Wednesday, January 13, 2010

Clinical Education and Development Lead to develop and lead the ‘Embedding Informatics Clinical Education’ (eICE) programme

Clinical Education and Development Lead to develop and lead the ‘Embedding Informatics Clinical Education’ (eICE) programme

NHS Connecting for Health (or whatever their acronym is this week) are re-advertising the vacancy for a one year secondment to the post of Clinical Education and Development Lead to develop and lead the ‘Embedding Informatics Clinical Education’ (eICE) programme of work. The post will now be a secondment and they are happy to consider applicants who want to apply on a part time basis whilst maintaining other commitments.

The full advertisement and application form is available on NHS Jobs (job reference 930-CR5081) at

The job description says "The successful post holder will design and implement a health informatics clinical education strategy for the NHS and will therefore probably come from either a strategic workforce development or a clinical education background. The post holder will be a strong communicator, influencer and tactician and have a strong track record in managing small teams to deliver high quality outcomes. He or she will need to demonstrate both credibility and passion about the importance of informatics in clinical practice."

If it wasn't only available as a "secondment opportunity for NHS employees" and wasn't based in Leeds I might have been interested in applying for this one.

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Monday, March 23, 2009

Database State

Today the Joseph Rowntree Reform Trust published a major report on the Database State. In it Ross Anderson and colleagues chart the rise of public sector databases which impact on everyones lives.

The report arose from the loss by Her Majesty's Revenue and Customs of two discs containing personal information about nearly 50% of the population and a series of high profile fiascos and data loses and challenges over effectiveness, privacy, legality and cost.

The report assesses 46 databases across the major government departments, and finds that:

* A quarter of the public-sector databases reviewed are almost certainly illegal under human rights or data protection law; they should be scrapped or substantially redesigned. More than half have significant problems with privacy or effectiveness and could fall foul of a legal challenge.

* Fewer than 15% of the public databases assessed in this report are effective, proportionate and necessary, with a proper legal basis for any privacy intrusions. Even so, some of them still have operational problems.

* Britain is out of line with other developed countries, where records on sensitive matters like healthcare and social services are held locally. In Britain, data is increasingly centralised, and shared between health and social services, the police, schools, local government and the taxman.

*The benefits claimed for data sharing are often illusory. Sharing can harm the vulnerable, not least by leading to discrimination and stigmatisation.

* The UK public sector spends over £16 billion a year on IT. Over £100 billion in spending is planned for the next five years, and even the Government cannot provide an accurate figure for cost of its ‘Transformational Government’ programme. Yet only about 30% of government IT projects succeed.

The report uses a traffic light system to examine the databases - those achieving a red rating are "almost certainly illegal under human rights or data protection law and should be scrapped or substantially redesigned". These include three systems specifically relevant to health and social care:

* ContactPoint, which is a national index of all children in England. It will hold biographical and contact information for each child and record their relationship with public services, including a note on whether any ‘sensitive service’ is working with the child;

* the NHS Detailed Care Record, which will hold GP and hospital records in remote servers controlled by the government, but to which many care providers can add their own comments, wikipedia-style, without proper control or accountability; and the Secondary Uses Service, which holds summaries of hospital and other treatment in a central system to support NHS administration and research;

* the electronic Common Assessment Framework, which holds an assessment of a child’s welfare needs. It can include sensitive and subjective information, and is too widely disseminated;

Other databases in the field including the NHS Summary Care Record, which will ‘initially’ hold information such as allergies and current prescriptions, are rated amber which means "a database has significant problems, and may be unlawful. Depending on the circumstances, it may need to be shrunk, or split, or individuals may have to be given a right to opt out".

Out of the 48 databases studied only 6 are given a "green light".

I' still working my way through the whole 63 page report and I'm currently analysing the significance and likely impact of the chapter related to the Department of Health.

The report has already been highlighted by the Guardian in its report entitled "Right to privacy broken by a quarter of UK's public databases, says report". It will be interesting to see what other reaction it receives and, most importantly, whether the direction of travel for government IT is changed at all.

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Wednesday, March 18, 2009

CfH Learning to Manage conference

Today I travelled to London for a connecting for health conference relaunching the “Learning to Manage Health Information” strategy.

Learning to Manage (LtM) was first launched in 1999 with a refresh in 2002 to set guidelines for the inclusion of health informatics into the curriculum for education for clinicians. It’s effectiveness in achieving it aims was limited and therefore it has been revised and updated. The intention of the new document is to provide guidance for educators, regulators and commissioner of education on appropriate learning outcomes for different professions at different stages of their education.

The day, which was held at the Royal College of Obstetricians and Gynaecologists, was opened by Martin Severs, the chair of the NHS Information Standards Board. He dealt with the housekeeping issues and invited participants to comment during the final plenary – however there were no question and answers sessions for any of the speakers during the day – and the final plenary was managed to prevent “awkward” questions from the like of me – this style seems to be Connecting for Health’s way of managing potential problems at events like this. Martin briefly described some of the relevant history including the launch in 1999 of the first version of the LtM document, which, as he said was endorsed by many but acted on by few. He suggested that the emphasis, and strap line, for the National Programme for IT in the NHS had changed over that time and now was much more focused on patient safety and patient participation.

He introduced a video message from Bruce Keogh, who welcomed delegates to the conference which he considered important – although he was unable to attend in person. He also stressed the importance of good quality information underpinning patient care and suggested that in the past there had been too much data but too little useful information and hoped that today’s event would be helping to change that. He suggested that there should be a clinical information officer in each NHS organisation – although there was no detail about what there role would entail. There was also no detail about whether they would have any ability to change practice, and what sorts of knowledge and skills these people would have and where they would be recruited from. He also mentioned the development of quality observatories in each NHS region which would be able to provide relevant information, in a usable format, for clinical teams to enhance their analytical capacity.

