Safer IT Systems for the NHS Dr Maureen

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 Management Requirements IT solutions to patient safety problems Process re-design

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 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 £ 6 B 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) • • • 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 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 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 and…. Other industries would!

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. • 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 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 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 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

ANY QUESTIONS? www. npsa. nhs. uk maureen. baker@npsa. nhs. uk