Clinical Care Computing 2006 on 4 July 2006 provided a most interesting review of current topics in clinical computing. Particular themes were the importance of IT in improving patient safety and providing clinical decision support.

The opening keynote was from Richard Smith [link] . His first point was that we are in the middle of the transition from industrial age medicine, which encourages high-tech care, to information-age medicine, which encourages low-cost individual self-care. IT and knowledge management will play a vital role in enabling this transition. His second point was that cost of care and outcome are not closely related; some specialised centres have relatively low costs and excellent outcomes. His third main point is that the central problem faced by clinicians is, to quote Muir Gray: “Doctors are overwhelmed with information, but cannot find the information they need when confronted with a question”. Finally, some of us behave like Sicilians; to quote from the Guiseppe di Lampedusa’s The Leopard – “The Sicilians never want to improve for the simple reason they think themselves perfect; their vanity is stronger than their misery”.

Niels Rossing [link] next described the Danish experience in implementing electronic messaging for primary care laboratory results, prescriptions, referrals, discharges and reimbursements, which are now close to 100%. This is now being extended to other Baltic countries. Key lessons include the need for long-term political support, consensus amongst all stakeholders, rigorous testable standards, keeping it simple and adequate budgets to include training costs.

Terry Young [link] then talked about value propositions for clinical computing. The value proposition indicates the maximum possible value of a project, so sets an upper boundary on the potential budget. Various approaches can be used, but it is not easy to develop value propositions for healthcare information systems and we need better research and evaluation data. If we had better value propositions we would make better investment decisions.

John Fox [link] from Cancer Research UK (CRUK) summarised evaluation studies of various clinical decision support systems. The evidence suggests that computerised decision support technologies can help prevent medical and organisational errors. Success factors include being integrated into the clinical workflow, providing support at the time of making the decision and providing actionable recommendations, not just assessments.

Paul Taylor [link] (CHIME) gave a fascinating case study about how clinical decision support tools in mammography screening tends to have high sensitivity but low specificity. Work is needed to tune any prompting system to reduce inappropriate false positives so that they are not routinely ignored.

Clive Flashman [link] described the role of the National Patient Safety Agency in making safety management a key issue in the NHS Connecting for Health NPfIT. Every product that connects to the spine must now have an end-to-end hazard assessment, a safety justification case and a safety closure report. Joint projects have been established for: right patient, right care; safer handovers and safer prescribing. The aim is to build systems that are inherently safe.

Charlie Martin [link] described and demonstrated Beating the Blues, the first computer-based therapy to be made available throughout the NHS, following endorsement by NICE earlier this year. Beating the Blues is computer provided cognitive behavioural therapy for depression and anxiety. He described the rigour of the 5-year period of evaluation process needed to obtain endorsement by NICE.

Pradeep Ramayya described AxSys Technology’s [link] approach to clinical computing and how they provide local flexibility on top of a common platform. The Excelicare product has been selected as the national generic clinical system for Scotland. It is integrated with the national Scottish Care Information (SCI) products to allow communications between primary and secondary care.

David Morgan from Safe Surgery Systems [link] returned to the theme of patient safety and the importance of reducing an possibility of wrong site or wrong-side errors during surgery. Safe Surgery uses RFID wrist-bands and wireless hand-helds to positively identify patients at each stage in the patient journey. These ideas may well have applications in blood transfusion, infection control and other areas.

Peter McNair [link] described an ambitious project to standardise clinical protocols across 14 hospitals in Copenhagen. 35 working groups have been established, each looking at about 10 clinical pathways. Each clinical pathway is entered into the InferMed Arezzo [link] guideline engine and evaluated in the clinic to ensure clinical usability. Arezzo is integrated with the patient’s EPR.

Andy Frangleton [link] from First DataBank Europe and Andrew Barker [link] from Doncaster Royal Infirmary described the application of prescribing decision support to help in hospital pharmacy.

Chris Jones [link] from EMIS Knowledge described the range and use of Mentor, which is one of the most widely used clinical knowledge systems in the UK, available to both primary care staff and patients, via PatientUK.

Finally Nat Billington from Medic to Medic described recent developments in enabling the localisation of the Map of Medicine [link] , which quick access to evidence-based best practice guidelines.