Designing & Implementing Clinical Information Systems

1. Designing & Implementing Clinical Information Systems Dr. Morkos Fakhry CSW Group Ltd.

2. Agenda • Important aspects to be considered • User Environment • User Interface • Access Control • Required System Functions • Technology • Standards • Delivery Requirements Designing & Implementing Clinical Information Systems

3. User Environment User Interface Access Control System Functions Technology Standards Delivery Requirements Important aspects Designing & Implementing Clinical Information Systems

4. USER ENVIRONMENT

5. USER ENVIRONMENT • Define your target users • Define your target locations • Understand the user environment • User expectations • Patients • Healthcare Professionals • Managers and researchers Designing & Implementing Clinical Information Systems

6. Define your target users • Patients and carers,care professionals, including: general practitioners; medical staff; social workers; community/district nurses; school nurses; community midwives; health visitors; practice nurses; physiotherapists; community dentists; pharmacists; opticians; occupational therapists; counsellors; speech therapists; podiatrists; dieticians; domiciliary care workers;service managers, and administration staff. Designing & Implementing Clinical Information Systems

7. Define your target locations • GP practices;service user’s home;care professional’s home (out of hours duty staff);GP practices;health centres;clinics;dental practices;day Centres;nursing Homes;PCT and social services offices;outreach clinics;A&E;schools;workplace;prison health care;residential homes and hostels; andcommunity and acute hospitals. Designing & Implementing Clinical Information Systems

8. Understand the user environment • Patient’s characteristics: • Very sensitive about any information about their conditions. • What are the complications of my disease? • What are the probabilities of those complications? • Is there any statistics known about it? • Is there a definite treatment? • What are the various options? • How can I evaluate each option? Designing & Implementing Clinical Information Systems

9. Understand the user environment • Doctor’s characteristics: • Responsible for more than one patient at a time. • Each level is supervised by another level. For example in the secondary care you will find the registrar who is responsible for many patients and supervised by a specialist or the consultant. So the situation is tense!! • Very busy. Designing & Implementing Clinical Information Systems

10. Understand the user environment • Nurses’ characteristics: • Performing a lot of regular processes and e.g. giving medications, fluid balance calculation, supervising providing care to patients at all time • Very busy • Under pressure from doctors Designing & Implementing Clinical Information Systems

11. Understand the user environment • All: • NOT computer experts • Don’t sit in front of the computer • Face tense situations • Active environment (the most active after a battle field) • Complex environment (a lot of interlinking activities, disciplines and communities are involved in the patient care) • Are interested in the global picture as well as the detailed one! Designing & Implementing Clinical Information Systems

12. User expectations (Patients) 1. Feel confident that information about them and their history of care is accurate and easily accessible to any other professional involved with their care and with a need to know, except where the patient has expressed a view to the contrary. 2. Be reassured that their professionals have access to information about the latest care knowledge and practice. 3. Be reassured that the information that they provide at any healthcare encounter is kept secure. Designing & Implementing Clinical Information Systems

13. User expectations (Patients) 4. Be able to look at their records and have the ability to amend or add information (taking into account the legal implications). 5. Be able to understand their care process through use of “patient-friendly care pathway views” 6. Be offered the opportunity to exercise choice over date, time and place of future encounters with care services 7. Be offered choice over where to pick up prescriptions Designing & Implementing Clinical Information Systems

14. User expectations (Patients) 8. Be able to use a range of technologies – PC’s, phones, digital TV – to interact with care services and at times that are convenient to them 9. Have access to evidence of the quality of care provided to them or by local providers 10. Be able to understand their records and to derive beneficial advice and support from them 11. Provide links to patient communities and support groups Designing & Implementing Clinical Information Systems

15. User expectations (Healthcare professionals) 1. Have ready access to information about their patients when they want it, from wherever they want it (including peripatetic staff), and structured in a format they want 2. Have ready access to the knowledge, clinical tools and related services they need to support their clinical decision making process 3. Be able to use high quality information in support of the implementation of audit, peer review, clinical effectiveness and other aspects of Clinical Governance Designing & Implementing Clinical Information Systems

16. User expectations (Healthcare professionals) 4. Be able to rely on the fact that they will be notified about responses to service requests – which could be referrals or test requests - or lack of response within an appropriate time period 5. Be assured that their records and communications with patients and colleagues are secure and conformant with agreed information sharing protocols 6. Be able to participate in lifelong learning through access to education, training and development services Designing & Implementing Clinical Information Systems

