paperless n.
Skip this Video
Loading SlideShow in 5 Seconds..
“ Paperless ” PowerPoint Presentation
Download Presentation
“ Paperless ”

Loading in 2 Seconds...

play fullscreen
1 / 26

“ Paperless ” - PowerPoint PPT Presentation

  • Uploaded on

“ Paperless ”. Prof Jonathan Kay Clinical Informatics Director NHS England Overview. Starting points Why it matters My experiences of trying to make it happen How to make it easier. Starting points. Current processes and technology

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about '“ Paperless ”' - ellema

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript


Prof Jonathan Kay

Clinical Informatics Director

NHS England

  • Starting points
  • Why it matters
  • My experiences of trying to make it happen
  • How to make it easier
starting points
Starting points
  • Current processes and technology
  • Secretary of State’s speech
  • Analogies from other domains
  • National projects: the Technology Fund
current processes and technology
Current processes and technology
  • Within organisation
    • Old records
    • Things the EPR can’t do
  • Across organisations
    • Documents printed from computers
    • Snail-mail transport of paper
    • Scanning in general practices
  • Data networks in place and good enough
  • Data transport systems not yet good enough
    • Directory services
    • Action on nondelivery
secretary of state s speech january 2013
Secretary of State’s speechJanuary 2013

Jeremy Hunt, the health secretary will launch the project on Wednesday alongside a report claiming it could save nearly £5bn a year, after the costs are taken into account. He said it should also improve patient care and save lives.

"More importantly [than money] it can save billions of hours of time so nurses can spend more time with patients if they are not behind the nurses station trying to fill out forms," Hunt said. "And I think it can save thousands of lives. A lot of the safety problems in the NHS – people being prescribed with the wrong medication, and 'never events' where people have the wrong arm amputated – it's wrong to say technology is the panacea but it can make a big, big difference."

how does computerisation help healthcare
How does computerisation help healthcare?
  • Lower unit cost of process
  • Improved patient safety
  • Reduced data burden on clinicians
    • Data for other people
    • Computerisation
analogies from other domains
Analogies from other domains
  • Retail: commerce and entertainment
  • Amazon, EasyJet, DVLA…
  • Banking
  • Utilities
document management technology
Document management technology
  • Generated in many ways
  • Communicated by computer or scanned
  • May be tagged by sender or recipient, but…
  • Processing after receipt limited or impossible
  • Different from electronic data interchange
  • Widely used in many sectors
  • Maturity of the Clinical Documents Architecture standard
  • “Multiformat vendor-neutral”…
why it matters1
Why it matters
  • Lower unit cost of process
    • … mostly saving staff time, but is it cash-releasing?
  • Improved patient safety
    • … better decision making because relevant information is available
    • … removing discontinuities
  • Marker for process re-engineering
  • Marker for computerisation
my experiences of trying to make it happen1
My experiences of trying to make it happen
  • Laboratory Medicine reports
  • Radiology reports
  • Clinical communications into general practices
laboratory medicine reports primary care
Laboratory Medicine reports, primary care
  • Tens of reports per practice per day
  • Thousands of reports per laboratory per day
  • Switched off paper 20y after full coverage with computerised transmission
  • Agreement with lead GPs, PCT, LMC
  • Each practice was asked to ask the laboratory to switch-off
  • Three rounds, with authority to complete in the third
  • Lots of people couldn’t imagine it working
  • Very few complaints
  • Residual problems with workflow after receipt
laboratory medicine reports secondary care
Laboratory Medicine reports, secondary care
  • Inpatients and outpatients
  • Thousands of reports per laboratory per day
  • Agreement with hospital boards
  • Legal opinion
  • No local choice by department or clinician
  • Agreed exceptions after consultation
    • Cellular pathology
    • Blood transfusion
    • Occupational Health
laboratory medicine reports secondary care1
Laboratory Medicine reports, secondary care
  • Response to consultation: this is going to be a big problems in outpatients. Some clinicians rely on the paper report to say that a report is available. What is safe practice?
    • Consultants wanted to keep the nudge
    • Experts wanted closed-loop approach
  • Can we wait for EPR?
  • Decided to switch off paper reports
    • Working well
    • Some residual complaints
    • Made the transition to EPR easier
radiology reports primary care
Radiology reports, primary care
  • A few of reports per practice per day
  • Hundreds of reports per department per day
  • Tried to switch off paper 2y after full coverage with computerised transmission
  • Agreement with lead GPs, PCT, LMC
  • Followed laboratory medicine reports, and liaison committee to handle all communications
  • Radiology department: “More expensive to switch off paper than continue to send it”
incoming letters to general practices
Incoming letters to general practices
  • Realisation of time spent scanning
  • Variation of technology across practices
  • “Transfer of Information Task Force”
    • Representation
    • Project manager
  • Quick count of flows
procurement of middleware
Procurement of middleware
  • Cover all practices
  • Cover high-volume senders
  • Handle paper (by scanning) or emailed documents
  • Middleware supplier has to manage connection to GP systems
  • Document transfer model, with some tags
  • Flows now working
    • Emergency department letters
    • Out of hours notifications
  • Improving tags
  • Content
  • Timeliness
  • Add more flows
how to make it easier1
How to make it easier
  • Form a liaison group first
  • Get the right architecture and technology
  • Choose the right flows to change first
  • Implement as a series of quick, short modules
  • Learning from others
  • Not waiting for perfection
timeliness and quality
Timeliness and quality
  • If users think that subsequent steps are slow there’s not much reason to speed up
  • Senders don’t know recipient’s views
  • Actively monitor timeliness and quality
other issues
Other issues
  • The last 5 metres to the bedside
  • Workflow without paper
    • Routing
    • Annotation
  • Misunderstandings about information governance
    • Neutrality about media
    • Duty to share
    • Caldicott principles
what i need to know from you
What I need to know from you
  • How can I find out the current state of play?
  • How fast can you deliver your changes?
  • How mature is Clinical Documents Architecture?
  • What do you want NHS England to do from the centre?