Clinical I nformation Access Clinical I nformation Access Program - - PowerPoint PPT Presentation

Clinical I nformation Access Clinical I nformation Access Program Program

A Clinical Decision Support System for NSW Clinicians

A Clinical Decision Support System for NSW Clinicians

www www. .clininfo clininfo.health.nsw. .health.nsw.gov gov.au .au

New South Wales New South Wales

• Population of NSW

Population of NSW 6,500M 6,500M

• Clinicians in Public Health Facilities

Clinicians in Public Health Facilities 81,000 81,000

• Number of Public Hospitals

Number of Public Hospitals 210 210

• Community Health Centres

Community Health Centres 280 280

• Area Health Services

Area Health Services 18 18

Goal Goal

Provide the doctors, nurses and allied health Provide the doctors, nurses and allied health professionals (clinicians) of NSW Health with professionals (clinicians) of NSW Health with access to on-line information via the WWW access to on-line information via the WWW to support clinical practice, education and to support clinical practice, education and research at the point of care. research at the point of care.

GPs Office GPs Office

Community Health Community Health Centre Centre Hospital Hospital

Clinic Clinic Ward Ward ICU ICU ED ED

Project Milestones Project Milestones

• Endorsed by the Clinical Systems Steering

Endorsed by the Clinical Systems Steering Committee in December 1996 Committee in December 1996

• CIAP management committee established in

CIAP management committee established in January 1997 January 1997

• Project Officer commenced March 1997

Project Officer commenced March 1997

• CIAP Area Representatives established in April

CIAP Area Representatives established in April 1999 1999

• Project Go-live July 4 1997

Project Go-live July 4 1997

Knowledge/ Reference Databases: Knowledge/ Reference Databases:

• All doctors, nurses, allied health professionals (clinicians)

All doctors, nurses, allied health professionals (clinicians) and librarians who work in the public health system in NSW and librarians who work in the public health system in NSW

• Includes hospitals, community health, public health, rural

Includes hospitals, community health, public health, rural GPs, Ambulance and Corrections Health GPs, Ambulance and Corrections Health

All other information: All other information:

• Any interested user in the world

Any interested user in the world

Authorised Users Authorised Users

Project Resources Project Resources

Manager Clinical Systems Project Officer Clerk (Web Editor)

CI AP Representatives All AHSs Clinical Systems Steering Committee CI AP Committee

Hospitals Hospitals Hospitals Hospitals

Listservers

100 CIAP Representatives

• nurses
• doctors
• AHPs
• librarians

Project Team Responsibilities Project Team Responsibilities

• Promote communications

Promote communications

• Web enable local content from NSW hospitals

Web enable local content from NSW hospitals

• Maintain the web site

Maintain the web site

• Manage the vendor contract

Manage the vendor contract

• Develop marketing and education materials

Develop marketing and education materials

• Co-ordinate education statewide

Co-ordinate education statewide

CI AP Clinical Representatives CI AP Clinical Representatives

• Established in 18 Area Health Services,

Established in 18 Area Health Services, Corrections Health and Ambulance Corrections Health and Ambulance

– – Liaise with management, clinicians and DoH Liaise with management, clinicians and DoH – – Organise training and education sessions Organise training and education sessions – – Allocate passwords and IDs to authorised users Allocate passwords and IDs to authorised users – – Distribute marketing materials e.g Distribute marketing materials e.g flyers

flyers,

, posters

posters

– – Establish local clinical committees to govern IT Establish local clinical committees to govern IT – – Provide feedback on local information needs Provide feedback on local information needs

Key Drivers Key Drivers

• Support Evidence Based Medicine

Support Evidence Based Medicine

• Reduce Adverse Events

Reduce Adverse Events

• Support Education and Research

Support Education and Research

• Better Access to Decision Support Information

Better Access to Decision Support Information

Evidence Based Medicine(EBM) Evidence Based Medicine(EBM)

EBM is the conscientious, explicit and judicious use of EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the current best evidence in making decisions about the care care of individual patients. This practice means individual patients. This practice means integrating individual clinical experience with the best integrating individual clinical experience with the best available external clinical evidence from systematic available external clinical evidence from systematic research". research".

CIAP supports CIAP supports EBM via the Cochrane Library, Therapeutic Guidelines, EBM via the Cochrane Library, Therapeutic Guidelines, Professional Literature. Professional Literature.

(

(Sackett Sackett et al., BMJ, 1996, 312, et al., BMJ, 1996, 312, pp pp.72-3) .72-3)

Adverse Event Adverse Event

An AE is defined as an injury or complication An AE is defined as an injury or complication which resulted in disability or prolongation of which resulted in disability or prolongation of hospital stay and was caused by the health hospital stay and was caused by the health care received rather than by the disease care received rather than by the disease from which the patient suffered. from which the patient suffered.

Wilson Wilson et al., An analysis of the causes of adverse events from the Quality in Australian Health et al., An analysis of the causes of adverse events from the Quality in Australian Health Care Study Care Study

Adverse Events Adverse Events

• 50,000 Australians suffer permanent disability

50,000 Australians suffer permanent disability

• Australia loses over three million bed-days

Australia loses over three million bed-days per annum per annum

• Potential savings from preventable AEs in

Potential savings from preventable AEs in 1995-96 would be $4.17 billion 1995-96 would be $4.17 billion

• (47 billion in the US each year - 1998).

