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

Overview • • • Patient safety in Connecting for Health NPSA commissioned study Safety Overview • • • 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 (NPf. IT) in NHS AIMS • To deliver a 21 National Programme for IT (NPf. IT) in NHS AIMS • To deliver a 21 st 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 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 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 £ 6 B programme

Maximising safety in primary care systems • NPSA funded study (£ 55, 000) from 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 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 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% 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) • • • Allergy alert may Results from NPSA funded study (University of Nottingham) • • • 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 NPf. IT • DCMO requested NPSA to conduct Development of Safety Management Approach in NPf. IT • DCMO requested NPSA to conduct highlevel risk assessment of NPf. IT • NPSA Risk Adviser conducted assessment early summer 2004 • Report delivered to NPSA and NPf. IT June 2004

Report findings NPf. IT currently not • Formally incorporating safety as a benefit to Report findings NPf. IT 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 NPf. IT not addressing safety in an explicit, proactive, structured and robust manner Conclusion NPf. IT not addressing safety in an explicit, proactive, structured and robust manner and…. Other industries would!

NPf. IT Action • Work in partnership with NPSA to address safety concerns • NPf. IT 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. 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 Cf. H product, and every product that connects over the Safety Management Requirements Every Cf. H 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 Cf. H Responsibilities • The Director of Clinical Safety, Professor Muir Gray, Chairs the Cf. H 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 Cf. H Programme Development Board and RIDs

IT solutions to patient safety problems • • Right patient right care Clinical Hand-offs IT solutions to patient safety problems • • 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 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 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

ANY QUESTIONS? www. npsa. nhs. uk maureen. baker@npsa. nhs. uk ANY QUESTIONS? www. npsa. nhs. uk maureen. [email protected] nhs. uk