Skills and Competencies Gained and Used
in a Large Teaching Hospital In London
Dr Jack Barker
Consultant General and Respiratory Physician
Clinical Director for IT
(Chief Clinical Information Officer)
Kings College Hospital
Kings College Hospital
Kings Health Partners
My Background
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School
Middlesex Hospital Medical School
Went roaming
Brompton - research
Kings
South Africa – health systems
Kings – Chest and General Physician
Kings EPR team
My prejudices
• You don’t just have to be good, you have
to prove it
• If we routinely implemented everything we
know we wouldn’t have to do any more
research for a few years
• IT is likely to do more for patients’ health
than any drug implementation
• Paper is a rubbish technology
• I really want the NHS to work
What we did at Kings and where we have
got to?
• Implemented an EPR
• Implemented some specialty systems
A few words about specialty systems
What have we delivered to the
hospital?
iCM
• Orders and order sets
• Results review
• Document presentation
• Electronic prescribing
• PACS integrated and context linked
DIY
• Discharge Summaries
• Integrated letter making tool
• Emailing to GPs
• Electronic note keeping at the bed side
• Quality views and reminders
What have the big challenges been?
• Picking a good EPR
• Keeping the iCM EPR when the three boroughs
merged
• Keeping the iCM EPR when a new CEO arrived
• Stopped filing results
• Stopped filing clinic letters
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Electronic prescribing and medicines administration
Paperless inpatient note keeping
Quality reports
Keeping the consultants happy
A challenge to ePrescribing
• “We believe that the current
EPMA system should be
immediately halted for fatal
flaws to be fixed, with a view
to implementing a new
system. We believe that the
Trust Wide roll out of EPMA
should be stopped with
immediate effect in order not
to further compromise patient
safety”
How to provoke your colleagues
Dear Colleagues,
We are trying to continue our progress towards a paperless hospital. We believe that this is
a more effective way of storing and retrieving information about our patients.
I have been asked to confirm that there is no requirement
to store a paper copy of clinic letters in the paper notes as
they are all stored in the EPR.
This is consistent with
• Our wish to reduce dependency on paper
• Our move towards paperless outpatient clinics
• Our eventual move to paperless inpatient work
• Our plan (starting September 2010) to email all clinic correspondence to GPs in Lambeth,
Southwark and Lewisham
Questions are welcome. Please think carefully before “replying to all”.
Jack
Jack Barker
Chair – KCH Clinical Documentation Committee
Clinical Director for IT
The response
165 emails!
EPR down times and go slows
Unplanned Network Downtime 4 hours
8760 hours in a year 0.05%
Unplanned EPR downtime
3 hours
8760 hours in a year 0.03%
Paper notes unavailable
876 hours
8760 hours in a year 10%
Two weeks in the life of a CCIO
How can we categorise this?
• Strategy
– KCH
• EPR Software strategy
• Reporting and Quality
– Kings Health Partners
• Implementation
– KCH EPR (e.g. iv lines, vte)
• Development
– Specialty System Development – Respiratory Med.
– KCH EPR development (drug chart, quality views, Insulin)
• External Contacts
– RCP
– BCS
– Suppliers and Consultancies
What have I signed up to?
Jack Barker’s Service Objectives - Trust Goals for 2012
Continue making measurable progress with paperless hospital IT – Paperless hospital
Complete real time clinical quality reporting strategy Infection control / minimising harm acquired in the
hospital, Capacity planning and patient flow
Develop IT support and strategy for daily review of patients including nursing, junior staff and consultants.
Faster, Safer Hospital
Complete Diabetic Quality Chart for Oral Hypoglycaemic and sub-cutaneous Insulin and develop IT
strategy for the support of patients with Diabetes Improving diabetes care project
Complete paediatric growth charts IT Paperless hospital
Pilot electronic clerking in medicine (improve emergency care pathway, KHP alcohol strategy, mental and
physical health)
Review Hospital at Night Handover strategy - Improve identification and escalation of acutely ill patients
Review hospital at night, night time referrals strategy Improve identification and escalation of acutely ill
patients
Introduce KCH/GKT portal? - Support KHP integration
Bring anaesthetic chart into EPR
Bring WardWare vital signs into EPR Improve identification and escalation of acutely ill patients
Improve capture of diagnoses and procedures
Develop strategy for ICU ePrescribing
Describe IT support for Liverpool care pathway and Amber Improving end of life care project
Develop clinical IT support requirements for the integrated care pilot Implement Integrated Care Pilot for
frail older people
Undertake TB service review
What do I think would help someone to be
a really good CCIO?
General Qualities
Essential
Desired
• Ability to develop and
maintain relationships
• Vision
• Imagination
• Leadership
• Courage
• Persistence
• Communication skills
• The respect of
colleagues
• Cleverness
• Discretion
• Diplomacy
Undesired
• Stubborn
• Bull in a china shop
• Lacking leadership
IT skills
Essential
Desired
• Data presentation
tools,
PowerPoint/Keynote
• Database design and
use
• Data interpretation
spreadsheet
• HTML, Reporting
services
• Statistical analysis
• Automation tools
• Mathematics A level
Clinical
• Exposure to as many of the principal environments in which the IT will be
used
–A+E
–Take
–Wards
–Theatres
–Out-patients
–Multi-disciplinary meeting
• Responsibility for a "system".
• Responsibility for returning a dataset
• Academic
–an understanding of how clinical IT might be used to support research
–an understanding of how clinical IT might be used to support teaching
Closing thoughts
• The skills you need may depend on the
strategy you take
• They will only use it if it's easier and works
better than what went before
• Don’t expect too many thanks
• If it goes well – you will get respect
Thank you