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The report also criticises an "outdated model of change – centrally driven, project oriented, rationalistic, with a focus on documentation and reporting, and oriented to predefined, inflexible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 http://preview.tinyurl.com/3jf6hk, 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.

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.

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.

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.

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

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.

Technorati Tags: NHS, NPfI, CfH, ETD

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.

Technorati Tags: NPfIT, BCSHIF, CfH

Patients win right to keep records off NHS computer | Health | SocietyGuardian.co.uk

Patients win right to keep records off NHS computer | Health | SocietyGuardian.co.uk

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?

Technorati Tags: NPfIT, BCSHIF, CfH

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:

http://www.bcs.org/upload/pdf/BCS-HIF-report.pdf

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

Technorati Tags: NPfIT, BCSHIF, CfH