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

1. 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

2. Kings College Hospital

3. Kings Health Partners

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

5. 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

6. What we did at Kings and where we have got to? • Implemented an EPR • Implemented some specialty systems

7. A few words about specialty systems

8. 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

9. 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

10. 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”

11. 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 Barker Chair – KCH Clinical Documentation Committee Clinical Director for IT

12. 165 emails! The response

13. EPR down times and go slows

14. Two weeks in the life of a CCIO

15. 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

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

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

18. 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

19. 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

20. 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

21. 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

22. Thank you