(47 billion in the US each year - 1998).

Adverse Events Adverse Events

Adverse drug events are the fourth leading Adverse drug events are the fourth leading cause of death in the USA cause of death in the USA

• the equivalent of a commercial jet

the equivalent of a commercial jet crash every single day crash every single day

( (Lazarou Lazarou et al 1998) et al 1998)

More Food for Thought More Food for Thought

40,000 people are shot dead each year in 40,000 people are shot dead each year in the USA…….. the USA…….. ……..You are therefore more likely to be ……..You are therefore more likely to be killed by a doctor than a gun killed by a doctor than a gun

New Graduates, Post Graduates and Students New Graduates, Post Graduates and Students in the health professions have clinical in the health professions have clinical information needs beyond the University information needs beyond the University

– – Sydney University Graduate Medical Program is WWW Sydney University Graduate Medical Program is WWW based learning based learning – – Wollongong University has computer skills as a pre- Wollongong University has computer skills as a pre- requisite to graduating with a nursing degree requisite to graduating with a nursing degree – – The Post Graduate Medical Council has Web based The Post Graduate Medical Council has Web based learning modules and also links to CIAP learning modules and also links to CIAP

Supporting Education Supporting Education

“ “WWW access now has Medico-legal

WWW access now has Medico-legal

• ramifications. Hospitals are plausibly
• ramifications. Hospitals are plausibly

liable if clinicians can’t access best- liable if clinicians can’t access best- evidence” evidence”

Professor Enrico Coiera Professor Enrico Coiera (Computer Science, UNSW)

(Computer Science, UNSW)

Medico - Legal Considerations Medico - Legal Considerations

Medico-Legal I ssues Medico-Legal I ssues

• An Israeli court recently issued a verdict that

An Israeli court recently issued a verdict that a doctor, who does not update his medical a doctor, who does not update his medical knowledge with professional literature is knowledge with professional literature is liable for malpractice. liable for malpractice. ……………if he just had access to the CIAP!!!! ……………if he just had access to the CIAP!!!!

• QUALITY Care

QUALITY Care

• The Continuum of Care

The Continuum of Care

• Evidence Based Medicine

Evidence Based Medicine

• World’s Best Practice

World’s Best Practice

• Information Culture

Information Culture

Buzz Words!! Buzz Words!!

None of these can be achieved without access to quality information. None of these can be achieved without access to quality information. This makes the CI AP a tool of modern medicine This makes the CI AP a tool of modern medicine

Pre-implementation Pre-implementation Survey Survey

Priority One Information Resources

100 200 300 400 500 600 700 800 900 Medline MIMS CINAHL Clinical Practice Guidelines Procedures/Protocols Clinical Pathways Paediatric Handbook Policies On-line Journals PsycINFO Cochrane Library Harrisons Internal Medicine

Pre-I mplementation Survey

I nformation Resources I nformation Resources

• Databases

Databases

– – Medline and CINAHL Medline and CINAHL – – Cochrane Library Cochrane Library – – HealthStar HealthStar – – PsycINFO and the mental health journal collection PsycINFO and the mental health journal collection – – Core medical and nursing journals Core medical and nursing journals – – MIMS MIMS – – Micromedex - Poisons, Toxicology, Martindale, Micromedex - Poisons, Toxicology, Martindale, Emergindex Emergindex – – Therapeutic Guidelines Therapeutic Guidelines – – Interactive ECG Interactive ECG – – Ten on-line textbooks Ten on-line textbooks

I nformation Resources I nformation Resources

• NSW Hospital/ Health Dept. Documents

NSW Hospital/ Health Dept. Documents

– – Policies Policies – – Procedures Procedures – – Protocols Protocols – – Clinical practice guidelines Clinical practice guidelines – – Clinical Pathways Clinical Pathways – – Reports - Surveys, Strategies etc. Reports - Surveys, Strategies etc. – – Data Data

Models

Models

Other I nformation Resources Other I nformation Resources

• Medical dictionaries

Medical dictionaries

• CIAP representatives contact details

CIAP representatives contact details

• Links to local Area Intranets

Links to local Area Intranets

• Listservers

Listservers

• Links to International clinical web sites

Links to International clinical web sites

Australian Health Links Australian Health Links

The World The World

Utilisation Statistics Utilisation Statistics

MI MS MI MS

5000 10000 15000 20000 25000 30000 35000 40000 F e b . M a r c h A p r i l M a y J u n e J u l y A u g . S e p t . O c t . N

• v

.

February 99 - November 99

Micromedex Micromedex

1000 2000 3000 4000 5000 6000 7000 8000 9000 10000

Feb March April May June July August Sept. Oct. Nov.

February 99 - November 1999

Antibiotic Guidelines Antibiotic Guidelines

500 1000 1500 2000 2500 3000 3500 4000 4500 5000

F e b r u a r y M a r c h A p r i l M a y J u n e J u l y A u g u s t S e p t . O c t . N

• v

.

