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

许多国家的许多观察员已经认识到，用于卫生服务的资源不断增加并不能也不能保证统一的高标准护理。造成这种情况的原因包括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应对我们今天看到的信息洪流、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。临床决策支持是一项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。决策支持系统有很多种，从简单的提示和提醒医生和护士，到就患者的诊断或治疗方案提供建议的系统，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，它们有助于汇集所有相关信息和当前知识，这些信息和知识与患者的特殊情况有关，并有助于为患者做出正确的决定。英国一直处于研究的前沿，需要改善临床实践的质量和安全性，并开发用于临床决策支持和主动知识管理的先进技术。帝国理工学院和圣玛丽医院的查尔斯·文森特教授是研究医疗差错和其他不良事件原因的权威专家。牛津大学的John Fox教授和爱丁堡大学的David Glasspool博士是设计支持决策和治疗计划的先进技术方面的专家，他们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。同样来自爱丁堡的David Robertson博士是分布式开放系统知识共享领域的领军人物。该项目的主要目的是制定一个概念框架和技术战略，以解决确保在日常患者护理中及时和正确地使用当前最佳临床实践知识的关键挑战。该项目有若干具体目标，包括：(1)审查可通过使用先进信息技术缓解的医疗保健服务问题的主要原因，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。技术示范将侧重于一个特定的临床范例，如癌症的早期检测、诊断和管理。然而，尽管示范将有一个特定的临床重点，它将基于通用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些类型的信息通信技术系统的临床、技术和社会技术标准。最后，该项目将发表一份报告，内容包括：实现这一重大挑战项目目标的技术选择；必须支持这些技术发展的技术和社会技术原则；制定改善临床决策质量和安全的系统路线图；更有效地传播新的研究成果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.