The Role of Information Technology in Clinical Governance. Fernando D. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. Information Technology in
Clinical Governance
Professor Devaka Fernando
Sheffield Hallam University
Associate Medical Director
Sherwood Forest Hospitals NHS Trust

2. • ‘A framework through which NHS organisations
are accountable for continuously improving the
quality of their services and safeguarding high
standards of care by creating an environment in
which excellence in clinical care will flourish’.

3. Building Block model for CG

4. • Patient safety
• Evidence Based Medicine
• Health Technology Assessment
• Reflections
• Summary

5. Patient safety
• As to disease, make a habit of two things – to
help, or at least do no harm- Hippocrates,
Epidemics (book I Chapter XI) c 400 BC
• Medicine used to be simple, ineffective and
relatively safe. It is now complex, effective and
potentially dangerous. Professor Cyril Chantler

6. Patient Safety
• Defined as freedom, as far as possible, from
harm or risk of harm, caused by medical
management (as opposed to harm caused by
the natural course of the patients original illness
or condition).

7. Harm to patients
• Mostly not deliberate
• Not through serious incompetence
• Mainly normally competent clinicians working in
inadequate systems.
• Most harm caused by medical practice is
avoidable.

8. Steps to Patient safety
• Build a safety culture (open and fair)
• Lead and support staff
• Integrate risk management
• Promote reporting
• Involve and communicate with patients
• Learn and share safety lessons
• Implement solutions to prevent harm

9. • Patient safety
• Evidence Based Medicine
• Health Technology Assessment
• Reflections
• Summary

10. On what evidence do we choose
technology?
• Personal experience
• Reasoning and intuition
• Colleagues
• Endorsement
• Published evidence (what type of publication ?)

11. Evidence based Medicine
• The process of systematically reviewing,
appraising and using research findings to aid
the delivery of optimum clinical care to patients.
• Based on strength and weight of scientific
evidence on clinical effectiveness when
allocating resources.

12. EBM a multifaceted process of
assuring clinical effectiveness.
• Production of evidence through research and
scientific review.
• Production and dissemination of evidence
based clinical guidelines.
• Implementation of evidence based, cost
effective practice through education and
management of change.
• Evaluation of compliance with agreed practice
guidance through clinical audit and outcomes
focussed incentives.

13. Grading evidence: Levels of
evidence.
High Quality Meta analyses, Systematic reviews or
Randomised clinical trials.
High quality systematic reviews of case control or cohort
studies or well conducted case control or cohort studies
Non analytic studies, case reports, case series.
Expert opinion.

14. Critical appraisal
• A method of assessing and interpreting the
evidence by systematically considering its
validity, results and relevance to the area of
work considered.

15. • Patient safety
• Evidence Based Medicine
• Health Technology Assessment
• Reflections
• Summary

16. HTA: The bridge between evidence
and policy making.
• Provides a range of stakeholders involved in
planning, purchasing and investing in
healthcare, with accessible, usable and
evidence based information that will guide
decisions about technology.

17. Health Technology Assessment :
systematically examines effects of
application of health technology
• Safety
• Clinical efficacy
• Clinical effectiveness
• Cost
• Cost effectiveness
• Organisational implications
• Social consequences
• Legal consequences
• Ethical considerations

18. Some HTA related definitions
• Clinical effectiveness: How do the health
outcomes of the technology compare with
available treatment alternatives.
• Cost Effectiveness: Are these improvements in
health outcomes commensurate with additional
costs of the technology?

19. Health Technology Assessments
• Helps policy makers decide which technologies
are effective and which are not.
• Defines most appropriate indications for their
use.
• Reduces or eliminates interventions that are
unsafe, ineffective or whose cost is too high
compared with benefits.

20. • Patient safety
• Evidence Based Medicine
• Health Technology Assessment
• Reflections
• Summary

21. How does your organisation
• Procure Health care technology in general?
• Medicines?
• Equipment ?
• Information technology?

22. What evidence base do you use to
assess IT systems in Health care?
What evidence base supports your
product?

23. • Patient safety
• Evidence Based Medicine
• Health Technology Assessment
• Reflections
• Summary

24. Summary
• ICT systems are a health care intervention.
• Systems for evaluating their efficacy and safety should
be as robust as those evaluating other health care
technologies.
• An integrated approach by consumers of health care
technology and providers of technology required.
• A corporate culture of evidence based critical appraisal
is required
• Consequent corporate buy in from developers,
providers and purchasers of IT solutions in health care
is required.