Friday, May 25, 2007

Joined-Up Healthcare

25 May 2007
A report has just been published on the sad death of Penny Campbell, who died of blood poisoning two years ago, after calling the health service eight times in four days [BBC News, May 25th 2007].

Apparently each of the calls was treated as a separate event, with no linkage made between them.

Joined-up services doesn't just mean joining up disparate events and processes. Sometimes it's hard enough to join up multiple instances of the same event/process.

In an earlier post on Healthcare Reform, I referred to the possibility of triage. If we can separate simple cases from complex ones, then nurses and other professionals can take some responsibility for the simple cases, call in the doctors for medium cases, and send the most complex cases into hospital.

But it appears that Penny Campbell's fate was the exact reverse of this. The system (if you can call it a system) of out-of-hours healthcare seems to result in highly trained doctors perfoming at a level of capability barely any better than what could be achieved by nurses and other professionals.

A number of issues for event-driven SOA there.

10 March 2010
This case was mentioned on BBC radio this morning. Dr Simon Eccles of NHS Connecting for Health appeared to suggest that the NPfIT Summary Care Records might have saved Penny Campbell's life. As Tony Collins points out in his blog (BMA and CfH argue it out over NPfIT Summary Care Records), this claim assumes that the relevant doctors would be able and willing to add sufficiently detailed notes to the Summary Care Record in such a case. As it happens, the current scheme (which is something like ten years overdue already) doesn't allow for such notes to be added to the Summary Care Record. (Perhaps the word "summary" provides a little clue there.)

The key point here is that "joined-up" doesn't just mean putting all the data into some vast and horribly expensive data store, so that thousands and thousands of people around the country can look at your summary care record, it's about having a joined-up process that allows the doctors and other health professionals actually involved in your case to use their medical expertise and intelligence to produce the best possible outcomes. Lots of people remain sceptical that the current scheme would ever achieve this. See my post What's Wrong with the Single Version of Truth.

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