The first keynote was given by Dr Maureen Baker, Clinical Director for Patient Safety, NHS Connecting for Health (CfH). She outlined the increasing importance of quality in NHS IT systems and made the links to the importance of these areas in education for clinical staff as well as managers. The history of the patient safety movement and some of the key documents were presented. She argued that we need to accept that human error and fallibility is inevitable, but that systems should be designed to minimise the effects of these by drawing parallels with other complex and high risk industries. She presented an example from her own practice as a GP of how the potential for errors could be built into IT systems. She leads the board which signs off software being developed for use in the NHS as being safe and outlined how this “baton of safety” is handed over once the new systems are rolled out into practice. I wanted to raise issues about the involvement of front line staff at the design stage but didn’t get the opportunity.

Di Millen, Head of Informatics Development, NHS Connecting for Health then introduced participants to the document being launched today. Learning to Manage Health Information: a theme for clinical education – Making a difference. She outlined the work which had got us to this point but suggested rather than being an end point this was a beginning of gathering examples of good practice and developing a community of practice. The information on how this new version of the document was going to influence the “real world” and strategies to implement it was sketchy – but there was no opportunity at this point to explore this further. She mentioned two key issues which come up every time she meets anyone: connection between the NHS network N3 and the JANET network used in education and the issuing of smartcards to students. She promised more on the second issue later in the day. The full text of the document should be available tomorrow at Although I’ve seen drafts of the document I shall take a little longer to review it and then post some comments on this blog. Di also briefly “dangled some carrots” for the future work including some LtM related research grants – to be administered through the UK Faculty of Health Informatics.

After the coffee break participants were invited to attend one of a variety of workshops. Obviously as I was presenting in one I can’t comment on what went on in others, which included:

• Designing a Health Informatics Teaching Session - Jeannette Murphy, Senior Research Fellow, CHIME, University College London
• Introducing Clinical Information Systems (CIS) into the undergraduate clinical curriculum Sue Clamp, Director of the Yorkshire Centre for Health Informatics
• Finding a solution to Health Informatics Educator/Teacher/Facilitator Paucity - Paula Procter, Reader in Informatics and Telematics in Nursing, School of Nursing and Midwifery, University of Sheffield
• Embedding record standards in the undergraduate and postgraduate curriculum: why, what and how? Prof John Williams, Director of Health Informatics at the RCP
• A theoretical and practical approach to teaching record access – Dr Brian Fisher, GP & Dr Amir Hannon, GP
• Map of Medicine – Ketan Patel, Implementation Manager, Map of Medicine (workshop only delivered in the afternoon)

I would have liked the opportunity to attend some of these – Note to self, must learn to say no occasionally when asked to do these things!

My own workshop Using simulated electronic health records in clinical education included my presentation on the university perspective but also Nick Jupp, eLearning Programme Manager - South West Strategic Health Authority and Kathy Sienko from Cerner.

We tried to provide different perspectives on the issues surrounding the pilot project we have been implementing using the Cerner Academic Education Solution (AES). The workshop generated quite a lot of interest and discussion with several people thinking about how they would approach similar issues in their own institutions.

During lunch I had lots of interesting discussions with friends and colleagues old and new – and while partaking of a quick cigarette in the sunny and pleasant grounds was filmed for the Vox Pop- although the questions were angled to get positive rather than negative comments.

After lunch the afternoon sessions were c haired by Dr Elizabeth White, Head of Research and Development, College of Occupational Therapists who introduced the two plenary speakers and a video greeting from Gifford Batstone who outlined the importance of informatics for quality practice and the changing role of clinicians from being the providers of information to that of helping patients and clients to understand information they were obtaining independently – primarily form internet sources. As there was no opportunity for a question and answer session on this I wasn’t able to raise current debates about the ways in which disparate information sources may e contributing to reduced trust in the professions and organs of the state and increasing trust in the experiences of lay people who have been through similar experiences.

Dr Mark Davies, Effective Medical Director, The NHS Information Centre for Health and Social Care (previously the Secondary Uses Service) who was talking about Information and Service Delivery. He briefly talked about the role of the Information Centre and set out the principles that management and research data should not need to be collected separately but should be generated from data collected in routine clinical practice. He emphasised the importance of data quality if the information is to be used to support patient care (while almost admitting how poor the information quality has been for years).

He used the three legged stool analogy first used by Denis Protti in which the three legs are Technology, Processes and People and saw today’s event as focussing on people. He should several ways in which data can be displayed to support decision making at various levels including the NHS dashboard of key indicators – see for more information. As with several others speakers NHS Choices was highlighted as the portal for public access – but little comment was made about the coming Patient Reported Outcome Measures (PROMS). I would have liked to raise issues around the use of NHS data by commercial companies (such as Dr Foster) in what he described as the third stage and procedures for anonymisation and pseudanonymisation - but there was no opportunity to do this.

The next speaker was Suzanne Truttero, Midwifery Advisor CNO directorate; Department of Health addressed the topic Measuring the Quality of Maternity Care. She described the myriad of different documents, guidelines, measures etc which have been developed over the years and the work to bring these together. The current use of balanced score cards, dashboards & patient satisfaction surveys were also described.

An extra speaker, Philip Gill, from the registration authority, was slotted into the programme at this point to address frequent queries about students being able to gain smart cards for NHS systems while in training. He set out the two stage process required. The first being identity checks which can be delegated to the universities and the second stage related to specific access rights which, he argued, needed to be done by the trusts. He recognised that some trusts were “being awkward” about this, but described a pilot with Nottingham university which has overcome some of the issues and promised further information and guidance for trusts (which universities would be able to quote) on the NHS Employers web site by the end of this week.

After a refreshment break the workshops from the morning were repeated to give each of the attendees the opportunity to attend a different session.

