DR IAN RECHNERCONSULTANT INTENSIVIST

ROYAL BERKSHIRE NHS FOUNDATION HOSPITAL

Paperless ICU-our experience

Contents

Conflicts of interest

What is needed

Our situation What we had What we have now Barriers to change

What we would like to do

Conflicts of interest

My personality is “process”

Hate stupid time

Have no computer degrees/qualifications

Been using ICU electronic record since 2003 (2000)

Hamilton Medical & Phillips

Hind sight

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don't know. But there are also unknown unknowns. There are things we don't know we don't

know.

Why do we need this?

Computers everywhere

Data management & analysis

Able to view in more than one place

Archive

Closed loop systems

And many, many more

Problems of healthcare and computerisation

Different teams work in silos

Not patient focused – in general

Write the same thing down several times

Lack of joined up thinking

No real time information

When I

grow up I want

to be..

How we join the two

Difficult to explain benefits

iPhone 3 vs iPhone 5 Windows 95 vs Windows 8 Map vs satnav Colour vs black and white TV Horse vs motor car

IT worker and healthcare worker in one

Ways of doing things

My situation

Intensivist since 2005

1997 RBH - Eclipses

Feb 2010 – went live with Philips Oversaw this project Introduced prescribing Interfaced

Blood results Infusion pumps

Reporting

Royal Berkshire NHS FT

http://www.healthcare.philips.com/main/products/patient_monitoring/products/intellispace_cca/

How we used to do it

What you need

IT support within the hospital

Hardware – interfaces & backup

Work stream processes

Healthcare workers who work together

ICU IT support team to keep it maintained

Support contracts

In reality

Dedicated individual – 10 hours per week – 1 year

Supportive management group

ICU and IT workers to configure

Wheeling and dealing

You help me, I help you

Demonstrate adverse events

What you need

“3 o’clock in the morning test”

2013

Flow sheet of system

What you need

Configuration

User friendly

Bound data – stops silly results

Identification tags – right results – right patient

Overview of patients – dash board

USER BENEFIT

Barriers to success

Staff poor with computers

Can’t touch type/navigate

“have to write down to force them to check”

People not acknowledging they can’t do something

Budgetary – mainly adverse events overcame this

What we have now

Access anywhereInterfaced

Blood results – microbiology, histology, ABG, etc ECG Infusion pumps Ventilator observations

Notes – typed and scannedPrescriptionsLinesICNARC

Overview

Monitoring interface

Observations & comments

Observations & comments

Interface observations - ventilators

Line & tubes

Laboratory results

Microbiology

Notes – multi disciplinary notes

Prescriptions

Money, money, money - CCMDS

The future

Building the smart ICU

Medical devices

Informatics to address care gaps

Information to reduce adverse events

Information to demonstrate affects of care

ICU Care gaps

Can't find something - nurse, defib, drug, etc - can use RTLS - real time locating system. Bar code/chip which can then use to locate via wireless

Data overload, background noise, alarms - how can we reduce the number of alarms? Switch to delivery & filter alarms - only select a-systole and VF, rest of ECG alarms ignore? Fused alarms - low BP and high HR for e.g. 

The electronic record has holes in it - devices and data not associated with patient, time delay. Link device to a patient or link device to a room.

The future

Future proof - build so it lasts and built to grow

Mainly used to store and keep a record of what care is given - we don't look at pattern recognition, disease process, data mining to improve global care

Mining is expensive and the medical world do not have the knowledge of patient care.

Thanks and questions