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Medical Leadership, Complex Systems, Open Platforms
Dr Tony Shannon16th October 2015
Tony ShannonM.B. B.Ch. B.A.O. UCD, IrelandFellow of College of Emergency Medicine England
Fellowship in Informatics USAMSc in IT Management England
(Clinical Lead, NHS Connecting for Health – National Programme for IT)
(Chair, Clinical Review Board, openEHR Foundation)
Consultant in Emergency Medicine, Leeds Teaching HospitalsChief Clinical Information Officer, Leeds TH/Leeds NHS & Social Care
Director, Frectal Ltd
21st Century Healthcare
• Healthcare:
• Leadership: • Complexity: • Platforms:
• Change:
• Pics x 2
Medical Leadership
• Ts 3rd UCD grad
Complex Systems
1908
Languages- Tower of Babel
• Medical• Management• Technical
• Cartoon... Very been confused in meeting?• Or • Who?
Cynefin Framework
Snowden, D., Boone, M. (2007). "A Leader's Framework for Decision Making". Harvard Business Review: November 2007, pp 69–76.
Complex Probe
10000 1000
Inate 10
Complicated Analyze
Chaos Act Simple Categorize
Complex Adaptive Systems
• Many parts, Many interactions• Perpetual novelty
• Identify Patterns– e.g., Weather, Internet, Human Body, Healthcare– Self-organise
• Iterative, Evolutionary Change– Golden Spiral
Referral in
Assessment
Plan CareDeliver Care
Referral Out
Operational (1 patient)
Strategic (++ patients)
Tactical ( > 1 patient) Resource management
Performance management
Key Patterns in Health Care
NHS National Programme for IT
Thinking in silos Process versus IT Closed solutions
NHS EDs – after 4 hour std
Value = Quality ↑ Risk↓ Cost↓ Time↓
ATLS = People + Process + Tech
Nebraska, 1976
Open Platforms
1987
Chamerlan 17th-18th C
Leeds TH 200+
Enterprise Wide
System x
Common Web UI
Integration EngineESB
A B C
1
2
3
4
5
Core Process
Core Process
Core Process
Core Process
Core Process
Modular
SOA
Enterprise wide
System Y
Access/SQL
Current State of the HIT Market
Healthcare Change: State of the EcosystemStandards: Vendors: Innovators: Disconnect
International Standards
Local Innovators
eHealth Bodies
& Vendors
The Future
5 Key Features of The Platform
• Usability• Integration• Clinical Kernel• Code & Community• Governance & Leadership
#1 UI & Usability
Leeds TH 200+
Enterprise Wide
System x
Common Web UI
Integration EngineESB
A B C
1
2
3
4
5
Core Process
Core Process
Core Process
Core Process
Core Process
Modular
SOA
Enterprise wide
System Y
Access/SQL
# 2 Integration
#3 Clinical Kernel
• Clinically oriented• Reusable list of clinical
statements
• Maximal dataset• Can be coded with
terminologies
e.g. Pulse, BPLeeds Care Record datasetEnd of LifeKey contactsetc
• Computable
#4: Code & Community
# 5 Governance & Leadership
NHS England 2011
Leeds
Flickr.com/photos/62766743@n07
• 1 million population served• £800 million budget• 200,000 ED attendances• 14,000 staff• 600+ consultants• 300+ information siloes
DevelopmentClinically LedUser CentredAgile Development
The beginning...
3 Key Levels
Single Patient Multiple PatientsClinical Intelligence View
Single Patient View
Multi-Patient View
Aggregated Data View
Single Patient View
Single Patient View
Virtual Ward View
Collaborate : Innovate : Open Towards an open health & care platform
@RippleOSI www.RippleOSI.org
Six componentsFoundation layer
Open Requirements
Open GovernanceOpen Citizen
Technical Platform
Open ViewerOpen IntegrationOpen Architecture
# Clinical Kernel- Archetype
• Clinically oriented
• Maximal dataset– Can be coded with
terminologies
e.g. Pulse, BPKey contactsetc
• Computable
• Reusable
Story re VA
• Ken Kizer pic & Best case anywhere
21st Century Healthcare
International Standards
Local Frontline Innovators
National eHealth Bodies
& Vendors
Regional
21st Century Healthcare
• Healthcare: Leadership Required
• Leadership: Doctor: Nurse: Manager• Complexity: People: Process: Technology• Platform: Open: Source : Standards
• Change: Think Smarter
Thank you
tony.shannon@frectal.com
tony.shannon@frectal.comwww.frectal.com
@frectally
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