Safe and Sound: ICT services to ensure quality and safety of patient care

许多国家的许多观察家都认识到，不断增加的保健服务资源并不能也不可能保证统一的高标准保健。其中的原因是个人的错误和组织层面的失败。这些问题极难根除。个人和组织根本没有能力科普我们今天所看到的大量信息、新的医学知识以及政策和程序的不断变化。随着研究和新的医学知识推动临床实践的变化，这个问题只会变得更糟，提供始终如一的高质量和安全的医疗保健服务只会变得更加困难。信息和通信技术可以在许多方面发挥重要作用。临床决策支持是一个特别有前途的技术选择，因为它可以帮助提高常规临床实践的一致性和质量，在需要的地方，在护理点。有许多种决策支持系统，从医生和护士的简单提示和提醒，到提供患者诊断或治疗方案建议的系统，再到可以帮助自动构建个性化护理计划的新兴技术。所有这些系统的共同之处在于，它们有助于汇集与患者特定情况相关的所有相关信息和当前知识，并有助于为患者做出正确的决定。英国一直是研究提高临床实践质量和安全性以及开发临床决策支持和主动知识管理先进技术的先锋。帝国理工学院和圣玛丽玛丽医院的查尔斯·文森特教授是医疗差错和其他不良事件原因方面的领先专家。牛津大学的John Fox教授和爱丁堡大学的大卫格拉斯普博士是设计先进技术以支持决策和治疗计划的专家，并发表了一系列独特的证据，证明这些技术可以为提高护理质量和安全性做出重大贡献。大卫罗伯逊博士，也在爱丁堡，是一个领先的研究人员在知识共享的分布式，开放式系统。该项目的主要目的是制定一个概念框架和技术战略，以解决关键的挑战，确保目前的知识，最佳临床实践是用在一个及时和正确的方式在日常病人护理。该项目有一些具体目标，包括（1）对医疗保健服务中可以通过使用先进信息技术来缓解的问题的主要原因进行审查，以及（2）展示集成决策支持，通信协调服务以及知识共享和传播等关键功能的技术的技术可行性。技术演示将集中在一个特定的临床范例，如早期发现，诊断和癌症的管理。然而，尽管演示者将有一个特定的临床重点，它将基于通用的原则和可重复使用的方法。该项目的一个重要成果将是了解评估这类信息和通信技术系统的临床、技术和社会技术标准。最后，该项目将发布一份报告，内容包括：实现这一重大挑战项目目标的技术选择;必须支持此类技术开发的技术和社会技术原则;开发提高临床决策质量和安全性的系统的路线图;更有效地传播新研究和最佳临床实践知识。

Many observers in many countries have recognised that ever increasing resources for health services do not and cannot guarantee uniformly high standards of care. Among the reasons for this are errors by individuals and failures at organisational level. These problems are extremely difficult to eradicate. Individuals and organisations simply do not have the capacity to cope with the flood of information, new medical knowledge and constant changes in policies and procedures that we see today. This problem can only get worse as research and new medical knowledge drive changes in clinical practice, and the provision of consistently high quality and safe healthcare services can only become even more difficult. ICT has an important role to play in many ways. Clinical decision support is a particularly promising technological option as it can help to improve consistency and quality of routine clinical practice where it is needed, at the point of care. There are many kinds of decision support systems ranging from simple prompts and reminders for doctors and nurses, to systems that give advice on a patient's diagnosis or treatment options, to emerging technologies that can help in the automated construction of personalised care plans. What all these systems have in common is that they help to bring together all the relevant information and current knowledge that is relevant to a patient's particular circumstances and help to make the right decision for that individual. The UK has been in the vanguard of research into the need for improvements in the quality and safety of clinical practice and the development of advanced technologies for clinical decision support and active knowledge management. Prof. Charles Vincent of Imperial College and St. Mary's Hospital is a leading expert in the reasons for medical error and other causes of adverse events . Prof. John Fox of Oxford University and Dr. David Glasspool of Edinburgh University are specialists in the design of advanced technologies for supporting decision-making and treatment planning, and have published a unique body of evidence that these technologies can make a significant contribution to improving quality and safety of care. Dr. David Robertson, also in Edinburgh, is a leading researcher in knowledge sharing in distributed, open systems.The main aims of the project are to develop a conceptual framework and technical strategy to address the key challenge of ensuring that current knowledge of best clinical practice is used in a timely and correct way in routine patient care. The project has a number of specific goals including (1) carrying out a review of the leading causes of problems in healthcare delivery that can be mitigated by using advanced information technology, and (2) demonstrating the technical feasibility of a technology which integrates the key functions of decision support, communication coordination services, and knowledge sharing and dissemination. The technical demonstrator will focus on a particular clinical exemplar, such as early detection, diagnosis and management of cancer. However, although the demonstrator will have a specific clinical focus it will be based on generic principles and reusable methods. An important outcome of the project will be an understanding of clinical, technical and socio-technical criteria by which ICT systems of these kinds may be assessed. Finally the project will publish a report that covers: the technological options for achieving the objectives of this grand challenge project; technical and socio-technical principles that must underpin development of such technologies; a road map for developing systems for improving quality and safety of clinical decision-making; more effective dissemination of new research and knowledge of best clinical practice.