A perspective of Knowledge Management in the NHS Dr Jim Hughes Head of Knowledge Management Cheshire...
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Transcript of A perspective of Knowledge Management in the NHS Dr Jim Hughes Head of Knowledge Management Cheshire...
A perspective of Knowledge Management in the NHS
Dr Jim Hughes
Head of Knowledge Management
Cheshire and Merseyside SHA
Broad questions
What does the Head of KM in Cheshire and Merseyside SHA do?
A(nother) definition of KM!NHS KM and Connecting for HealthNew role for librarians? 18 week target – using data effectively
What does Head of KM do?
Internal role IT services and Informatics Library service Freedom of Information Knowledge Management – e-filing, effective use
of tools, technology and people to work smarter
Job description – cut down this tree
Tools available
Tools / people required
What does Head of KM do?
External Line manage Health Care Libraries Unit (HCLU) CfH - knowledge management North West VLE (e-learning) Data warehouse PCT Shared services – Information knowledge
management / contract management Public Health ; Dr Foster; TIS
KM in – Practice based Commissioning; Management of Long term Conditions
‘SOFT’ KM
‘HARD’ KM
So much to know, so little time!
A(nother) definition of knowledge management
A healthy mix of:-
Tools Technology Processes People
Organisations Behaviours Culture
A(nother) definition of knowledge management
What do we do with it?
Capture Code Store (organise) Access Disseminate – MOBILISE – collaborate - share
Put it back in!
A(nother) definition of knowledge management
And of course - the management bit
Strategy Implement Monitor Evaluate
Connecting for Health - KM
Directorate of clinical knowledge process and safety led by Sir Muir Gray
http://www.connectingforhealth.nhs.uk/delivery/serviceimplementation/kps/
The following eleven slides are taken from Muir Gray’s presentation on the National Knowledge Service taken from the above public web site.
The application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade
Muir Gray (January 2005)
The application of what we know can prevent and minimise the 7 ubiquitous healthcare problems
Errors and mistakes Poor quality healthcare Waste Unknowing variations in policy and practice Poor patient experience Overenthusiastic adoption of interventions of low value Failure to get new evidence into practice
Muir Gray (January 2005)
3 types of generalisable knowledge
Knowledge from research - Evidence
Knowledge from measurement of healthcare performance - Statistics
Knowledge from experience - Of patients and clinicians
2 types of particular knowledgeKnowledge about this patient
Knowledge about this serviceMuir Gray (January 2005)
For good health people need pure clear knowledge, just as they need pure clear water
Muir Gray (January 2005)
The knowledge spectrum before the internet
Knows KnowsA little A lot
Patient PrimaryCare
Secondary(hospital)Care
Professor
Muir Gray (January 2005)
The knowledge spectrum after the internet -1
Knows KnowsA little A lot
PatientPrimaryCare
Secondary(hospital)Care
Professor
Muir Gray (January 2005)
The knowledge spectrum after the internet - 2
Knows KnowsA little A lot
PatientPrimaryCare
Secondary(hospital)Care
Professor
Muir Gray (January 2005)
The knowledge spectrum after the internet - 3
Knows KnowsA little A lot
PatientPrimaryCare
Secondary(hospital)Care
Professor
Muir Gray (January 2005)
The mission of the National Knowledge Service is to ensure that all decisions can be based not only on best current knowledge but also on the needs and preferences of the individual patient
Contact Muir Gray- [email protected]/1/2005
Better Consultations, Better Decisions, Better Communication
Generation
Organisation
Localisation
Mobilisation
Utilisation
National Knowledge Service
Co-ordinated procurement &Production (£100M) National Library for Health (£50M)NHS Direct Online
Map of Medicine
NHS Care Records ServiceN3National decision support service
Patient & professional Education & services
QuestionAnsweringService
Muir Gray (January 2005)
Ignorance is like cholera; it cannot be controlled by
the individual alone it requires the organised
efforts of society
Muir Gray (January 2005)
Delivering the benefits from CfH
Key knowledge management principles Making knowledge the enemy of disease Supporting decisions that patients make Supporting decisions in clinical practice Creating and mobilising the knowledge base Using knowledge in the consultation process Integrating knowledge into learning and
decision making
Assessment
Tests
Intervention Diagnosis and Decision
Results
Picture Archiving and Communication
System
Order Communications
1. Existing knowledge
sources
2. New sources
3. Present Knowledge ‘in patient’ context
4. Suggest appropriate decision –
patient specific
Choose and Book
Electronic Transmission of Prescriptions
Care Records Service
A vision of using knowledge in the consultation process
Warranted codified knowledge
KnowledgeDelivery
Disseminate knowledge
through existing local professional
activity
Capture local experience
Capture knowledge from
growing information base
– eg care pathways
Local healthcare professional communities of practice
Knowledge from local innovations
Local learning and dissemination
Knowledge used in the consultation
National learning and dissemination
Disseminate knowledge e.g.
