Clinical Computing

In The UK

Clinical Computing proactively supporting an innovative research program


Clinical Computing has been invited by one of the UK's leading Renal Programmes to participate, with a number of leading universities, as a technology partner, in an innovative research program to evaluate the effective use of technology to support the multi-disciplinary care of patients with kidney disease.

Background

The Sussex Renal Innovation Programme (SRIP) has been set up to address the increasing complexity and cost involved in managing and treating patients with chronic kidney disease.

The team responsible for the evaluation of the SRIP program comprises the following organisations, each of which are leaders in their respective specialist fields. They are:

Project Sponsor
Dr Lawrence Goldberg
Consultant Nephrologist and Chief of Specialised Services
Sussex Kidney Unit, RSCH

Supporting Organisations

  • Dept of Economics, University of Surrey - Research Fellow
  • School of Applied Social Science, University of Brighton - Research Fellow
  • Clinical Computing - Technology Partner

The SRIP involves a re-design of renal services around a new clinical informatics system (Clinicalvision V) that is expected to support a number of improvements to the way renal services are delivered, including:

  1. The consolidation of patient data into a single, integrated electronic patient record (EPR) that can be accessed using new technologies by all those involved in a patient's care
  2. The ability for health care professionals to work remotely across the region to enable care to be provided closer to patients' homes, using telemedicine and virtual clinics.
  3. Increasing patient self-management and patient education opportunities, with patients having access to unique health information specific to their needs through an internet-based interface.

The Research Challenge

Research shows that IT innovation always involves organisational change and often demands that people work in different ways than they are used to.

If all stakeholders are not involved in the process of managing the change, then pockets of resistance can prevent any potential benefits from being realised. To facilitate complete user engagement and as a participatory approach to innovation, the SRIP set up an Action Learning Group (ALG), with representatives from different groups, to help manage the innovation and support changes to clinical practice. Stakeholders was defined broadly to include all those, including patients, who engage directly or indirectly with the information system in the process of delivering, supporting or accessing renal care services.

The SRIP therefore has two linked objectives. The first is to re-design renal services around the state-of-the-art clinical informatics system and other technologies; the second is to implement a user-engaged approach to this innovation which seeks to actively generate a participative, learning-based approach to the implementation of the new system that lays the foundation for its sustained and conscientious use.

The evaluation
In line with SRIP objectives, there are two overall aims to the proposed evaluation. They are to identify:

  1. The clinical and cost benefits that the SRIP delivers
  2. The opportunities and challenges posed by user participation and engagement for understanding, realising and measuring such benefits.

The clinical and cost benefit evaluation will aim to measure the anticipated improvements in the quality and safety of care, and changes in costs of delivering care using a before-and-after model.

To achieve this, a combination of qualitative and quantitative methods will be used. Examples of where users consider technology to have brought about a significant change in clinical decision-making or processes will be captured via qualitative description and, where appropriate, through measuring values, such as time to decision or patient throughput. These examples will be considered alongside costings produced by conventional cost analysis tools including Total Patient Costs and Payment by Results cost data. These two data sets will be compared with one another in order to discover if and how cost benefits can be realised.

Previous research suggests that it is often very difficult to attribute cost changes directly, especially in cases of complex innovations involving service re-design and new information systems. However, it is important to try to identify the economic opportunities from new service delivery models and communicate these more widely across the NHS. It is here that the socio-technical part of the evaluation controlled by the Research Fellows can contribute.

The socio-technical evaluation will focus on the process of change/innovation itself and its ambition to be participative, identifying the organisational, as well as technological, changes that are required to support the re-design of the renal services and make improved outcomes possible. This process-based evaluation will involve monitoring the implementation of the new health informatics system and its use in everyday clinical practices over the full project timeline. A key aspect of this part of the evaluation will be to identify where, when and how specific users or user groups are able to influence and help shape the innovation process and thereby contribute to the achievement of improved outcomes and benefits.

Benefits Of The Research Program

Together, the two parts of the evaluation will provide:

  1. Evidence to help NHS managers decide how best to approach complex IT-based innovations in health care to maximise the chances of realising significant clinical and cost benefits.
  2. Specific insights for clinical leads wishing to introduce new technology into services to support patients living with chronic disease
  3. Findings to support the management community understand the challenges of presenting the financial picture of costs and benefits for complicated, health-based technology projects.

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