Information Technology in

Clinical GovernanceProfessor Devaka Fernando

Sheffield Hallam University

Associate Medical Director

Sherwood Forest Hospitals NHS Trust

• ‘A framework through which NHS organisations

are accountable for continuously improving the

quality of their services and safeguarding high

standards of care by creating an environment in

which excellence in clinical care will flourish’.

Building Block model for CG

• Patient safety

• Evidence Based Medicine

• Health Technology Assessment

• Reflections

• Summary

Patient safety

• As to disease, make a habit of two things – to

help, or at least do no harm- Hippocrates,

Epidemics (book I Chapter XI) c 400 BC

• Medicine used to be simple, ineffective and

relatively safe. It is now complex, effective and

potentially dangerous. Professor Cyril Chantler

Patient Safety

• Defined as freedom, as far as possible, from

harm or risk of harm, caused by medical

management (as opposed to harm caused by

the natural course of the patients original illness

or condition).

Harm to patients

• Mostly not deliberate

• Not through serious incompetence

• Mainly normally competent clinicians working in

inadequate systems.

• Most harm caused by medical practice is

avoidable.

Steps to Patient safety

• Build a safety culture (open and fair)

• Lead and support staff

• Integrate risk management

• Promote reporting

• Involve and communicate with patients

• Learn and share safety lessons

• Implement solutions to prevent harm

• Patient safety

• Evidence Based Medicine

• Health Technology Assessment

• Reflections

• Summary

On what evidence do we choose

technology?

• Personal experience

• Reasoning and intuition

• Colleagues

• Endorsement

• Published evidence (what type of publication ?)

Evidence based Medicine

• The process of systematically reviewing,

appraising and using research findings to aid

the delivery of optimum clinical care to patients.

• Based on strength and weight of scientific

evidence on clinical effectiveness when

allocating resources.

EBM a multifaceted process of

assuring clinical effectiveness.

• Production of evidence through research and scientific review.

• Production and dissemination of evidence based clinical guidelines.

• Implementation of evidence based, cost effective practice through education and management of change.

• Evaluation of compliance with agreed practice guidance through clinical audit and outcomes focussed incentives.

Grading evidence: Levels of

evidence.

High Quality Meta analyses, Systematic reviews or

Randomised clinical trials.

High quality systematic reviews of case control or cohort

studies or well conducted case control or cohort studies

Non analytic studies, case reports, case series.

Expert opinion.

Critical appraisal

• A method of assessing and interpreting the

evidence by systematically considering its

validity, results and relevance to the area of

work considered.

• Patient safety

• Evidence Based Medicine

• Health Technology Assessment

• Reflections

• Summary

HTA: The bridge between evidence

and policy making.

• Provides a range of stakeholders involved in

planning, purchasing and investing in

healthcare, with accessible, usable and

evidence based information that will guide

decisions about technology.

Health Technology Assessment :

systematically examines effects of

application of health technology

• Safety

• Clinical efficacy

• Clinical effectiveness

• Cost

• Cost effectiveness

• Organisational implications

• Social consequences

• Legal consequences

• Ethical considerations

Some HTA related definitions

• Clinical effectiveness: How do the health

outcomes of the technology compare with

available treatment alternatives.

• Cost Effectiveness: Are these improvements in

health outcomes commensurate with additional

costs of the technology?

Health Technology Assessments

• Helps policy makers decide which technologies

are effective and which are not.

• Defines most appropriate indications for their

use.

• Reduces or eliminates interventions that are

unsafe, ineffective or whose cost is too high

compared with benefits.

• Patient safety

• Evidence Based Medicine

• Health Technology Assessment

• Reflections

• Summary

How does your organisation

• Procure Health care technology in general?

• Medicines?

• Equipment ?

• Information technology?

What evidence base do you use to

assess IT systems in Health care?

What evidence base supports your

product?

• Patient safety

• Evidence Based Medicine

• Health Technology Assessment

• Reflections

• Summary

Summary

• ICT systems are a health care intervention.

• Systems for evaluating their efficacy and safety should

be as robust as those evaluating other health care

technologies.

• An integrated approach by consumers of health care

technology and providers of technology required.

• A corporate culture of evidence based critical appraisal

is required

• Consequent corporate buy in from developers,

providers and purchasers of IT solutions in health care

is required.