A perspective of Knowledge Management in the NHS Dr Jim Hughes Head of Knowledge Management Cheshire and Merseyside SHA Broad questions What does the Head of KM in Cheshire and Merseyside SHA do? A(nother) definition of KM! NHS KM and Connecting for Health New role for librarians? 18 week target – using data effectively What does Head of KM do? Internal role IT services and Informatics Library service Freedom of Information Knowledge Management – e-filing, effective use of tools, technology and people to work smarter Job description – cut down this tree Tools available Tools / people required What does Head of KM do? ‘SOFT’ KM External Line manage Health Care Libraries Unit (HCLU) CfH - knowledge management North West VLE (e-learning) Data warehouse PCT Shared services – Information knowledge management / contract management Public Health ; Dr Foster; TIS KM in – Practice based Commissioning; Management of Long term Conditions ‘HARD’ KM So much to know, so little time! A(nother) definition of knowledge management A healthy mix of:Tools Technology Processes People Organisations Behaviours Culture A(nother) definition of knowledge management What do we do with it? Capture Put it back in! Code Store (organise) Access Disseminate – MOBILISE – collaborate - share A(nother) definition of knowledge management And of course - the management bit Strategy Implement Monitor Evaluate Connecting for Health - KM Directorate of clinical knowledge process and safety led by Sir Muir Gray http://www.connectingforhealth.nhs.uk/delive ry/serviceimplementation/kps/ The following eleven slides are taken from Muir Gray’s presentation on the National Knowledge Service taken from the above public web site. The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade Muir Gray (January 2005) The application of what we know can prevent and minimise the 7 ubiquitous healthcare problems Errors and mistakes Poor quality healthcare Waste Unknowing variations in policy and practice Poor patient experience Overenthusiastic adoption of interventions of low value Failure to get new evidence into practice Muir Gray (January 2005) 3 types of generalisable knowledge Knowledge from research - Evidence Knowledge from measurement of healthcare performance - Statistics Knowledge from experience - Of patients and clinicians 2 types of particular knowledge Knowledge about this patient Knowledge about this service Muir Gray (January 2005) For good health people need pure clear knowledge, just as they need pure clear water Muir Gray (January 2005) The knowledge spectrum before the internet Knows A little Patient Knows A lot Primary Care Secondary (hospital) Care Professor Muir Gray (January 2005) The knowledge spectrum after the internet -1 Knows A little Primary Care Knows A lot Patient Secondary (hospital) Care Professor Muir Gray (January 2005) The knowledge spectrum after the internet - 2 Knows A little Primary Care Knows A lot Secondary (hospital) Care Patient Professor Muir Gray (January 2005) The knowledge spectrum after the internet - 3 Knows A little Primary Care Knows A lot Secondary (hospital) Care Professor Patient Muir Gray (January 2005) The mission of the National Knowledge Service is to ensure that all decisions can be based not only on best current knowledge but also on the needs and preferences of the individual patient Contact Muir Gray- [email protected] 1/1/2005 National Knowledge Service Generation Question Answering Service Co-ordinated procurement & Production (£100M) Organisation National Library for Health (£50M) NHS Direct Online Localisation Map of Medicine Mobilisation NHS Care Records Service N3 National decision support service Utilisation Patient & professional Education & services Better Consultations, Better Decisions, Better Communication Muir Gray (January 2005) Ignorance is like cholera; it cannot be controlled by the individual alone it requires the organised efforts of society Muir Gray (January 2005) Delivering the benefits from CfH Key knowledge management principles Making knowledge the enemy of disease Supporting decisions that patients make Supporting decisions in clinical practice Creating and mobilising the knowledge base Using knowledge in the consultation process Integrating knowledge into learning and decision making A vision of using knowledge in the consultation process Picture Archiving and Communication System Order Communications Tests Care Records Service Assessment Results Intervention Diagnosis and Decision 1. Existing knowledge sources Choose and Book 2. New sources Electronic Transmission of Prescriptions 4. Suggest appropriate decision – patient specific 3. Present Knowledge ‘in patient’ context A vision of integrating knowledge into learning and decision making Knowledge Delivery National Specialist Groups Knowledge Acquisition Warranted codified knowledge Disseminate knowledge e.g. Map of Medicine National learning and dissemination Knowledge used in the consultation Disseminate knowledge through existing local professional activity Local learning and dissemination Knowledge from local innovations Local healthcare professional communities of practice Capture knowledge from growing information base – eg care pathways Capture local experience Clinical Knowledge Management Do Once and Share – developing clinical pathways (Sharing) National Library for Health (Resources) Single Search Environment (Search and Retrieval) Virtual Learning Environment (Learning) Map of Medicine and national clinical guidelines (Evidence) National care record / Data spine / common IT / common coding (Technology) Communities