Clinical I nformation Access Clinical I nformation Access Program - PowerPoint PPT Presentation

Clinical I nformation Access Clinical I nformation Access Program Program A Clinical Decision Support System for NSW Clinicians A Clinical Decision Support System for NSW Clinicians www. .clininfo clininfo.health.nsw. .health.nsw.gov gov.au .au www

New South Wales New South Wales • Population of NSW Population of NSW 6,500M • 6,500M • Clinicians in Public Health Facilities Clinicians in Public Health Facilities 81,000 • 81,000 • Number of Public Hospitals Number of Public Hospitals 210 • 210 • Community Health Centres Community Health Centres 280 • 280 • Area Health Services Area Health Services 18 • 18

Goal Goal Provide the doctors, nurses and allied health Provide the doctors, nurses and allied health professionals (clinicians) of NSW Health with professionals (clinicians) of NSW Health with access to on-line information via the WWW access to on-line information via the WWW to support clinical practice, education and to support clinical practice, education and research at the point of care. research at the point of care. Community Health Community Health Centre Centre GPs Office GPs Office Hospital Hospital Clinic ED Clinic ED Ward ICU Ward ICU

Project Milestones Project Milestones • Endorsed by the Clinical Systems Steering Endorsed by the Clinical Systems Steering • Committee in December 1996 Committee in December 1996 • CIAP management committee established in CIAP management committee established in • January 1997 January 1997 • Project Officer commenced March 1997 Project Officer commenced March 1997 • • CIAP Area Representatives established in April CIAP Area Representatives established in April • 1999 1999 • Project Go-live July 4 1997 Project Go-live July 4 1997 •

Authorised Users Authorised Users Knowledge/ Reference Databases: Knowledge/ Reference Databases: • All doctors, nurses, allied health professionals (clinicians) • All doctors, nurses, allied health professionals (clinicians) and librarians who work in the public health system in NSW and librarians who work in the public health system in NSW • Includes hospitals, community health, public health, rural • Includes hospitals, community health, public health, rural GPs, Ambulance and Corrections Health GPs, Ambulance and Corrections Health All other information: All other information: • Any interested user in the world • Any interested user in the world

Project Resources Project Resources Manager Clinical Systems CI AP Clinical Systems Steering Committee Committee Project Officer Clerk (Web Editor) 100 CIAP Listservers Representatives Hospitals Hospitals CI AP - nurses Representatives - doctors Hospitals Hospitals All AHSs - AHPs - librarians

Project Team Responsibilities Project Team Responsibilities • Promote communications Promote communications • • Web enable local content from NSW hospitals Web enable local content from NSW hospitals • • Maintain the web site Maintain the web site • • Manage the vendor contract Manage the vendor contract • • Develop marketing and education materials Develop marketing and education materials • • Co-ordinate education statewide Co-ordinate education statewide •

CI AP Clinical Representatives CI AP Clinical Representatives • Established in 18 Area Health Services, Established in 18 Area Health Services, • Corrections Health and Ambulance Corrections Health and Ambulance – Liaise with management, clinicians and DoH Liaise with management, clinicians and DoH – – Organise training and education sessions Organise training and education sessions – – Allocate passwords and IDs to authorised users Allocate passwords and IDs to authorised users – – Distribute marketing materials e.g Distribute marketing materials e.g flyers , posters – flyers , posters – Establish local clinical committees to govern IT Establish local clinical committees to govern IT – – Provide feedback on local information needs Provide feedback on local information needs –

Key Drivers Key Drivers • Support Evidence Based Medicine Support Evidence Based Medicine • • Reduce Adverse Events Reduce Adverse Events • • Support Education and Research Support Education and Research • • Better Access to Decision Support Information Better Access to Decision Support Information •