As I was tidying up after our workshop and talking to lots of interested people I was a little late attending the final plenary. This brought the day to a close with an attempt to enable participants and speakers to engage in dialogue about the ways in which the work from the day could be taken forward. Lots of speakers welcomed the intentions but said that there was a need for commissioners of education, regulatory bodies and others to take it onboard – and for CfH and other NHS bodies to work with the few “lone voices” in universities to raise health informatics up the agenda at all levels of clinical education.

In general the day was quite interesting and it was good to meet others working in related fields, however it has not convinced me that the new version of Learning to Manage… is going to bring about the revolution which is needed – and that despite what was said today we might be at a similar event in 10 years time discussion the same sorts of issues – I’ve already booked my place with Di Millen!

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Tuesday, January 27, 2009

PAC report on NPfIT

The House of Commons Public Accounts Committee has today published a damming report on the NHS's National Programme for IT (NPfIT) and Connecting for Health - the atgency "delivering" it. The report entitled "The National Programme for IT in the NHS: Progress since 2006" points out the delays and cost implications of current problems and highlights other issues concerning the the potential effects of the systems on the NHS and its patients.

The media this morning seems full of comment about the financial status of the programme and relationships with suppliers. (see links below) This is not surprising given the remit of the committee, however there is less comment on the lack of clinical functionality in the systems being deployed and the effect of this on the expectations of clinical staff. In addition some important points are made about data security and confidentiality of patient records and the concerns health professionals and the public have about this.

The report says "The Department considers that the current levels of support [from staff] reflect the fact that for many staff the benefits of the Programme are still theoretical," and comments on the requirements on staff to change how they work with little or no consultation.

The tension between the role of suppliers who are responsible for the security of the systems themselves, and NHS organisations and staff who are responsible for keeping secure any data they access are briefly explored. The report also points out "Access to the Care Records Service is controlled through Smartcards and passcodes, though these are not yet in use in all Trusts because early releases of the care records software in London and the South do not support them and the Trusts concerned therefore continue to rely on passwords." The change in the consent model adopted for the sharing of patient records to a "Consent to View" approach is also mentioned.

I hope to post some more thoughts when I've had time to read the report in full.

Further comment and analysis is available from:

BBC News - Warning over fresh NHS IT delays

Times Online - MPs point to 'further delays and turmoil' for £12.4 billion NHS computer upgrade

EHealth Insider - PAC gives NPfIT six months to deliver CRS

HSJ - NHS Confed calls for IT programme overhaul

Public - MPs' recommendations to improve NHS IT - in full

Public - Harsh MP committee report condemns NHS National Programme for IT

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Thursday, January 08, 2009

New Professionalising Health Informatics portal from CfH

The NHS's Connecting for Health has today launched a new portal for Professionalising Health Informatics, or PHI for short.

It claims to be an online 'one-stop shop' portal supporting personal and professional development in Health Informatics (HI), however the limited amount of resources availability didn't impress me.

I'm not really sure who it is aimed at - presumably NHS staff in England - and they might find it useful - but others may argue that its limited scope and extensive use of NHS (& general "management speak") jargon off putting. Several mentions of "selecting the options to the right-hand side of the screen" when there weren't any options on the right hand side also put me off.

It is promised that the portal will be expanded and kept up to date so I hope it becomes more useful in the future.

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Friday, August 22, 2008

"Independent" report into NHS IT

Yesterday it was announced that The Conservatives have commissioned a review of NHS IT to be led by Dr Glyn Hayes of the BCS.

The review intends to focus on practical ways to to get the maximum patient benefit from IT and informatics in health and social care over the next five to ten years.

Written evidence is invited from any individual or organisation with an interest in the area by the end of September. Oral hearings will then be held in October and November, with a first draft expected in December and the final report is to be published by the end of March 2009.

The Review Group's remit, which is set out in full in a letter published on E-health Insider is to:

1. Establish how clinical, public, and management needs can most effectively be met by information technology
2. In the light of the developments and progress of the last few years, establish a vision for IT in the NHS, health and social care
3. Set out a strategy for achieving that vision including a workforce strategy
4. Advise on action for the current Government to take
5. Advise on the policy options to be considered for implementation by an incoming Conservative Government.

I have some concerns about the independence of the review, because of the political sponsors, however I respect Glyn's integrity enough to believe that he will do a good job and produce a balanced report. I can't see him as the tories Ara Darzi but do believe the review has something to offer and I will be contributing to it as soon as I get some time.

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Monday, July 14, 2008

NHS Informatics review

At the end of last week the Department of Health published the Health informatics review report led by Matthew Swindells.

Much of the coverage has focussed on the new "freedom" for trusts to purchase "Interim Solutions" until Connecting for Health products are available eg E-Health Insiders "NHS Informatics Review says trusts need 'interim' systems" and Computer Weekly "Health chiefs tell NHS trusts not to wait for NPfIT".

These are important, however some of the other areas of the report are also worthy of consideration. The need for leadership in the Health Informatics domain at local and national levels is discussed with several recommendations for initiatives to develop the informatics workforce and training for the clinical workforce, and sharing learning from implementations. It would have been nice if a little more detail about the education and training initiatives had been included.

The report talks about "Creating confidence" and I would agree that "stakeholders" (patients and staff) and their feelings about the programme are key to success, however I'm not sure that some of the platitudes about improving confidentiality, security and governance of information will achieve this. The NHS Care Records Guarantee is held up as an example of good practice, but some of its inherent weaknesses identified in the Report of Evaluation of Summary Care Record Early Adopter Programme in May, are not addressed.

Additionally, issues around the interface between the NHS Care Records Service and other bodies including social care, voluntary sector organisations, independent sector treatment centres, hospices etc for the exchange of information and dissemination of information by the Secondary Uses Service from the NHS Information Centre are alluded to - with plans for consultations. I would suggest that these issues, which some of us were highlighting years ago should have been addressed by now.

