Hệ thống CNTT an toàn hơn cho NHS

Safer IT Systems for the NHS
Dr. Maureen Baker CBE DM FRCGP
Special Clinical Adviser NPSA
Clinical Safety Officer CfH


Overview
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Patient safety in Connecting for Health
NPSA commissioned study
Safety Management Requirements
IT solutions to patient safety problems
Process re-design


National Programme for IT (NPfIT) in NHS
AIMS
• To deliver a 21st Century health service that is
better for patients, citizens, clinicians and people
working in the NHS through the efficient use of
ICT
• To improve the convenience, quality and SAFETY
of patient-centred care by ensuring that those
who give and receive care have the right
information, at the right time

Why do we need it?
• Medical and clinical knowledge continually
expanding
• Patients want more involvement in their care
• Traditional paper-based recording and storage
systems can no longer provide effective support
for NHS
• Many hospitals and most general practices now
have some form of electronic patient record that
cannot easily be shared
• Data and information not easily shared across
NHS


Why is this important to NPSA?
• Huge potential to support clinicians in practising
safely – prescribing, transfer of information,
clinical decision support
• Platform to enable NPSA solutions work – right
patient right care, transfer of care
• Opportunity to exert major influence for safety on
£6B programme


Maximising safety in primary care systems
• NPSA funded study (£55,000) from University of
Nottingham
• Conducted during 2003
• Emerging findings conveyed to NPSA while study

on-going and influenced programme of work


Objectives of study
• Identify the most important safety issues
regarding GP computer systems
• Assess GP computer systems in terms of these
safety features
• Determine GPs’ knowledge, views and training
needs in relation to computerised safety features
• Work with stakeholders to produce specifications
for GP computer suppliers and for training
practice staff


Primary care contacts
• 1 million consultations with GPs in UK every
working day (NHS Plan, 2000)
• 100,000 home visits by community nurses every
day (NHS Plan, 2000)
• 617 million prescriptions dispensed by
community pharmacists in year 2002-3 in
England (source PPA)
• 50 million prescriptions dispensed in dispensing
practices in year 2002-3 in England (source PPA)


Medication errors - English general practice
• Medication error rate between 1% and 10% of all
prescriptions generated

• From lower estimate could be 6,500,000
medication errors
• Estimated 1% of medication errors in general
practice are clinically significant
• Could be 65,000 cases of harm in England
annually


Results from NPSA funded study
(University of Nottingham)
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Allergy alert may not be generated
Hazard alert generated every third prescription
Single keystroke to over-ride alert
No audit trail
Not all safety functionality activated (eg contraindications)
• Hazards generated by drop-down menus
• GPs unsure of safety functionality on systems
• Some think functionality is present when it isn’t
(eg contra-indications)


Development of Safety Management
Approach in NPfIT
• DCMO requested NPSA to conduct highlevel risk assessment of NPfIT

• NPSA Risk Adviser conducted
assessment early summer 2004
• Report delivered to NPSA and NPfIT June
2004


Report findings
NPfIT currently not
• Formally incorporating safety as a benefit to drive
the programme
• Formally risk assessing systems and processes
• Formally risk assessing solutions to ensure no
new risks introduced
• Relying on those involved to instinctively
address patient safety


Conclusion
NPfIT not addressing safety in an
explicit, proactive, structured and
robust manner and….
Other industries would!


NPfIT Action
• Work in partnership with NPSA to address safety
concerns
• Safety Management Approach evolved in
workshops Autumn 2004
• Based on IEC 61508 (international standard for

safety critical software)
• Agreed with and supported by NPSA
• Implemented January 2005


Aims of Safety Management Approach
• To deliver IT systems which improve clinical
safety.
• To provide suppliers with an easy to use and
robust safety management system.
• To provide Trusts with assurance and clear
guidance on the actions they need to take to
ensure systems are deployed in an effective and
safe manner.


Safety Management Requirements
Every CfH product, and every product that
connects over the spine to have
• End-to-end hazard assessment
• Safety justification case
• Safety closure report
When closure report signed off, then ‘certificate
of authority to deploy’ issued


Responsibilities
• The Director of Clinical Safety, Professor Muir
Gray, Chairs the CfH Monthly Safety Committee.
• The National Patient Safety Authority (NPSA)

have seconded Dr Maureen Baker as the Clinical
Safety Officer.
• Muir and Maureen will ensure liaison with the CfH
Programme Development Board and RIDs


IT solutions to patient safety problems
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Right patient right care
Clinical Hand-offs
Interface issues
Management of investigations and
results


Process design
• Poor processes can lead to patient safety
incidents
• Automating poor processes still yields poor
results for patient safety
• Clinicians need to feed into development of
systems
• Change in working processes should be
determined by clinical requirements, not by the
way in which IT systems have been designed

Safety Principles
• Systems designed to deliver safer patient care
• Patient safety embedded at every level –
specification; design; testing and quality
assurance; implementation and use in clinical
setting
• Structured risk assessment incorporated into
development processes
• Aim for inherently safe systems