum choice for end-users

10. Disease management system project: DMSP • Common principles • Based on patient pathway • Translated into workflows • Platform and organisation independent • Electronic communications • Three conditions • Heart Failure • Breast Cancer • Diabetes

11. Primary care Either Secondary care Heart failure clinic Sheet 2 IP admission Transfer of referral data and e-booking Referral proforma Sheet 1 Preliminary conclusions? LVSD Heart failure suspected Summary of conclusions from heart failure clinic No Single message to put on register Yes a*: if continuing care to be in acute trust initiates appropriate arrangements. If to be primary care initiates request message to 1y care to book patient into their clinic Placed on heart failure register Initiation of treatment with ACE and diuretics LV systolicdysfunction Discovered to have heart failure in OPD a* Up-titration of drugs Requires further investigations Sheet 4 Initiation of Beta blocker &/ spironolactone Call/recall systems for chronic disease management Further treatment Sheet 3 Stabilisation

15. Where to go from here? • DMSP is proof of concept • Direct communication between local systems may be unnecessary in NPfIT (via spine) • Recognition that the interface between the clinician and the system is the most important element of design • Extend into other more difficult areas • Major task in ‘information out’