NHS Choices and HealthSpace are held up as examples of good practice (and I understand are now receiving enhanced funding) and they are important, but they do not make up for the delays and deficiencies in the delivery of the Care Records which were a primary purpose of Connecting for Health.

It will be interesting to see if the Health Informatics Review implementation programme which is being set up, and the "enhanced" local ownership predicted will be successful in breaking some of the log jams which are currently blocking progress and I look forward to their more detailed report which is promised for the autumn.

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Tuesday, June 17, 2008

CfH Conference - The Information Revolution

Today I attended the annual Connecting for Health Conference for Nurses, Midwives & Healthcare Practitioners entitled "Culture Change in Professional Practice - The Information Revolution".

This years event was held at Central Hall, Westminster and was less busy and exciting than the first event I attended a couple of years ago, with less than 200 booking for the event & quite a few of them not attending (and quite a few leaving early).

Although I arrived a little late because of delays (again) on First Late Western Trains, I caught most of the welcome and introduction by Barbara Stuttle and Susan Osborne, Connecting for Health's National Clinical Leads for Nurses. They gave some standard messages about the integration of systems and current drivers in the NHS with a particular focus on providing "connected care in the community" based on risk and demographic change.

The first keynote speaker was Dame Christine Beasley, the Chief Nursing Officer at the Department of Health. She highlighted the complexity of care and listed the "achievements" of Connecting for Health - a list of figures obviously provided by one of her staff and which didn't stand up to too much scrutiny. She mentioned her visit yesterday when she had seen the "Mobile Clinical Assistant", which is basically a robust laptop which can be disinfected, in practice (see Intel , Motion Computing etc.) She highlighted safety issues, particularly related drugs and polypharmacy, and emphasised the importance of HealthSpace (which is unavailable as I write this). A final mention was made that a National Director for Nursing is to be appointed in Connecting for Health and within her organisation chart this role was seen as being fairly high level - with the "Clinical Leads" reporting to them. It will be interesting to see who is appointed to this role - and whether they make a difference in terms of engagement with the professions and to the culture of CfH.

The coffee break was followed by three "knowledge sessions". The first of these was by Gill Stollen (?sp) talking about Lorenzo development. She started from a historical perspective related to paper records - and asked for nurses to tell them what the Lorenzo releases should do. Several speakers during the day repeated this request for nurses to get involved and help to specify what the systems, which are under development, should help nurses in their practice. The thought which came to my mind was that CfH should have involved clinicians when the original specifications were drawn up five years ago & maybe they would be further along with implementation (and have more NHS staff "on board") than they have at present.

The second knowledge session was about clinical assisstive technology (which I would call telehealth) led by George MacGinnis (Assistive Technology Programme Manager, NHS Connecting for Health), who was wearing his falls monitor! This session also included Helen Rollins a community matron in Swindon. She described a program which has put blood pressure, pulse oximetry etc monitors, and scales into the homes of patients with COPD connecting to a monitoring centre. Staff at the centreare able to detect changes in patients conditions enabling intervention where needed. The examples of success, which she described, have led to further developments, with blood sugar and other monitors being connected to the system via a variety of peripherals. She also touched on the interface between health and social care - including who should be funding this work.

The next presentation was by Mike McAtominey about the new Essential IT Skills programme which has replaced the ECDL as basic IT skills training provision in the NHS and NHS Health which teaches staff about Information Governance. He did say that this was being made available to students in Universities on NHS related courses and I will have to follow this information up. I picked up a copy of the training materials, which have been developed by University Hospitals of Morecambe Bay NHS Trust, in the exhibition and will be taking a look at them when I get some time.

During the morning delegates had been encouraged to write questions on slips of paper for a panel session which convened after lunch. The panel included: Susan Osborne (National Clinical Lead for Nurses), Michael Thick (Chief Clinical Officer for Connecting for Health), Ian Cowles (Group Director NHS CRS Implementation), Marlene Winfield (National Patient Lead NHS Connecting for Health), Julie Tindale (National Clinical Lead for Midwifery) and Yvonne Pettigrew (National Clinical Lead for Allied Health Professions) with the questions being selected and put by Barbara Stuttle. The questions put to the panel touched on a variety of topics, but a cynic might suggest they had been selected to enable the panel to give their "set pieces". A question about Local Ownership and clinical engagement brought nice phrases about SHA clinical leads been "brought on board"; partnership working with social services about assisstive technology brought platitudes about shared budgets and a question about system failures and downtime - brought claims about the national spine being available 99.99% of the time.

There were various other questions but what really annoyed me about this session wasn't the fact that none of my SIX (awkward) questions was put, but that when statements were made by the panel no follow up questions or comments were allowed from the floor. Two particular statements which I wanted to respond to were a statement that everyone had the right to opt out of having a summary care record - which I believe is untrue as you have to have a record (otherwise your GP and others in the NHS will not be able to treat you) but that you can refuse consent for it to be shared - and even this is limited. One of my questions that wasn't asked was about the evaluation report on the Summary Care Record early adopter sites and its recommendation that England move to the approach being taken in Scotland and Wales to "consent to view". The other statement which I felt needed further exploration was that Connecting for Health is paying for 90% of implementation costs - if you talk to local trusts etc you get a different story where, even if they use the software products being provided by Connecting for Health, the hardware and training costs are the ones they are having difficulty in meeting.

Barbara did say to me privately that the answers to questions that were put and those that weren't will be put on the Connecting for Health web site (if & when I find them I will add a link) - and asked me to email her my concerns about the answers given - I will sent her the URL for this blog post and offer the opportunity to post a comment in response & see what response I get. The controlled format of this session and refusal to take questions or comments doesn't bode well for the new culture of openness I thought we might see after the departure of Richard Granger as Director General. It might also be a response to last weeks vote by GPs at the BMA’s annual Local Medical Committees conference expressing no confidence in the government’s ability to store electronic patient records safely, and backing calls to support patients who wish to opt-out of the Summary Care Record (SCR), and a motion calling for a halt on any further development of plans to develop Care Records Service plans.