Map of Medicine
KnowledgeAcquisition
National Specialist Groups
A vision of integrating knowledge into learning and decision making
Clinical Knowledge Management
Do Once and Share – developing clinical pathways (Sharing)
Map of Medicine and national clinical guidelines (Evidence)
Communities of clinical practice (People / Experts)
National Library for Health (Resources)Single Search
Environment (Search and Retrieval)
Virtual Learning Environment (Learning)
National care record / Data spine / common IT / common coding (Technology)
And finally from Muir Gray….
“Love your librarian and free her from the library”
Muir Gray (January 2005)
A new role for librarians?
HCLU review outcomes Focus on core business Professional development New roles for new times Improved communication
A new role for librarians?
Do Once and Share50 clinical areas
Developing common care pathways Communities of interest Giving context to the technology
Librarian role active clinical engagement Access to clinical knowledge resources Works alongside clinical team
18 week target – using data effectively
Background NATCANSAT commissioned to develop data
warehouse for SHA HES Clearnet data (CDS) Ambulance A+E Diagnostics
Outputs to assist in development of strategic configuration of services and Monitor diagnostic
18 week target – using data effectively
Most recently to develop models to understand pinch points in the 18-week referral to treatment pathway
NATCANSAT working with DH and pioneer Trusts.
Following slides courtesy of Dr Brian Cottier – Head of National Cancer Services Analysis Team (NATCANSAT) – March 2006
Hospital “X” PAS Data
IP Episodes 331,207OP Episodes 1,010,713AED Episodes 217,756Imaging Procedures 1,172,398Endoscopy Procedures 79,048
ReferralReceived
DateElective Date
Imaging
Endoscopy
Pathology
BookAnotherOP Visit
Admission ProcedureOP Visit(1 to n)
GP Referral
InterConsultant
Referral
AED Referral
Discharge
Discharge
Elective Surgery
Frequency of Procedures
Count Of EPIKEY Trust
Procedure Level 2Aintree Hospitals
NHS TrustDiag.Endo.Exam/Lower Bowel Using Fibreoptic Sigmoidosco 7,086Other Excision of Lesion of Skin 5,876Destruction of Haemorrhoid 3,456Diagnostic Fibreoptic Endoscopic Exam/Upper Gastrointe 3,372Other Operations On Varicose Vein of Leg 3,092Primary Repair of Inguinal Hernia 2,781Excision of Gall Bladder 2,059Diagnostic Endoscopic Examination of Colon 1,468Ligation of Varicose Vein of Leg 1,445Transluminal Operations On Femoral Artery 1,242Injection Into Varicose Vein of Leg 1,037Other Excision of Breast 868Diag.Endo.Exam/Sigmoid Colon Using Rigid Sigmoidoscope 851Block Dissection of Lymph Nodes 619Excision of Haemorrhoid 566Excision of Nail 513Excision of Rectum 491Total Excision of Breast 490
Breast SurgeryElective
Joint ReplacementsHips & Knees
PAS#
RAD Proc Code
RAD Proc Description
RAD Consultant
RAD Cons Spec
RAD Cons Spec Code