17. User expectations (Managers & Researchers) 1. Have ready access to aggregated and anonymised information to support research, planning and management of care services. 2. Be able to use high quality information in support of the implementation of clinical governance and improvement of public health 3. Be able to participate in lifelong learning through access to education, training and development services Designing & Implementing Clinical Information Systems

18. The User Interface

19. User Interface • Introduction • Information capture • Information Analysis and Reporting • Tools and Reporting • Information Governance Designing & Implementing Clinical Information Systems

20. User Interface Introduction1/5 • The interface is by far the most important aspect in any computer system, not to say how important it is in Healthcare Systems. • Through only one screen and two speakers, the system should be able to declare, maximally, the richness and beauty of the content. Designing & Implementing Clinical Information Systems

21. I NT ERFACE Patient Healthcare System Healthcare Personnel Others User Interface Introduction2/5 Designing & Implementing Clinical Information Systems

22. User Interface Introduction3/5 • The interface is like a piece of glass between the user and the content. If this piece of glass has any unclear part, it can hide a very precious part of the content; hence the content would be useless in the users’ eyes. • If this piece of glass doesn’t have logical pointers to different parts of the content, then it would be very hard for the user to reach what he or she wants. Designing & Implementing Clinical Information Systems

23. User Interface Introduction4/5 • Furthermore, if this piece of glass is not putting the psychological and cultural status of the user in consideration, then it will quickly distract his or her attention and push him or her to abandon using the system. Designing & Implementing Clinical Information Systems

24. User Interface Design and Development Content Target Users User Interface Introduction5/5 Designing & Implementing Clinical Information Systems

25. Clear/ Simple Proactive Enjoyable Logic/ Intuitive User Interface Technically Advanced Standard Intelligent Creative User Interface Characteristics Designing & Implementing Clinical Information Systems

26. Information capture • Data Entry • User Interface and Navigation • Patient Access • Help Facilities • Codes and Coded Fields • Mandation of fields • Capture of non-textual data Designing & Implementing Clinical Information Systems

27. Data Entry • Rapid and user-friendly method of data input, • The facility for structured, coded data capture, as well as unstructured free text., • Simplify structured data collection such as pick-lists, short lists and precoded templates. • Users should be able to generate their own short lists of frequently entered items in a variety of easily accessible forms. • The service must provide forms of data entry other than keyboard such as voice recognition, bar-coding, hand-held devices etc to promote greater efficiency. Designing & Implementing Clinical Information Systems

28. Navigation • Fast navigation around screens and sub screens for experienced users, intuitive or explanatory navigation for inexperienced users . • All screens must be customisable e.g. to meet personal requirements (colour, text size etc). • Users must be alerted, upon logging onto the service, about any messages for them. • The initial screen should contain the data of most interest to the users (e.g. list of patients, alert messages, results outstanding but not read, etc). • Reduce effort by minimising necessary keystrokes and allowing for default options, which can be over-ridden when appropriate. Designing & Implementing Clinical Information Systems

29. Patient Access • Access by patients to their own care records. • Enable patients to record their own information (e.g. self-care) attached to their care record. Designing & Implementing Clinical Information Systems

30. Help Facilities • Help facilities must be available at both data item level and at menu level. • Help should be accessible on-line and in a form that is appropriate to both new and experienced users. • The whole documentation service should also be available in paper and electronic form. Designing & Implementing Clinical Information Systems

31. Codes and Coded Fields • On-line validation of all structured, coded data, without degradation of response times. • Allowing users to check the accuracy of all structured data collected by review of the coded term against the user term. • The system must be sufficiently flexible for structured data collection to use any coding system. • There must be consistent clinical terminology throughout. For instance if ‘Diabetes’ or ‘Shooting chest pain’ is entered in one area of the system, then it must be understood as the same concept in another. Designing & Implementing Clinical Information Systems

32. Mandation of fields • Enable mandation of appropriate data fields to conform with minimum data requirements for central purposes, as identified by professional and statutory bodies. • Enable flexibility of the specification of data to be collected, to allow for evolution and development over time and continuing conformance with national requirements. Designing & Implementing Clinical Information Systems

33. Capture of non-textual data • It must be possible for users to view images (e.g. X-ray, pathology and endoscopy) held on other systems and to incorporate these into reports and summaries as necessary. It should not be necessary for images to be held within a local system if remote viewing is possible. • The service must enable capture of data on equipment use. Designing & Implementing Clinical Information Systems

