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‘Enhancing medical care through ICT’Defence Health and Healthcare

Information Systems Requirements

Brigadier Martin CM Bricknell PhD DM L/RAMCHead Medical Operations and CapabilityHQ Surgeon General

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Expectations?

Patient care – clinical access to health records

Evidence of qualityThere were 75 validated clinical unexpected survivors from 1474

trauma cases in the period 02 April 2006 to 30 July 2008. (The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Phil. Trans. R. Soc. B 27 January 2011 vol. 366 no. 1562 171-191)

Associations between ‘Service’ and health – or not?

Integration of Defence health record into individuals’ longitudinal health record

Health of the Armed Forces

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Outline

Context

Current capabilities

Future capability requirements

Potential technological solutions

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CONTEXT

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The Healthcare Cycle

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External Context

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CURRENT CAPABILITIES

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Defence Medical Information Capability Programme - DMICP

• A networked Defence integrated Electronic Health Record (DiEHR).

• A multi-million pound programme over 10 years (2006-16)

• Clinical records for primary care, dental, rehabilitation and mental health..

• It covers records for all Regular personnel and occupational health records for the Reserves.

• DMICP is a Thin Client application based on a COTS General Practice software application, EMIS PCS.

• Business Intelligence (BI) capability is provided by IBM COGNOS tool.

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NCRS

NHS Trust PAS

JPA Server

DEMOGRAPHICS

FP-MES DATA

DENTAL RECORDS / FITNESS STATES

MEDICAL RECORDS / FITNESS STATES/ IMMUNISATION STATES

SENSITIVE MH DATA REHAB DATA

HQ

MANAGEMENT INFOHEALTH TRENDSPERFORMANCE

INDICATORSTREND ANALYSIS (EPIDEMIOLOGY)

REFERRAL DATA/ PATIENT RECORDS

ADMISSION DATA/ PATIENT RECORDS

FASTER TREATMENT

TIMES

Primary Dental

Primary Medical

DCMH Rehab

2nd CareiHR Server

DII

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View of the Consultation Page

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Whole Hospital Information System - WHIS

• Deployed hospital Patient Administration System (PAS) with added Clinical Support Tools (CST)

• Approx £10M pound over its 4 year expected lifespan

• It provides support for patient administration, bed management and hospital management information

• Limited links to Laboratory Information System (LIMS) and Imaging (RIS/PACS)

Camp BASTION hospital

WHIS

Lab

X-ray

DMICPdemographics

Defence Stats Centre forDefence Imaging

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Other applications and capabilities

Central Health Records Library

Joint Theatre Trauma Registry (JTTR)

Joint Patient Tracking Application (JPTA)

Significant Event Reporting System

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Observations

No single IT solution to the DMS health and healthcare information requirement

Procurement should be based on a spiral acquisition of services NOT an application and hardware

SME clinical users are the primary stakeholder

The introduction of IS requires x-DLOD organisational transformation.

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FUTURE DEFENCE HEALTH AND HEALTHCARE INFORMATION CAPABILITY REQUIREMENTS

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CORTISONE PROGRAMME

to provide a health and healthcare information capability that delivers the right information to the right people, at the right time and in the right format, in order to enable effective delivery of health and healthcare advice, health and healthcare services and medical operational capability, and thus support the Aim of the DMS

Aim of the DMS: To PROMOTE, PROTECT & RESTORE the health of the Defence population in order to maximise fitness for role

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CORTISONE Programme Family

REBRACE – future DiEHR

INTERMOLAR – bridge from present to future

ACTUARY – future WHIS

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CORTISONE core capabilities

Telemedicine

Near Real Time Disease Surveillance

Defence Health Records

Joint Military Operational Patient Registry

Patient Tracking Capability

Data integration capability

Professional Appraisal and Revalidation

Interoperability

• NHS

• Defence Core Network Services

• Other Defence Systems including Joint Personnel Administration and NATO MEDICS

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Network Diagram

DCNS

REBRACE

ARCHIVE

FIRM BASEPHC node

Deployed nodes

ACTUARY

PTA JMOPR

NHS

JPA

FIRM BASEOther User

IndependentClinician

Multinational nodes

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Future Technologies (1)

Source: http://www.tactical-life.com/news/israels-fisher-institute-reveals-medical-uav-for-civilian-or-military-use/

X

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Future Technologies (2)

Source: http://aic.ncr.vt.edu/?p=321

Source: http://www.nesta.org.uk/news_and_features/13for2013/the_commons_of_health_knowledge

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Summary

Context

Current capabilities

Future capability requirements

Potential technological solutions

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Questions

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Information is a critical capability