The clinical challenge we focus on in the project is the delivery of high quality, safe patient care throughout complex multidisciplinary care pathways. This challenge is not to be underestimated: a comprehensive breast cancer service, for example, directly involves many individual professionals from half a dozen clinical disciplines, covers a couple of hundred specific workflows, and around 65 clinically significant decision points, over a period of months, or years. We are addressing this by building a platform for deploying advanced decision-support, flexible workflow management and knowledge sharing services at the point of care. A major technical challenge is how to integrate and deliver support for such tasks in the complex, unpredictable and ever-changing context of healthcare delivery, and how to do this in a flexible yet scalable and safe way.
The problem
Many observers in many countries have recognised that ever increasing resources for health services do not and cannot guarantee uniformly high standards of care. Among the reasons for this are errors by individuals and failures at organisational level. These problems are extremely difficult to eradicate. Individuals and organisations simply do not have the capacity to cope with the flood of information, new medical knowledge and constant changes in policies and procedures that we see today. This problem can only get worse as research and new medical knowledge constantly drive changes in "best" clinical practice, and the provision of consistently high quality and safe healthcare services can only become even more difficult.
How can ICT help?
In 2001 the Institute of Medicine report Crossing the quality chasm identified six performance characteristics that, if improved, would significantly enhance the quality of healthcare given the current state of medical knowledge:
Safety — avoiding injuries to patients from the care that is intended to help them.
Effectiveness — providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding under use and overuse).
Patient-centred - providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
Timeliness — reducing waits and harmful delays for those who receive and those who give care.
Efficiency — avoiding waste, in particular waste of equipment, supplies, ideas, and energy.
Equitability —providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socio-economic status."
Decision support, knowledge sharing and workflow management can all have a major impact on the safety, effectiveness, efficiency and timeliness of care: clinical decision-support systems are known to have benefits in all the above areas; formalising and sharing medical knowledge and up to date research can benefit efficacy and safety, and assisting care planning and workflow management also have great potential to benefit efficiency and equitability.
However, people care for people, not computer systems. Information technology can help to improve the chances of doing that better and the right technology, implemented judiciously, can dramatically improve those chances. CDS systems are a natural response to an urgent, clinical need with significant, economic significance; done right, the introduction of this technology can herald a revolution in the quality of care that patients receive.
More details about the contribution of the Safe and Sound approach to quality and safety are here.
Project goals
The main aims of the project are to develop a conceptual framework and technical strategy to address the key challenge of ensuring that current knowledge of "best clinical practice" is used in a timely and correct way in routine patient care. The project has a number of specific goals including
- carrying out a review of the leading causes of problems in healthcare delivery that can be mitigated by using advanced information technology
- demonstrating the technical feasibility of a technology which integrates the key functions of decision support, workflow, communication and coordination services, and knowledge sharing
- proposing a road map for taking these capabilities from the research lab into clinical use
The technical demonstrators will focus on a particular clinical exemplar, the early detection, diagnosis and management of breast cancer. However, although the demonstrator will have a specific clinical focus it will be based on generic principles and reusable methods.