Evidence Based Medicine(EBM) Evidence Based Medicine(EBM) EBM is the conscientious, explicit and judicious use of EBM is the conscientious, explicit and judicious use of current best evidence in making decisions about the current best evidence in making decisions about the care of individual patients. This practice means individual patients. This practice means care integrating individual clinical experience with the best integrating individual clinical experience with the best available external clinical evidence from systematic available external clinical evidence from systematic research". research". CIAP supports EBM via the Cochrane Library, Therapeutic Guidelines, EBM via the Cochrane Library, Therapeutic Guidelines, CIAP supports Professional Literature. Professional Literature. ( (Sackett Sackett et al., BMJ, 1996, 312, et al., BMJ, 1996, 312, pp pp.72-3) .72-3)

Adverse Event Adverse Event An AE is defined as an injury or complication An AE is defined as an injury or complication which resulted in disability or prolongation of which resulted in disability or prolongation of hospital stay and was caused by the health hospital stay and was caused by the health care received rather than by the disease care received rather than by the disease from which the patient suffered. from which the patient suffered. Wilson Wilson et al., An analysis of the causes of adverse events from the Quality in Australian Health et al., An analysis of the causes of adverse events from the Quality in Australian Health Care Study Care Study

Adverse Events Adverse Events • 50,000 Australians suffer permanent disability 50,000 Australians suffer permanent disability • • Australia loses over three million bed-days Australia loses over three million bed-days • per annum per annum • Potential savings from preventable AEs in Potential savings from preventable AEs in • 1995-96 would be $4.17 billion 1995-96 would be $4.17 billion • (47 billion in the US each year - 1998). (47 billion in the US each year - 1998). •

Adverse Events Adverse Events Adverse drug events are the fourth leading Adverse drug events are the fourth leading cause of death in the USA cause of death in the USA the equivalent of a commercial jet - the equivalent of a commercial jet - crash every single day crash every single day (Lazarou Lazarou et al 1998) et al 1998) (

More Food for Thought More Food for Thought 40,000 people are shot dead each year in 40,000 people are shot dead each year in the USA…….. the USA…….. ……..You are therefore more likely to be ……..You are therefore more likely to be killed by a doctor than a gun killed by a doctor than a gun

Supporting Education Supporting Education New Graduates, Post Graduates and Students New Graduates, Post Graduates and Students in the health professions have clinical in the health professions have clinical information needs beyond the University information needs beyond the University – Sydney University Graduate Medical Program is WWW Sydney University Graduate Medical Program is WWW – based learning based learning – Wollongong University has computer skills as a pre- Wollongong University has computer skills as a pre- – requisite to graduating with a nursing degree requisite to graduating with a nursing degree – The Post Graduate Medical Council has Web based The Post Graduate Medical Council has Web based – learning modules and also links to CIAP learning modules and also links to CIAP

Medico - Legal Considerations Medico - Legal Considerations “ WWW access now has Medico-legal “ WWW access now has Medico-legal ramifications. Hospitals are plausibly ramifications. Hospitals are plausibly liable if clinicians can’t access best- liable if clinicians can’t access best- evidence” evidence” Professor Enrico Coiera (Computer Science, UNSW) Professor Enrico Coiera (Computer Science, UNSW)

Medico-Legal I ssues Medico-Legal I ssues • An Israeli court recently issued a verdict that An Israeli court recently issued a verdict that • a doctor, who does not update his medical a doctor, who does not update his medical knowledge with professional literature is knowledge with professional literature is liable for malpractice. liable for malpractice. ……………if he just had access to the CIAP!!!! ……………if he just had access to the CIAP!!!!

Buzz Words!! Buzz Words!! • QUALITY Care QUALITY Care • • The Continuum of Care The Continuum of Care • • Evidence Based Medicine Evidence Based Medicine • • World’s Best Practice World’s Best Practice • • Information Culture Information Culture • None of these can be achieved without access to quality information. None of these can be achieved without access to quality information. This makes the CI AP a tool of modern medicine This makes the CI AP a tool of modern medicine

Pre-implementation Pre-implementation Survey Survey