The following speakers, to a dwindling audience, included Keith Ward from the University of Huddersfield who talked about his Nursing Documentation Project which included an examination of 10,000 nursing records and nine months of observation. He described the use of an intuitive humanist model which conflicted with the "medical" information processing model, which he saw as underpinning the development of software systems within Connecting for Health. He suggested that "algorithm approaches" are deskilling nurses and how requests for data recording, which was not relevant to nursing care amounted to "cumulative unreasonableness".

Kathy Sienko from Cerner talked about the importance of preparing the professional workforce for the digital environment and some of the vital issues which need to be addressed before systems go live.

The final speaker was Simon Eccles (National Clinical Director, Secondary Care, NHS Connecting for Health) who urged everyone to get involved and gave a first look at their new DVD which is supposed to persuade everyone of the benefits of Connecting for Health. The short versions we were shown (with lift music) will not, in my humble opinion, achieve this, but I will reserve judgement until I've had more time to review it more fully.

The conference closed with more exhortations from various of the clinical leads for everyone to get on board.

Although it was a nice opportunity to meet up with some old colleagues I left the conference feeling disheartened, and unless they are likely to change significantly I will not be attending one of these again.

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Thursday, May 15, 2008

Masterclass Event - Social Networking in the NHS

Today (Thurs 15th May) I'm attending a NHS Faculty of Health Informatics Masterclass Event - The Power and the Perils of Social Networking Tools in the NHS

The day is being held at the British Library was to be chaired by Bev Ellis (Vice Chair – NHS Faculty of Health Informatics and Head of Health Informatics – University of Central Lancashire) but she was on a train with delays at Bletchley. Therefore Bruce Elliot took over those duties, and started with an intro to the NHS Faculty of Health Informatics, and set out the aims for the day and dealt with practical issues.

The first presentation by Rowan Purdy ( ex Head of Knowledge Services – Care Service Improvement Partnership and now Senior consultant, Surepoint) covered "An overview of current Social Networking tools and predictions for the future". He started with hands up on a roller coaster for who had IT & used it to social networking (at work). He gave the definition of social networking from Wikipedia and talked about some of the ways in which people use the characteristic tools. He talked about the bottom up v top down approaches both online and off line. He looked at feeling oppressed by their email & advocated RSS readers as a way to manage this. He moved on to talk about blogs as personal and corporate voices, and then moved on to instant messaging for immediacy and emotion. He talked about Skype and video conferencing tools. He then gave an overview of wikis for collaborative editing for agenda, papers etc. and how house style and peer review emerges. He mentioned clear forest which tries to extract meaning from content and talked about how the various tools link together. Social tagging as a way of adding labels & keywords to create tag clouds and social bookmarking eg delicious was presented as another social networking tool. Social libraries eg librarious and Youtube and other media sharing eg flikr were discussed along with MySpace, Facebook & LinkedIn (I gave trying to link to them all live at this point).

He then talked to tools for social networking in the NHS eg NHS networks, Knowledge community, & CISP developments. He then talked about how some of these tools could be used within NHS organisations to produce a layer of loosely connected social tools. He highlighted the importance of the culture and passion rather than technology & mentioned the importance of leadership & behaviours. He got out his crystal ball to look at the future Web2.0 & Web3.0 providing more power to people to reuse content eg Yahoopies, QEDwiki, adding the personal touch & customisation eg BBC site. Second Life & its application to real work looked at potential applications for the future. The cabinet office was given as a potential example iterative policy documents. His final points were that technology is not key but that people being willing to take risks are the way to take small steps to help each other move forward. His gave the attribution for his photos etc and encouraged others to do the same otherwise people will stop sharing. The Q&A started with discussion of inclusion, IT literacy, access etc etc. Rowan suggested that some social tools eg Flikr are a way for getting those with less IT skills switched on to IT use, through the element of fun. The risk of the multiplicity of tools can reduce communication rather than improve it came up as a question & this raise issues of "smartness" & "interoperability" & building onto & connecting with others. The generational issues were also highlighted - and in came the words "control" by the organisation.

The power and the potential of the patient’s voice in transforming Health services – the experience of Patient Opinion – Paul Hodgkin (GP and Chief Executive – Patient Opinion) He started by highlighting the importance of recognising the things that are importance for individuals. He looked at what is driving social networking
*Economics of voice
*Economics of collaboration
*Economics of reputation

He used examples of photos from Flikr clearly describing patients experiences and rateMDs and similar sites. The freedom of speech issues and payment by advertising were seen as increasing the rankourous nature. He also talked about patient opinion & how they are checked & 5% edited & add tags. He also highlighted how the comments can be used to change practice. Collectivised wisdom as a social benefit and the importance in getting the tone right in web based responses - so it doesn't look like a whitewash. The issues of access and IT use in the elderly were addressed with phone and paper alternatives described. The profile of responders was discussed but not claimed to be representative but covers all almost all NHS services. He talk about how postings can be directed to the right managers and other key interested players via email alerts. The comments are rated so that you can filer the types of comments you want to see, and various reports are generated. It was funded by the DoH & is now funded by small subscriptions from Trusts etc & the benefits of this were highlighted. He moved on to talk about NHS choices - Your thoughts & the importance of independence and the value base and the similarities and differences between the different approaches. He talked about the advantages & disadvantages of surveys, user groups etc and the underlying business models. He described some of the lessons learned from the Patient Opinion experience and the advantages and highlighted some of the difficulties to achieve adaptation and use by public services - its about conversation not about data - not representative but useful. He took a Q&A session about Patient opinion which discussed identities, & how the data could inform reviews of the NHS & links to public health depts. Looking at the Return on Investment in terms of improvements compared to investment & whether this data was available + getting subscriptions out of hospitals and PCTs, SHAs, DoH etc.

