Skills and Competencies Gained and Used in a Large Teaching Hospital In London

Dr Jack Barker

Consultant General and Respiratory Physician

Clinical Director for IT

(Chief Clinical Information Officer)

Kings College Hospital

Kings College Hospital

Kings Health Partners

My Background

• School• Middlesex Hospital Medical School• Went roaming• Brompton - research• Kings• South Africa – health systems• Kings – Chest and General Physician• Kings EPR team

My prejudices

• You don’t just have to be good, you have to prove it

• If we routinely implemented everything we know we wouldn’t have to do any more research for a few years

• IT is likely to do more for patients’ health than any drug implementation

• Paper is a rubbish technology• I really want the NHS to work

What we did at Kings and where we have got to?

• Implemented an EPR• Implemented some specialty systems

A few words about specialty systems

What have we delivered to the hospital?

iCM •Orders and order sets•Results review•Document presentation•Electronic prescribing•PACS integrated and context linked

DIY•Discharge Summaries•Integrated letter making tool•Emailing to GPs•Electronic note keeping at the bed side•Quality views and reminders

What have the big challenges been?

• Picking a good EPR• Keeping the iCM EPR when the three boroughs

merged• Keeping the iCM EPR when a new CEO arrived• Stopped filing results• Stopped filing clinic letters

• Electronic prescribing and medicines administration• Paperless inpatient note keeping• Quality reports• Keeping the consultants happy

A challenge to ePrescribing

• “We believe that the current EPMA system should be immediately halted for fatal flaws to be fixed, with a view to implementing a new system. We believe that the Trust Wide roll out of EPMA should be stopped with immediate effect in order not to further compromise patient safety”

How to provoke your colleagues

Dear Colleagues, We are trying to continue our progress towards a paperless hospital.  We believe that this is a more effective way of storing and retrieving information about our patients. 

I have been asked to confirm that there is no requirement to store a paper copy of clinic letters in the paper notes as they are all stored in the EPR. This is consistent with•Our wish to reduce dependency on paper•Our move towards paperless outpatient clinics•Our eventual move to paperless inpatient work•Our plan (starting September 2010) to email all clinic correspondence to GPs in Lambeth, Southwark and Lewisham Questions are welcome.  Please think carefully before “replying to all”. Jack

Jack BarkerChair – KCH Clinical Documentation CommitteeClinical Director for IT

The response

165 emails!

EPR down times and go slows

Unplanned Network Downtime 4 hours 8760 hours in a year 0.05%

Unplanned EPR downtime 3 hours 8760 hours in a year 0.03%

Paper notes unavailable 876 hours 8760 hours in a year 10%

Two weeks in the life of a CCIO

How can we categorise this?•Strategy

– KCH•EPR Software strategy•Reporting and Quality

– Kings Health Partners

•Implementation– KCH EPR (e.g. iv lines, vte)

•Development– Specialty System Development – Respiratory Med.– KCH EPR development (drug chart, quality views, Insulin)

•External Contacts– RCP– BCS– Suppliers and Consultancies

What have I signed up to?Jack Barker’s Service Objectives - Trust Goals for 2012

Continue making measurable progress with paperless hospital IT – Paperless hospital

Complete real time clinical quality reporting strategy Infection control / minimising harm acquired in the hospital, Capacity planning and patient flow Develop IT support and strategy for daily review of patients including nursing, junior staff and consultants. Faster, Safer Hospital

Complete Diabetic Quality Chart for Oral Hypoglycaemic and sub-cutaneous Insulin and develop IT strategy for the support of patients with Diabetes Improving diabetes care project

Complete paediatric growth charts IT Paperless hospital

Pilot electronic clerking in medicine (improve emergency care pathway, KHP alcohol strategy, mental and physical health)

Review Hospital at Night Handover strategy - Improve identification and escalation of acutely ill patientsReview hospital at night, night time referrals strategy Improve identification and escalation of acutely ill patients

Introduce KCH/GKT portal? - Support KHP integration

Bring anaesthetic chart into EPR

Bring WardWare vital signs into EPR Improve identification and escalation of acutely ill patients

Improve capture of diagnoses and procedures

Develop strategy for ICU ePrescribing

Describe IT support for Liverpool care pathway and Amber Improving end of life care project

Develop clinical IT support requirements for the integrated care pilot Implement Integrated Care Pilot for frail older people

Undertake TB service review

What do I think would help someone to be a really good CCIO?

General Qualities

Essential

•Ability to develop and maintain relationships•Vision•Imagination•Leadership•Courage•Persistence•Communication skills•The respect of colleagues

Desired

•Cleverness•Discretion•Diplomacy

Undesired

•Stubborn•Bull in a china shop•Lacking leadership

IT skills

Essential

•Data presentation tools, PowerPoint/Keynote

•Data interpretation spreadsheet

Desired

•Database design and use

•HTML, Reporting services

•Statistical analysis

•Automation tools

•Mathematics A level

Clinical•Exposure to as many of the principal environments in which the IT will be

used–A+E–Take–Wards–Theatres–Out-patients–Multi-disciplinary meeting

•Responsibility for a "system".

•Responsibility for returning a dataset

•Academic –an understanding of how clinical IT might be used to support research–an understanding of how clinical IT might be used to support teaching

Closing thoughts• The skills you need may depend on the strategy you take

• They will only use it if it's easier and works better than what went before

• Don’t expect too many thanks

• If it goes well – you will get respect

Thank you