16th September 2015The third meeting of the CCIO took place in the Sláinte Healthcare Offices on the 16 th of September and was attended by over 60 members.

The day was broken into 3 sessions.

Session 1Session one set the scene with an ‘overview of National Standards for Better Safer Care’ by Ms Marie Kehoe O'Sullivan(Director of Safety and Quality Improvement, HIQA). This was followed by a practical tutorial by Ms Tracy O’Carroll, Health Information Programme Coordinator.

 Ms Kehoe O’ Sullivan set out the strategic importance of information in healthcare. She is confident that some of the care lapses that have occurred in some settings in the past would not have happened with a robust governance and information management framework. She explained how HIQA actively support and enable a culture of patient safety and quality improvement by ‘Standards development, Standards revision, Guidance development and Quality Improvement methodologies’. Standards were explained in terms of quality dimensions and capacity and capability factors (please see below). Standards relating to integrated care were highlighted and explained (Standard 2.3 in particular).

Theme 8 of the National Standards for Safer, Better Healthcare ‘the use of information’ lead to a very interesting explanation of Information Governance. IG was defined as providing a means of bringing together all the relevant legislation, guidance and evidence based practice that apply to the handling of information in order to facilitate;

collection of high quality data maintenance of privacy and confidentiality of service users information being held securely

appropriate safeguards for the secondary use of information.

 

The dimensions of data quality was further expanded upon using the graph below.

Privacy and confidentiality were discussed in the context of The Data Protection Act 1988 , The Data Protection (Amendment) Act 2003 and the Freedom of Information Acts 1997 and 2003.

The need for a Privacy Impact assessment (PIA) was highlighted and a PIA was explained as a process that facilitates the protection and enhancement of the privacy of individuals by:

 

o Considering the future privacy consequences of a proposed project or initiativeo Evaluating the broad privacy implications of projects and relevant legislative

complianceo Mitigating privacy risks where possible

 

Data security was then explained and the distinction between primary and secondary use of data was effectively made. HIQA’s fundamental information principles were graphically illustrated (please see below) and discussed.

The key points of the talk were summed up as:

Collect quality data Be clear to patients/service users how their information will be used and shared Ensure appropriate Consent for use There should be an underlying principle of “No surprises” Provide a publicly available statement of information practices Conduct a Privacy Impact Assessment Audit compliance regularly

 

 

Dr Ray Nethercott, Consultant Paediatrician of the Western Trust in Northern Ireland then gave a very engaging talk on the‘Opportunities and Challenges for Patient Safety’in an eHealth Mediated Health Service. 

Dr Nethercott began honestly and bravely by announcing that, in Northern Ireland, they don’t have this sorted, by acknowledging that very few do and that this is hard stuff to get right.

 The audience were brought through the development of the CCIO movement in Northern Ireland.

At the start of this journey, Dr Nethercott was asked 3 questions:

For eHealth what does NI need?

What does your organisation need?

What do we want to achieve?

By way of answer he gave ‘CCIO’s’, ‘CCIO’s’ and ‘world domination’ respectively!

 

The CCIO network in Northern Ireland comprises of Chief Clinical Information Officers that: are organisational appointments; remain clinically active; they possess clinical informatics skills and they have experience of eHealth technology deployments.

Dr Nethercott spoke of the opportunities, for clinicians, that have arisen from ehealth mediated solutions in Northern Ireland as being:

 

Smarter working Reducing variation Secure messaging More POC diagnostics Personalized medicine Vitrual clinics Patient portals Enterprise EHR’s

 

Patient care and safety were core to Dr Nethercott’s talk and the following areas which saw increases in patient safety were discussed: the clinical record; Medication (in terms of prescribing and administration); Test ordering and results verification; Care interfaces/handover and Observations.

Our attention was also brought to the service design opportunities e-health mediated solutions would allow for in terms of: Evidence based pathways; Multi-professional contribution; Model of care; Patient satisfaction and Appropriate and Dependable Technology. Other value-adding-items resulting from introducing this form of care such as Patient empowerment, Population health, Clinical Research, Better financial accountability, Positive learning and Better patient experience were developed upon by Dr Nethercott.

The many challenges that lie ahead of us on this clinical informatics journey were brought to our attention. The need to carefully manage the associated changes necessary to adapt to this way of delivering healthcare were outlined to us. Particular guidance was given in terms of trying to really understand the perspectives of people who will be involved in this change, selling the vision, ensuring adequate resources are provided, planning to succeed, taking win’s and using them and lastly evaluation your success.

It is fair to say that we share the vision of our Northern Ireland colleagues in the quest for better information, better decisions and better care.

