Professor Michael Thick, the chief clinical officer for Connecting for Health, says that the Department of Health’s IT agency has transformed itself from being largely technical to one that places patient safety as its number one concern – safety trumping contract considerations or delivery timetables.
Speaking exclusively to E-Health Insider in Berlin last month Professor Thick, a transplant surgeon with a career-long interest in computers in medicine, said that there had been a sea change in clinicians’ involvement in the programme – partly due to concerns about clinician engagement – moving from “clinical advice” to “clinical authority.”
Professor Thick said this new authority was most clearly seen in the fact that any new IT system from the programme and its suppliers now required a Clinical Authority to Release (CATR). “Without that the system cannot be deployed at all. And that’s a very significant change, a milestone for safety.”
Asked whether there had been cases where the CATR had not been granted and systems delayed, Professor Thick said: “Yes, we have many examples of that. Often we will give a sort of limited CATR on the grounds that if an organisation can show firstly that they’ve got successful potential manual work-arounds then we can still allow the release to happen.
“Or it may be that it’s an actual defect in software in which case we’ve got a proper work plan for the supplier to do the repair. And also if we’re convinced if that’s going to happen we do the same.
“But certainly there are many instances where the authority has not been given”.
He said that the current focus on clinical safety dated back to a 2004 review by the chief medical officer of whether the NPfIT programme was taking patient safety seriously – placing it as its first priority. "This found that there was not a patient safety culture in what was largely a technical organisation that saw how you use information as someone else’s concern."
However, since the 2004 review far-reaching changes had been made said, Professor Thick. In addition to his appointment he said: "NPfIT has established a clinical safety programme, led by a secondee from the NPSA [National Patient Safety Agency] http://www.npsa.nhs.uk/, adopted the IEC 61508 patient safety standard and set up clinical training on safety for all clinicians within the programme." Professor Thick said that CfH and the NPSA were “two sides of the same coin”.
"The whole of the CfH programme is now organised around clinical safety," said CfH’s top doctor. He said that as an agency CfH was now focused on producing safer IT products, and making sure the implementation of those systems is safe.
A key part of his job, he said, was ensuring patient safety had the profile it deserved. Professor Thick joked that he was one of the first people into CfH’s Leeds offices “shortly after Richard Granger.”
He said the clinical safety team had very close ties with the NPfIT national integration centre (NIC), where the testing of new systems is done. “It’s very important we have doctors involved in the process to make sure they work as they should and conform with normal clinical practice and the way doctors normally work.”
He said that clinical risk management was now of paramount concern with detailed documentation developed for clinical risk assessment. "We’re working with suppliers to make sure that the products they provide are completely safe."
“We’re working to ensure that the systems delivered by CfH and its suppliers are both safe in the way they operate and also safe during the time they are implemented, and this is obviously going to be quite a considerable challenge.”
Professor Thick said this commitment to patient safety was best seen in the fact that every product delivered by NPfIT had to secure ‘Clinical Authority to Release’ before it could be deployed into the NHS. He said this over-rode all other concerns and delivery schedules.
“While there have always been clinicians involved in CfH this has principally been as an advisory role, and there’s been a rather difficult tension between the advice clinicians have given the programme and the other forces at work on the programme: like timelines we are invited to keep; like the financial constraints; like keeping up to contracts; the commercial issues.
“So, I think, probably as a result of the scrutiny we’ve had from the government about clinical engagement and the consequence of appointing a chief clinical officer we’ve been able to turn that round now to the notion of clinical authority rather than just clinical advice.”
"Within CfH we [clinicians] now have authority whatever the impact on contracts, timelines or roll-out plans. If we do not think a product is safe it will not be deployed… That’s a big shift."
He said this same approach was now being applied to the implementation of NPfIT systems before they went into the field. Citing recent press coverage he said there had been problems. “We have had problems, with people being unable to print lists of clinics or outpatients and it created a horrendous situation for patients. They should all have been picked up before systems were deployed."
Professor Thick told EHI: “Implementation, we are discovering, as if we didn’t know it already, is a very, very complex process. It’s about process redesign within organisations, it’s about the culture of using systems and wanting to use them. It’s about using systems and wanting to use them. It’s about an enormous amount of training. It costs about six times as much to train the users as it does to buy the system and put it in.
“And I’m not convinced yet the NHS has got the balance right in terms of preparation and training before putting a new system in.”
He stressed however that new systems themselves would not improve patient safety, this could only come from the clinicians themselves. “The tool itself will not support patient safety. The tool is there to remind clinicians there are patient safety aspects to everything that they do. So it’s an aide memoir and it makes them behave in a particular way to ensure safety is considered.”
Speaking earlier at an EU e-health conference held earlier this month in Berlin, Professor Thick said that ensuring patient safety was the basic tenet of being a doctors, reminding the audience that the Hippocratic oath every doctor used to take included the pledge to “do no harm”. “Somehow we seem to have forgotten that,” he said.
However, he added, the Hippocratic oath was difficult to square with the fact that 10% of all hospital admissions are due to medical errors, particularlymedication errors.
Despite this level of often avoidable errors and harm to patients, he said that only a minority of hospitals internationally had yet implemented medication management or electronic prescribing system.
"Why is patient safety a principle that so many are ignoring when it’s mentioned in the first line of any statement by the great and the good?" asked Professor Thick.
He said that thankfully the UK was making strides to address the issue, with a key milestone being the chief medical officer publication of ‘An Organisation with Memory’ and setting up the NPSA, together with establishing electronic reporting of adverse incidents and errors.
"The National Programme for IT has been charged to implement a scalable electronic patient record system throughout the UK," said Professor Thick. "It is fundamental that the safest way to audit and improve healthcare is by having all patient information."
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