of clinical practice (People / Experts) And finally from Muir Gray…. “Love your librarian and free her from the library” Muir Gray (January 2005) A new role for librarians? HCLU review outcomes Focus on core business Professional development New roles for new times Improved communication A new role for librarians? Do Once and Share 50 clinical areas Developing common care pathways Communities of interest Giving context to the technology Librarian role active clinical engagement Access to clinical knowledge resources Works alongside clinical team 18 week target – using data effectively Background NATCANSAT commissioned to develop data warehouse for SHA HES Clearnet data (CDS) Ambulance A+E Diagnostics Outputs to assist in development of strategic configuration of services and Monitor diagnostic 18 week target – using data effectively Most recently to develop models to understand pinch points in the 18-week referral to treatment pathway NATCANSAT working with DH and pioneer Trusts. Following slides courtesy of Dr Brian Cottier – Head of National Cancer Services Analysis Team (NATCANSAT) – March 2006 Hospital “X” PAS Data IP Episodes OP Episodes AED Episodes Imaging Procedures Endoscopy Procedures 331,207 1,010,713 217,756 1,172,398 79,048 Pathology Endoscopy Imaging Book Another OP Visit AED Referral GP Referral Referral Received Date OP Visit (1 to n) Inter Consultant Referral Discharge Elective Date Admission Procedure Discharge Imaging Book Another OP Visit AED Referral GP Referral Referral Received Date OP Visit (1 to n) Inter Consultant Referral Discharge Elective Pathology Endoscopy Imaging Book Another OP Visit OP Visit (1 to n) Discharge Elective Date Admission Procedure Discharge Elective Surgery Frequency of Procedures Count Of EPIKEY Procedure Level 2 Diag.Endo.Exam/Lower Bowel Using Fibreoptic Sigmoidosco Other Excision of Lesion of Skin Destruction of Haemorrhoid Diagnostic Fibreoptic Endoscopic Exam/Upper Gastrointe Other Operations On Varicose Vein of Leg Primary Repair of Inguinal Hernia Excision of Gall Bladder Diagnostic Endoscopic Examination of Colon Ligation of Varicose Vein of Leg Transluminal Operations On Femoral Artery Injection Into Varicose Vein of Leg Other Excision of Breast Diag.Endo.Exam/Sigmoid Colon Using Rigid Sigmoidoscope Block Dissection of Lymph Nodes Excision of Haemorrhoid Excision of Nail Excision of Rectum Total Excision of Breast Trust Aintree Hospitals NHS Trust 7,086 5,876 3,456 3,372 3,092 2,781 2,059 1,468 1,445 1,242 1,037 868 851 619 566 513 491 490 Breast Surgery Elective Joint Replacements Hips & Knees PAS# Op Date Operation Description (IP) XYZ2134 4-May-04 Total Prosthetic Replacement of Hip Joint Using Cement XYZ2134 14-Dec-04 Other Total Prosthetic Replacement of Knee Joint RAD Cons RAD Spec Procedure Code Date 110 11-Jun-03 110 18-Sep-03 110 18-Sep-03 110 13-Nov-03 PAS# XYZ2134 XYZ2134 XYZ2134 XYZ2134 RAD Proc Code HIPB KNEB HIPB SCRT RAD Proc Description Plain Plain Plain NC RAD Consultant TM TM TM TM RAD Cons Spec (ORTHOPAE) (ORTHOPAE) (ORTHOPAE) (ORTHOPAE) XYZ2134 XYZ2134 XYZ2134 HIPR PEL HIPR Plain Plain Plain TM TM TM (ORTHOPAE) 110 (ORTHOPAE) 110 (ORTHOPAE) 110 13-Nov-03 28-Apr-04 6-May-04 SHA Analysis Joint Replacements Imaging Data RIS Systems Radiology Information System Data Extract Royal Liverpool Hospital Modality = CT Mod_Name CT Count Of uniqueid procedure CT BRAIN CT ABDOMEN GENERAL ENHANCED CT LUNGS ENHANCED CT LIVER ENHANCED CT LUNGS CT AORTA (ABDOMINAL) ENHANCED CT ABDOMEN GENERAL CT BRAIN ENHANCED CT SINUSES CT PANCREAS ENHANCED CT KIDNEYS ENHANCED CT PELVIS ENHANCED CT PELVIS CT LIVER CT BIOPSY CT ABDOMEN COLON ENHANCED CT CERVICAL SPINE CT KIDNEYS year_proc 1998 2,453 717 500 524 800 235 462 253 290 209 96 114 158 176 101 49 53 1999 2000 2001 2002 2003 Grand Total 2,528 2,917 2,942 2,873 3,019 16,732 975 1,343 1,397 1,501 1,548 7,481 750 816 796 915 810 4,587 647 744 789 736 691 4,131 725 740 501 489 380 3,635 281 361 307 378 512 2,074 281 312 277 270 301 1,903 254 323 334 293 392 1,849 211 192 294 284 438 1,709 328 360 211 219 133 1,460 109 148 180 146 149 828 148 152 155 89 61 719 157 103 91 96 112 717 122 104 123 69 56 650 89 115 96 57 54 512 64 166 235 465 40 66 58 82 111 406 61 62 68 56 61 361 Radiology Information System Data Extract Royal Liverpool Hospital Modality = CT Mod_Name CT Count Of uniqueid Spec_Name General medicine General surgery Accident and emergency (A&E) Geriatric medicine Gastroenterology Ear, nose and throat (ENT) clinical Haemotology Trauma and orthopaedics year_proc 1998 Urology Anaesthetics Nephrology Cardiology Cardiothoracic surgery Rheumatology Ophthalmology General Practice Clinical pharmacology 2,087 1,507 415 617 327 535 345 288 389 234 209 184 66 191 75 53 64 32 1999 2000 2001 2,096 2,315 1,999 1,722 2,145 2,005 469 618 879 718 752 797 525 740 703 443 469 501 341 309 492 315 415 368 416 356 199 169 220 262 176 269 252 196 241 315 107 135 142 279 137 2 62 113 100 72 63 110 64 89 78 44 60 67 2002 1,749 2,140 1,040 757 642 544 709 391 180 225 237 253 115 1 90 113 70 31 2003 Grand Total 2,063 12,309 2,557 12,076 1,121 4,542 755 4,396 633 3,570 810 3,302 620 2,816 497 2,274 236 1,776 352 1,462 308 1,451 258 1,447 228 793 3 613 87 527 107 518 104 469 234 Lessons from the 18 week exercise To develop analysis methodologies Inform PAS system development Establish a baseline position National SHA Trust Specialty To identify “Pinch Points” Summary and conclusions You may now open the Knowledge Management question paper You have until 2010 to complete all questions You may begin Did it all sink in? Any questions?