A break was them negotiated, before Paul continued to talk about the cost of collaboration based on Clay Shirky's book. Examples given included pledgebank, and suggested how this can be used to recruit people for campaigns etc at low cost for people who feel isolated which can be benign or malign. He looked at the public policy on choice based on exit or voice & how exit has been the main way in which choice has been expressed - but how we are likely to move towards voice. He moved on to the economics of reputation and gift economies. value no longer resides in scarcity in the digital economy and non financial incentives. Work satisfaction is related to autonomy - linked to NHS culture. He suggested using the sort of things that ebay does to rank sellers could be used to rate GPs, outpatients depts & consultants, based on end user satisfaction not process. Q&A discussed issues around doctors being willing to rate each other, and the tensions between localness and general access. Also discussion were raised around private v public comments. Patientslikeme was discussed as a possible way forward.

The next presentation was about Experiences in the power and the perils of the use of Social Networking tools by Healthcare Staff and in Higher Education by me. The presentation will be added here later.

A summary of research on the power of Staff, Patient and other blogs et al in influencing change in Health and across the Public Sector was to have been given by – Steve Moore (Director and Co-founder of Policy Unplugged) but he was unable to attend.

Using shared experiences: the future of social networking in the NHS Helen Nicol (Programme Manager – Capability & Capacity – NHS Connecting for Health and author of the "The Business of Knowing" blog). She described herself as interested in the way technology can enable learning and the interface between online and face to face. She talked about the conversational web and how the wisdom of the mases has a lot to offer in knowledge generation. She drew a parallel between the power of computer networks and networks of people. Her presentation was in two parts, one from the consumer perspective and the other from the organisational. She emphasised the points made earlier about people trusting user generated rather than professional advice and the useful "anonymity" of the web to investigate personal issues. The move to niche sites and applications for people with particular diseases or conditions was discussed, along with attitudes to institutions and conformity. The need for a recognition that there is more gray than black and white was highlighted. The expert patient approach and the qualitative components of interactions were seen as being key. Helen discussed espace and some of the issues which surround the "institution" and peoples willingness to "open up". The facebook group "Escape from NHS Connecting for Health" even got a mention, before moving on to look at appropriate business models. Helen then moved on from patients to the organisation and learning from experience. She raised questions about whether "communities of practice" can be engineered. Sermo was given as an example of the doctors lounge personified. Information arbitrage was then discussed as the model for pharmaceutical companies to gather data from communities of experts. The difficulties of creating communities either online or off line was explored with examples from espace. The demise of NHSnetworks was given as an example of the difficulties and OpenID and similar systems to integrate the disparate systems well suggested as the way of the future, and some suggestions for the NHS were put forward. Q&A touched on espace & whether it has a clear purpose.

The new report from Demos – "The Talking Cure: Why Conversation is the Future of Healthcare" was suggested as good reading.

The general discussion "What should be done in order to maximise the power and potential of Social Networking tools within the NHS and minimise risks?" was later than planned and occurred with final tea & coffee. The elephant in the room of "can you create a social network" was raised & the possible need for a "manager" was also raised. The importance of sharing between the different countries in the UK was highlighted.

Key messages were about trying things out and if its not working try something else. Support the mavericks & don't let them leave.

The place and ownership of social networking in the NHS raised problems & will be included in the final report which is being created as a wiki led by Rowan & the link to it will be placed here when available.

Delegates left for journeys home - with potential problems if they are getting trains up the west coast main line.

Members of eSpace and the NHS Faculty of Health Informatics can view copies of the presentations at:

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Tuesday, May 06, 2008

Report of Evaluation of Summary Care Record Early Adopter Programme

An interesting report has been published today into the evaluation of the Summary Care Record (SCR) Early Adopter Programme. It highlights many of the difficulties which have been encountered and makes recommendations to improve for the future.

The evaluation team led by Trisha Greenhalgh at University College London discusses criticisms of the programme focusing on "implementing a technology rather than a broader and more developmental focus on socio-technical change". They also make comment about the ethical and moral considerations inherent in the "current ‘hybrid’ consent model for the SCR, which is widely seen as overly complex and unworkable (and which many GPs and Caldicott Guardians see as unethical), and consider alternative models, notably ‘consent to view’, that have been shown to be acceptable and successful in comparable programmes" in Scotland and Wales. This was despite the fact that few of the patients in the pilot area reported strong feelings about whether they had a SCR and low levels of "opt out".

The report also criticises an "outdated model of change – centrally driven, project oriented, rationalistic, with a focus on documentation and reporting, and oriented to predefined, inflexible goals", and argues for "more contemporary models of change (which are programme-oriented and built around theories of sensemaking, co-evolution and knowledge creation) include soft systems methodology, technology use mediation and situated action".

The full (138 page) report is available from, and although I've only read the executive summary so far I think it should be compulsory reading for anyone involved in electronic health records.

Further commentary and discussion is taking place on the E-Health Insider site under Urgent review of SCR consent model recommended and elsewhere. It will be interesting to see if the lessons learned will be put into practice.

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Saturday, April 12, 2008

Nurses, Midwives & Healthcare Staff CfH conf June 2008

NHS Connecting for the health will be running their third annual "A conference for Nurses, Midwives & Healthcare Staff: Cultural Change in Professional Practice - The Information Revolution" on 17th June 08 at the Central Hall Westminster, London

The conference aims to: "provide delegates with an opportunity to learn more about the National Programme for IT and how it will deliver better and safer care, from a clinical and patient perspective. There will also be an update on the progress which has been achieved over the last twelve months, and an opportunity to see live demonstrations of some software packages. A Q&A panel will provide people with an opportunity to ask questions and provide feedback about their own experiences of using IT. An interactive session will also demonstrate key areas of the programme such as Lorenzo (patient administration system), essential IT and training on the job and clinical assistive technology. Speakers at the conference will include Chris Beasley, chief nursing officer, Susan Osborne and Barbara Stuttle, joint national clinical leads for the nursing professions.

