The story so far
Health Informatics Unit
– the first 10 years
John Williams
Director, Health Informatics Unit
15 September 2011
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
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
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 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.
WELSH GOVERNMENT
Hosted by Health Solutions Wales (HSW)
Validity/value of HES/PEDW
HES
PEDW
HES/PEDW are inappropriate for ‘clinical’ purposes at
a local level
– 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 population level
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
Data item in audit
proforma
% in
HES/ or
PEDW
Primary reason for
admission
84
Source of admission
71
Specialty of care in first 24
hours
52
Major co-morbidities
recorded
39
Surgery performed
84
Indication for surgery
0
Post surgery complications
0
In hospital death
91
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?
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 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
•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
http://www.connectingforhealth.nhs.uk/systemsandservices/clinrecords/24hour
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......
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
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Adam Fujinon
Ascribe Scorpio
Endosoft
KeyMed (Olympus)
Unisoft
Endoeasy
GI-Trac
Weblogik EMS
Locally developed solutions
Diabetes
Hypertension
GORD
Arthritis
Out-patients
The patient
focused
record
Procedures
Mrs Jones
In-patients
Specialist
nurse
telephone
support
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
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