34. Information Analysis and Reporting • Service outputs, such as reports and labels must be user definable, both in terms of content, medium and style of output. • Every data item in the system, both entered and derived, must be available to be pulled into the same report. • Operational reporting/documentation must be automated, where possible, and distributed in the most appropriate way e.g. electronically, direct faxing. • Enable the analysis of aggregate data for monitoring of quality (including outcomes), planning new services, supporting research activity, and the monitoring of training. Designing & Implementing Clinical Information Systems

35. Tools and Reporting • The production of clinical correspondence and messages e.g. outpatient letters and discharge letters; • The establishment of referral protocols that form the front end of the ICP; • Clinical decision support facilities in the broadest sense; • Data validation Designing & Implementing Clinical Information Systems

36. Information Governance • Confidentiality and Data Protection • Maintain User Access Controls and Authentication • Security • Audit Trail • Data Quality and Audit Designing & Implementing Clinical Information Systems

37. Access Control Privacy, Confidentiality & Security

38. Caldicott Report • All items of information which relate to an attribute of an individual ought to be treated as potentially capable of identifying patients, to a greater or lesser extent, and should be appropriately protected to safeguard confidentiality Designing & Implementing Clinical Information Systems

39. Principles 1- Justify the purpose(s) • Every proposed use or transfer of patient-identifiable information within or from an organisation should be clearly defined and scrutinised, with continuing uses regularly reviewed, by an appropriate guardian. Designing & Implementing Clinical Information Systems

40. Principles 2- Don't use patient-identifiable information unless it is absolutely necessary • Patient-identifiable information items should not be included unless it is essential for the specified purpose(s) of that flow. The need for patients to be identified should be considered at each stage of satisfying the purpose(s). Designing & Implementing Clinical Information Systems

41. Principles 3- Use the minimum necessary patient-identifiable information • Where use of patient-identifiable information is considered to be essential, the inclusion of each individual item of information should be considered and justified so that the minimum amount of identifiable information is transferred or accessible as is necessary for a given function to be carried out. Designing & Implementing Clinical Information Systems

42. Principles 4- Access to patient-identifiable information should be on a strict need-to-know basis • Only those individuals who need access to patient-identifiable information should have access to it, and they should only have access to the information items that they need to see. This may mean introducing access controls or splitting information flows where one information flow is used for several purposes. Designing & Implementing Clinical Information Systems

43. Principles 5- Everyone with access to patient-identifiable information should be aware of their responsibilities • Action should be taken to ensure that those handling patient-identifiable information - both clinical and non-clinical staff - are made fully aware of their responsibilities and obligations to respect patient confidentiality. Designing & Implementing Clinical Information Systems

44. Principles 6- Understand and comply with the law • Every use of patient-identifiable information must be lawful. Someone in each organisation handling patient information should be responsible for ensuring that the organisation complies with legal requirements. Designing & Implementing Clinical Information Systems

45. Access Control Based on: • The specialty of the creator of the document • The location of the creator of the document • The creator of the document • The patient • The ID of the document • The origin of the document • The specialty of the document • The sensitivity of the document • The classification of the document Designing & Implementing Clinical Information Systems

46. Required System Functions

47. Integrated Care Record Service (ICRS) Designing & Implementing Clinical Information Systems

48. What is Integrated Care Record Service (ICRS)? • Integrated: operating across the care continuum. • Care: covering both health and social care. • Record: single record based around the patient. • Service: to reflect a need to address not only the functionality required of the information systems but also the nature of the supporting services which will be required to effectively support professionals the delivery of the care process. Designing & Implementing Clinical Information Systems

49. What we want from an Integrated Care Records Service? Care Continuum! • A provision of all of the components of care that an individual patient or service user requires. These are not confined to a single care setting, or provided by an individual organisation or group of care professionals. • Patients have an increasingly sophisticated relationship with care services, and that their relationships. • Care Continuum extends over time and across care settings, care professionals and organisations. Designing & Implementing Clinical Information Systems

50. Generic Functions • Patient index and supporting reference files; • diagnosis, treatment and care management; • scheduling; • ordering, requesting and results reporting; • prescribing and drug administration; • access to knowledge; • clinical governance; • operational service management. Designing & Implementing Clinical Information Systems