RAD Procedure
DateXYZ2134 HIPB Plain TM (ORTHOPAE) 110 11-Jun-03XYZ2134 KNEB Plain TM (ORTHOPAE) 110 18-Sep-03XYZ2134 HIPB Plain TM (ORTHOPAE) 110 18-Sep-03XYZ2134 SCRT NC TM (ORTHOPAE) 110 13-Nov-03
XYZ2134 HIPR Plain TM (ORTHOPAE) 110 13-Nov-03XYZ2134 PEL Plain TM (ORTHOPAE) 110 28-Apr-04XYZ2134 HIPR Plain TM (ORTHOPAE) 110 6-May-04
PAS# Op Date Operation Description (IP)XYZ2134 4-May-04 Total Prosthetic Replacement of Hip Joint Using CementXYZ2134 14-Dec-04 Other Total Prosthetic Replacement of Knee Joint
SHA Analysis
Joint Replacements
Imaging Data
RIS Systems
Mod_Name CT
Count Of uniqueid year_procprocedure 1998 1999 2000 2001 2002 2003 Grand TotalCT BRAIN 2,453 2,528 2,917 2,942 2,873 3,019 16,732CT ABDOMEN GENERAL ENHANCED 717 975 1,343 1,397 1,501 1,548 7,481CT LUNGS ENHANCED 500 750 816 796 915 810 4,587CT LIVER ENHANCED 524 647 744 789 736 691 4,131CT LUNGS 800 725 740 501 489 380 3,635CT AORTA (ABDOMINAL) ENHANCED 235 281 361 307 378 512 2,074CT ABDOMEN GENERAL 462 281 312 277 270 301 1,903CT BRAIN ENHANCED 253 254 323 334 293 392 1,849CT SINUSES 290 211 192 294 284 438 1,709CT PANCREAS ENHANCED 209 328 360 211 219 133 1,460CT KIDNEYS ENHANCED 96 109 148 180 146 149 828CT PELVIS ENHANCED 114 148 152 155 89 61 719CT PELVIS 158 157 103 91 96 112 717CT LIVER 176 122 104 123 69 56 650CT BIOPSY 101 89 115 96 57 54 512CT ABDOMEN COLON ENHANCED 64 166 235 465CT CERVICAL SPINE 49 40 66 58 82 111 406CT KIDNEYS 53 61 62 68 56 61 361
Modality = CTRoyal Liverpool HospitalRadiology Information System Data Extract
Mod_Name CT
Count Of uniqueid year_procSpec_Name 1998 1999 2000 2001 2002 2003 Grand TotalGeneral medicine 2,087 2,096 2,315 1,999 1,749 2,063 12,309General surgery 1,507 1,722 2,145 2,005 2,140 2,557 12,076Accident and emergency (A&E) 415 469 618 879 1,040 1,121 4,542Geriatric medicine 617 718 752 797 757 755 4,396Gastroenterology 327 525 740 703 642 633 3,570Ear, nose and throat (ENT) 535 443 469 501 544 810 3,302clinical Haemotology 345 341 309 492 709 620 2,816Trauma and orthopaedics 288 315 415 368 391 497 2,274
389 416 356 199 180 236 1,776Urology 234 169 220 262 225 352 1,462Anaesthetics 209 176 269 252 237 308 1,451Nephrology 184 196 241 315 253 258 1,447Cardiology 66 107 135 142 115 228 793Cardiothoracic surgery 191 279 137 2 1 3 613Rheumatology 75 62 113 100 90 87 527Ophthalmology 53 72 63 110 113 107 518General Practice 64 64 89 78 70 104 469Clinical pharmacology 32 44 60 67 31 234
Modality = CTRoyal Liverpool HospitalRadiology Information System Data Extract
Lessons from the 18 week exercise
To develop analysis methodologiesInform PAS system developmentEstablish a baseline position
National SHA Trust Specialty
To identify “Pinch Points”
Summary and conclusions
You may now open the Knowledge Management question paper
You have until 2010 to complete all questions
You may begin
Did it all sink in? Any questions?