 

As the senior management team of the Chief Information Officer moves from transition to transformation, adopting araison d’etre for transformation as changing from ‘Commoditiy providers to business change champions’ by 2020, the CCIOs hope to facilitate clinical transformation through:

Service re-design Smarter clinical workflow System design & agility Evidence Based Care Hard Measure-ables Improved Clinical Outcomes and Clinical Productivity

 

 

Session 2Session two focused on information governance with Ms Clare Sanderson of IG information Governance explaining‘Information and eHealth Governance’ to a very attentive crowd of CCIOs.

 

As well as this being a difficult subject matter upon which to engage people, a power outage  did not deter this speaker from getting her learned points across. Clare, thank you for bearing with us and completing your presentation, technologically unaided!

Clare began by framing IG as the thing that allegedly: no-one finds exciting; that is someone else’s responsibility; that IT are responsible for and the thing that always stops us using information!

IG was then explained as a framework of legal and ethical standards, principles and best practice that apply to the handling of information including when personal, sensitive or confidential data is collected processed or shared.

Clare emphasised the need to get the balance right between sharing information and protecting it.

The three components of IG were individually addresses and discussed at length: People and Policies; Physical security and technical security. To close, the contractual agreements for data sharing agreements and data sharing contracts were discussed

This was immediately followed by a breakout session where participants discussed the 4 following themes:       

Experience of risks introduced in eHealth mediated service delivery; Current supports for assuring quality and safety of eHealth enabled services; Responsibility and authority for operationalizing eHealth governance and Enhancing eHealth functionality in line with continuous service improvement.

The two breakout sessions were facilitated by experienced clinical members of the CCIO and feedback was captured and discussed at the end of each session. Themes emerging from this were recorded by our academic partners at ARCH, Dr Maria Quinlan and Dr Gemma Moore. A report of these sessions will be emailed to each member of the CCIO once completed.

 

Session 3After lunch Mr Thomas Handler MD of Gartner shared his experiences of improving outcomes and patient safety through the use of clinical IT’. He opened by sharing his, and Gartner’s, vision that in 2020, healthcare is characterized by ‘Enhanced diagnosis, Precision care delivery and Expanded patient self-service’. Dr Handler then reported the alarming statistics that in 1999 the IOM reported that as many as 98,000 people die in any given year from medical errors that occur in hospitals but did not even report on non-lethal adverse events and in a 2010 article, the BMJ reported that 1 in 10 patients admitted to a hospital had an experienced an adverse event. He explained that the primary reason to implement advanced clinical systems is to reduce unnecessary practice variations. He explained how the implementation of these systems this can lead to improved quality of care and reduced costs.

 Dr Handler graphically displayed how an ‘EHR Needs to Support Future Care Delivery Models’.

The audience were then walked through the 5 generation of EHR’s and the incremental benefits of each generation was espoused. The need for and benefits of a 3 rd generation EHR solution were

explained as giving clinicians the ability to influence the care process for every single patient in real time in order to:

Ensure safety/prevent errors Encourage consistency and standards of care Better document services for revenue enhancement/audit Help update evidence-based practices and Alert, remind, nudge, invoke, require, escalate proactively

 

The healthcare megasuite was explained (please see below) and the concept of a post modern EPR was built upon this with room left for innovation at the edges (where some members of the CCIO currently reside).

The Quest for Precision Medicine and the benefits of this in terms of rapid breakthroughs and rapid approvals was championed and the impact of genomics upon precision medicine was illustrated.

 

The greater need for a team-wide approach to robust Clinical Decision Support and Workflow Infrastructure across boundaries was highlighted. The need for more supports for patients specifically in terms of Personal Health Management Tools, Patient-Entered Data to allow them to make their own health choices was depicted by an interesting personal narrative.

Lastly, the need to build a Connected, Cooperative Coordinated Environment: Interoperability Is sees as vital. The need for measurement, analytics and reporting to deliver this form of healthcare was Dr Handler’s concluding point.

Following on from his very well received presentation, Dr Handler further assisted us by facilitating each group round table discussion. This action, kindly agreed to by Dr Handler, we felt, brought more depth to each table’s individual’s discussion.  

The four areas we focused on in the second breakout session were:  

Raising awareness and understanding of clinical safety in eHealth enabled services Re-skilling health service personnel in line with eHealth ambitions Achieving economies of scale in eHealth projects/programmes and Influencing the national agenda for eHealth governance  

After a quick coffee break feedback was given and discussed from the second breakout session. Richard Corbridge, CIO, HSE then gave his closing observations and discussed the next steps for eHealth Ireland and the CCIO.