Health informatics has a key role to play in paramedic practice, and indeed all clinical practice. There is considerable momentum being gained in this area following the publication of the information strategy The power of information: Putting all of us in control of the health and care information we need (Department of Health, 2012).
Paramedics cannot ignore informatics, and instead have to embrace it and recognise with confidence that the use of information and technology to support clinical practice is not only something paramedics are already highly accomplished at in many areas, but which can also lead the agenda on.
The following sections are adapted from a series of articles written the Department of Health's Chief Health Professions Officer AHP Bulletin by members of the National AHP informatics strategic taskforce.
Patient safety and understanding informatics
So, what has informatics got to do with patient safety? The Department of Health says that:
‘Improving patient safety involves assessing how patients could be harmed, preventing or managing risks, reporting and analysing incidents, learning from such incidents and implementing solutions to minimise the likelihood of them reoccurring.’
This is something that is arguably all the more important in the shadow of the recent Francis report.
Patient safety is all about the systematic gathering and intelligent use of information, and implementing systems and technologies to support those activities.
Three important developments in health informatics are: implementing electronic patients records (EPRs), providing real-time access to evidence of effectiveness, and increasing the use of information and communication technologies (ICT) in the community.
EPRs enables routine recording of patient information that can be automatically coded for secondary uses and facilitate feedback for clinicians. There are two essential pre-requisites: standardised record headings and nationally agreed clinical language.
The implementation of EPRs will provide the technology to support patient information being recorded once and used many times for a multitude of purposes.
The routine recording of coded patient information under standardised record headings, by all care providers, will greatly reduce the burden associated with recording high-quality data when carrying out service evaluations, and local or national clinical audit and research, which in turn will lead to improved patient safety.
A second informatics component concerns providing access to evidence of effectiveness to support care planning and interventions in real time. Several organisations provide information online to help patients and carers to be better informed, or to support clinical decision making by health professionals.
A third informatics component is the use of ICT to enable patients to live in their own homes safely and for longer. Telecare provides monitoring of vital signs and alerts staff when problems arise. Telehealth provides better communication to enable remote consultations and professional support to complement home visits. Both of these components are likely to be significant in the future practice of paramedics and ambulance services with remote access to patient information, to telemedicine support from colleagues at a different location, or to online information to support clinical decision making. Summary Care Record and its future iterations will play a key role in the future.
The commissioning environment and making the most of informatics
Health informatics provides the tools to understand your service, and the power to demonstrate the impact of what you do, inspire effective service redesign and allow clinicians to effectively communicate with decision makers.
For most paramedics operating in day-to-day clinical practice, the relevance of the commissioning environment may be seen to be something that happens somewhere else, but it is a significant and important professional issues for paramedics.
Paramedics, perhaps unwittingly, are already informing commissioning decisions, but many of us will relate to the experience of collecting data and sending it off into the ‘ether’ for others to use—after all, what happens to your patient record and all the audit data you collect?!
The challenge for all AHPs is to move away from just being passive providers of services and patient information, to becoming engaged consumers and providers. This will allow you to understand the ‘commissioners-eye-view’ by contextualising your service from a population perspective and allow you to identify opportunities for innovative practice, focused around the service users. The government is committed to making £20 billion savings across the NHS and this ambition obviously filters down to those making commissioning decisions. Health informatics has a significant role in allowing us to quantify quality, support innovation, improve productivity and inform the prevention agenda, as well as accounting for the experiences and social context, something AHPs are expert in.
The Department of Health is committed to improving 3 million lives over the next 5 years using telehealth and telecare. This 3millionlives programme is an opportunity for AHPs to bring new technologies into their services to enhance care and patient experience.
So in the commissioning environment, looking to the future, paramedics need to use health informatics to identify new opportunities and provide innovative solutions. Through understanding the power of information you can better know your service and better describe the impact of what you provide for patients, whilst engaging with commissioning more effectively.
Proving my effectiveness supported by informatics
For a number of years, it has been the frustration of a majority of paramedics that the only feedback generated is that of a negative nature; much of which is due to failing to achieve an 8-minute response to a potentially life-threatening condition. The upsetting truth is that, irrespective of the clinical treatment received by the patient, for many years it has largely been the response time that has been the ‘be all and end all of measuring the performance of ambulance services’ (as has recently been reported by the National Audit Office). Indeed, ambulance trusts across the country may still face fines for failing to meet the time target.
The issue can be epitomised by many a paramedic who could be quoted as saying:
‘I got a phone call from the manager because apparently we failed to meet the ORCON target and get there within 8 minutes; we spent 2 hours on a successful resuscitation and the patient is now up and talking with his family— but we still failed, because we didn’t get there 20 seconds sooner!’
Of course the Francis report and indeed the Prime Minister's statement reflect on the negative consequences of top-down operational performance and financial targets, but what does it mean to all AHPs including paramedics, indeed all health and social care workers who work in such an environment?
The enlightened already acknowledge that such targets have some importance and relevance to clinical care. But, as some would argue more importantly, do these targets actually identify the quality of care and clinical interventions provided? The difficulty is how does a practitioner really assess their performance and effectiveness? How do paramedics identify errors, learn from their practice and how do ambulance services and commissioners really know that the quality of care and patient experience meets their plans and the public's expectations? These problems are easily transferrable to AHP clinical practice and indeed all clinicians and professionals working across health and social care.
It is in the wake of the Francis report that such issues can be highlighted so frankly and in such a forum; not only must paramedics be able to respond to patients with life-threatening emergencies quickly, but they must also deliver high-quality, patient-centred care. The time is right to make sure that as professionals, providers and commissioners, we can understand and measure this.
The ability to assess clinical performance, effectiveness, patient experience and quality of care is almost certain to find its champion in informatics. Likewise, as is the ability to collect data, at the point of care, which when collated together, can give clinicians a true understanding of the consequences of their actions. As paramedics, we know we have followed the guidelines when we resuscitate a patient, but if we could get feedback to learn how the patient is managing at home and accessing an independent life, this could transform practise.
With the Secretary of State's commitment to electronic patient records and the newly legislated powers of the Health and Social Care Information Centre, things will change. Data collected about a patient, for a patient, will be able to follow the patient through the care system, populating key summary information, which in turn will provide clinicians with a more complete picture of a patient's care, gradually building a comprehensive health history as each care episode is recorded electronically.
Conclusions
Informatics is a wide agenda, but critically important to the future development of the paramedic profession, both from a clinical practice perspective, but also academically, in relation to commissioning of services and much, much more.