February 99 - November 1999

Cochrane Library Cochrane Library

2000 4000 6000 8000 10000 12000 14000 Feb. March April May June July Aug. Sept. Oct. Nov.

February 99 - November 99

2000 4000 6000 8000 10000 12000 14000 16000 18000 F e b . M a r c h A p r i l M a y J u n e J u l y A u g u s t S e p t . O c t . N

• v

.

February 99- November 99

Medline, CI NAHL, HealthStar Medline, CI NAHL, HealthStar

• Information is available round the clock

Information is available round the clock

• Supports EBM

Supports EBM

• Improves communication - e.g. listservers

Improves communication - e.g. listservers

• Creates a technologically aware workforce

Creates a technologically aware workforce

• Reduces professional isolation for rural

Reduces professional isolation for rural clinicians clinicians

• Creates equity of access to information

Creates equity of access to information

• Reduces the cost of information

Reduces the cost of information

Benefits Benefits

CI AP CI AP

The Catalyst in Creating an I nformation Culture The Catalyst in Creating an I nformation Culture

• increased interest in using information to

increased interest in using information to improve clinical practice improve clinical practice

• clinical committees established statewide

clinical committees established statewide

• improved collaboration between

improved collaboration between

– – librarians and clinicians

librarians and clinicians – – Health Education Sector and NSW Health Health Education Sector and NSW Health – – Other States and Government Departments Other States and Government Departments

Technology Barriers Technology Barriers

• Low penetration of PCs in clinical areas

Low penetration of PCs in clinical areas

• Inadequate telecommunications infrastructure

Inadequate telecommunications infrastructure

• Inadequate IT resources to support CIAP

Inadequate IT resources to support CIAP

• Speed of the Internet (World Wide Wait)

Speed of the Internet (World Wide Wait)

• $$$$$

$$$$$

Organisational Barriers Organisational Barriers

• Negative attitude to I nternet access

Negative attitude to I nternet access for clinicians for clinicians

– – management management – – IT Directors IT Directors

• Poor understanding of clinicians

Poor understanding of clinicians information needs information needs

– – communicating value of information to management

communicating value of information to management

– – the I nternet is a “toy for clinicians to play with”

the I nternet is a “toy for clinicians to play with”

• Cost of I nternet access to hospitals

Cost of I nternet access to hospitals

I T Bloopers I T Bloopers

• ut of the mouths of……..
• ut of the mouths of……..

I T Director I T Director

“We (IT) will not provide access to the “We (IT) will not provide access to the Internet as we have a duty to save Internet as we have a duty to save clinicians from themselves” clinicians from themselves”

NHS Manager NHS Manager

“The Internet is proved to deprave and “The Internet is proved to deprave and corrupt and we will be drawn to looking corrupt and we will be drawn to looking at pornography all day” at pornography all day”

Reference: Reference: Carnall Carnall D (1999) NHS Librarians cannot Access the Internet, E-BMJ. 319:10 D (1999) NHS Librarians cannot Access the Internet, E-BMJ. 319:10 http://www. http://www.bmj bmj.com/ .com/ cgi cgi/content/full/319/7201/10/a /content/full/319/7201/10/a

I T Director I T Director

“we will not pass CIAP help enquiries on to “we will not pass CIAP help enquiries on to the CIAP representative because…..we just the CIAP representative because…..we just won’t…” won’t…”

Librarian Librarian

“The CIAP is just a load of hype created by “The CIAP is just a load of hype created by those clinicians at the NSW Health those clinicians at the NSW Health Department” Department”

Librarian Librarian

“I’ll have the CIAP up here over my dead body” “I’ll have the CIAP up here over my dead body”

RI P

“Those who think the Internet is overhyped “Those who think the Internet is overhyped and that it will become passe’ are deeply and that it will become passe’ are deeply misled.…….. Naysayers may provide misled.…….. Naysayers may provide comfort to the corporate Internet laggards comfort to the corporate Internet laggards

• f today, but this comfort will ultimately
• f today, but this comfort will ultimately

prove hollow and costly……....” prove hollow and costly……....”

A Wise Man Said……….. A Wise Man Said………..

“..our most important task now is to make “..our most important task now is to make health health managers, IT managers and politicians managers, IT managers and politicians understand how valuable information understand how valuable information technology is to practicing clinicians and how technology is to practicing clinicians and how much more there is to clinical IT than much more there is to clinical IT than spreadsheets and payroll programs” spreadsheets and payroll programs”

Clinician Clinician

The Lesson………………… The Lesson…………………

……...Listen to your Clinicians ……...Listen to your Clinicians

they know what their information needs are!!! they know what their information needs are!!!

The Future The Future

• Interstate Partnerships

Interstate Partnerships

• Expand CIAP content

Expand CIAP content

• Link to Prescription Decision Support Program

Link to Prescription Decision Support Program

• Increase education to support EBM

Increase education to support EBM

• Conduct Research

Conduct Research

• Collaborate with the Health Education Sector

Collaborate with the Health Education Sector

CI AP Score With Clinicians! CI AP Score With Clinicians!