Further details & booking form.

I hope to be attending this one & will do a report on this blog.

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Thursday, April 03, 2008

Call for Research Proposals - Evaluation of the effect of IT on interactions between healthcare workers and patients

The NHS Connecting for Health Evaluation Programme has an interesting call for proposals open at the moment. NHS CFHEP 010: Evaluation of the effect of IT on interactions between healthcare workers and patients is designed to "evaluate the effect of IT
on interactions between healthcare workers and patients...." and meet the "need to understand how different configurations of IT equipment and screen layouts may affect communication acceptability."

This area has long been an issue which has been perceived by some as a barrier to increased use of IT in healthcare delivery. It will be interesting to see the results in terms of IT arrangement and the effects of IT use on the time taken for consultations. It will be even more interesting to see if the results affect the perceptions and opinions of medical and other healthcare practitioners, who perceive that the use of IT in patient consultations may be seen as reducing their omnipotence & whether this may contribute to changes in medical paternalism.

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Saturday, April 21, 2007

Shared Care Record workshop

Yesterday I attended an "Open Workshop" organised by the NHS Faculty of Health Informatics.

The workshop was led by Dr Gillian Braunold (Connecting for Health, National Clinical Lead for GPs) and provided an opportunity to explore a range of issues surrounding the Summary Care Record which is currently being piloted by Connecting for Health. This will provide an outline record for every NHS patient, initially based on a summary by their GP.

The event was held at Armada House in Bristol which provided easy access for me and was one of the first organised by the Faculty in the south of England.

The day was opened and chaired by Dr Paul Woolman who introduced the day by outlining the case for the SCR by citing references ranging from the US Institute of Medicine Preventing Medication Errors to the New Statesman supplement on IT and Modernisation (Oct 2006).

Gillian outlined her background and asked delegates to describe their role and what they wanted to get out of the workshop. She then described some of the lessons and issues from the early adopter sites (such as that in Bolton which was announced in March). She discussed some of the issues around opaqueness, delays and politics and compared the approach in England with that in Hampshire, The Wirral and Scotland who are "getting on with it". She also raised issues, which ran throughout the day, about consent, opt-in and opt-out models and sealed envelopes, which have been discussed on this blog and elsewhere (eg SCR opt-out sets 'onerous' conditions, says GP EHI).

Of the £12.4 billion budget for the National Programme for IT only a small percentage is being spend on the SCR, but Gillian described it as being one of the keys to making all of the work on sharing records come true.

The rationale for the inclusion of medications and allergies in the first uploads of records was described, and linked to work on security and confidentiality including Role Based Access Controls (RBAC), workgroups, "legitimate relationships" audits & alerts, and aspects of physical security including smartcards.

Issues about data quality within records were briefly touched on along with developments for patient access via HealthSpace, including e-gif level 3 security which is promised for May 2007.

After lunch David Nash gave a demonstration of the Clinical Spine Application (now renamed Summary Care Record) showing the view that a doctor in A&E may get to the data which has been uploaded from a GPs record. This raised lots of discussion about RBAC, overriding dissent etc. Demonstrators (both online and stand alone) of this functionality are being built.

Dr Chris Frith then discussed sharing records with patients in his surgery and gave a demonstration of the ways in which patients can do this via the surgery web site and EMiS access. He described the advantages of patient access as increasing trust and accuracy and reducing errors. The usage figures are still quite low bu8t some useful insights are being gained.

Another demonstration, which had been arranged at short notice, was by Brian Seaton, who showed his own medical record from a credit card USB drive using HealtheCard and discussed the layout and cost issues related to keeping the record up to date and accessing it (especially when NHS computers are having USB ports removed because of data slurping).

The final part of the day was workshop where delegates divided into groups to consider some of the issues around business processes and consent models which are being raised by this work and still being grappled with.

Generally the day was quite a useful opportunity to learn about the latest developments and explore some of the ongoing issues, which are important for everyone whether healthcare professionals or patients. It will be interesting to see what the effects of the public information campaigns in early adopter areas will be and how many of the current proposals are still in place ina years time.

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Friday, March 16, 2007

1st uploads from GP to national spine

The first upload of GP patients records to the NPfIT national spine are about to start.

Bolton has been selected as the pilot site and two GPs practices in the town will begin uploading GP records as part of the "summary care record" which will contain containing details of name, address, medication history, serious illnesses and allergies. These will then be accessible to the out-of-hours provider and A+E department.

Letters and leaflets explaining the programme will go out in the next few weeks, and local residents will have the option to "opt out". This long fought for opt out will have three possible options. The first is a total refusal for their records to be uploaded. The second option is to limit the people who are able to access it and the final options is that particular details - such as an abortion or being on HIV medication - must not be uploaded (the so called and long awaited sealed envelope). However, very few details of how this will be achieved have yet been made available.

It will be very interesting to see how many people take one of the options to restrict the use of their personal and sensitive information.

Further information is available from:

* The Guardian 15th March First test launched of NHS's controversial 'Spine' database
* E Health Insider Starting gun fired for Summary Care Record roll-out

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Tuesday, February 13, 2007

NHS CfH Southern Cluster ETD day

Today I attended a study day organised by NHS Connecting for Health Southern Cluster Education, Training and Development (ETD) at Taunton Racecourse.

The day was chaired by Nick Jupp (ETD Lead, NHS Somerset Health Informatics)

The first speaker was different to the usual NHS "Men in Suits" when - Andrew Raynes (ETD Programme Manager, NHS CFH, Southern Cluster) appeared in his schoolboy outfit and used a high tech drum kit to illustrate points he wanted to make about working together, under the title of "NPfIT Skool of Rock". He achieved audience participation with the use of maracas and tambourines.
(I have video available for blackmail purposes)

The next (rather dry) presentation was on the Role and Benefits of Change Management within NPfIT by Steve Swift (Business Change Manager , Fujitsu NHS Services)

After coffee and some useful networking with colleagues from the NHS, Cerner and Fujitsu alliance, Phil Bolton (E-learning Development Manager, Royal United Hospital, Bath) gave a presentation about the issues they have experienced in training for their implementation of Cerner Millenium Release 0 which has been delayed for 14 months (so far) and demonstrated an elearning application they have developed rather than use the training domain provided by Fujitsu.

The final presentation of the morning was by Dr Roger Tackley (Chairman Southern Cluster Terminology Group SCCAG) who talked about the SNOMED CT terminology system as a concept. This seemed unfamilar to many of the trainers present and he emphasised the importance of this for clinical use of the Cerner Millenium system.

After a good lunch there were four parallel sessions:
• Table top challenge –Maria Scott (Clinical Benefits Advisors, NHS CFH)
• Professional Support and Development workshop - Di Wilson (ETD Networks Development Manager, NHS CFH) / Jackie Smith (Informatics Specialists Development Managers, NHS CFH)
• CIS Accredited Learning – Kamru Mohammed (ETD Systems & Platform Lead, NHS CFH)
• Implementing Training standards (What do you want out of the standards – A Case Study approach) – Jonathan Coe (ETD Standards Delivery Manager)

I attended the session on Professional Support and Development which involved teams using a variety of children's toys, sellotape, and modeling clay to represent what health informatics is and the knowledge and skills required - and the role of NPfIT (during which I got to do a bit of juggling!)

The day closed with a panel session answering (or trying to) some of the questions which had been put onto post it notes during the day by delegates.

An undercurrent to the day was provided by a report on the Radio 4 news this am which was carried by the Times as £6.2bn IT scheme for NHS ‘is not working and is not going to work’ with the comment that "A lack of vision and poor understanding of the sheer size of the task meant that the IT overhaul “isn’t working and isn’t going to work”, by Andrew Rollerson, an executive with Fujitsu. As I was sitting at a table with some of the staff from Fujitsu this caused some discussion!

Generally it was quite an interesting day - although obviously aimed at NHS ETD staff rather than me - and I did make some useful contacts and learn some bits I wasn't aware of.

I am assured that the power point presentations will be made available on the NHS Connecting for Health Southern Cluster Education, Training and Development (ETD) web site.

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Monday, December 18, 2006

BCS HIF report - The Way Forward for NHS Health Informatics

The Way Forward for NHS Health Informatics : Health Informatics Forum : BCS

The British Computer Society (BCS) Health Informatics Forum has produced a major new report which reviews the current state of Informatics in the NHS and suggests ways forward. Peter provided a link to this a couple of days ago but I've only just had a chance to read it.

The report suggests that the current problems facing the NHS's IT Programme require a realignment of the National Programme for IT.

According to the BCS Health Informatics Forum Strategic Panel, the NHS Connecting for Health (CfH) programme can still make a massive contribution to safer and more appropriate patient care and remains in full agreement with the Wanless report that 4% of NHS turnover should be spent on business led informatics.

"One of the fundamental goals," according to Dr Glyn Hayes, Chair of BCSHIF, "must be to support the diverse business processes that recognize local constraints and individual patients' values, and focus on delivery and implementation at Trust level. Instead of the current monolithic systems intended to meet most of the needs of users in a local health community, we need a range and choice of more innovative and agile solutions contributing to a common purpose, encouraged within national standards to deliver functionality in whatever way suits the users and suppliers. This should not be interpreted as ruling out adoption of local server provider (LSP) products where they fit the business requirements."

Key recommendations of the report include:

* The Provision of a business context for NPfIT at national and local level.
* A focus on local implementations at Trust and provider unit level, e.g. hospitals, diagnostic & treatment centres, community and mental health Trusts, practices. Providing specialty and service-based systems within provider units will encourage clinical involvement and give quicker benefits.
* There needs to be a major emphasis on standards to enable systems to interoperate effectively, rather than focusing on a few monolithic systems.
* The strategy should be evolutionary, building on what presently works and encouraging convergence to standards over time, rather than revolutionary.
* To adopt a truly patient-centred approach at the local health community level
* There are major issues about the sharing of electronic patient data which need to be resolved. These must not be hijacked by technical issues, and informed patient consent should be paramount.
* Transform NHS CfH into an open partnership with NHS management, users, the informatics community, suppliers, patients and their carers, based on trust and respect.
* The clinical professions, NHS management and informaticians should collaborate to provide clear and comprehensive guidance for all sectors on good record keeping and data management – clinical and other, and embed this in undergraduate and post graduate training. The NHS should facilitate the take-up of this guidance.

I feel the report contains a lot of good ideas, however in addition to the focus on managerial arrangements, current issues around information governance and ownership need greater emphasis along with the clinical benefits which should flow if the systems are put in place appropriately.

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Saturday, December 16, 2006

Patients win right to keep records off NHS computer | Health |

Patients win right to keep records off NHS computer | Health |

Today's Guardian is reporting that "The government has bowed to privacy concerns about a new NHS computer system and conceded that patients should be allowed a veto on information about their medical history being passed from their GP to a national database."

This follows the letter sent by the Department of Health a couple of weeks ago to those who expressed wories about the proposals.

I think it is also interesting that these reports are still quoting Lord Warner who "retired" earlier this week - & I do wonder why that retirement was announced on a big news day?

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Friday, December 15, 2006

BCSHIF report - where should NHS CfH go from here?

The report 'The Way Forward for NHS Health Informatics - Where should NHS Connecting for Health (NHS CFH) go from here?' prepared on behalf of the British Computer Society (BCS) by the BCS Health Informatics Forum Strategic Panel is now available.

A direct link to downloading the report is at:

There is a report on the Daily Telegraph website >>>

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