Informaticopia

Tuesday, November 24, 2009

Evaluating eHealth: How to make evaluation more methodologically robust

Evaluating eHealth: How to make evaluation more methodologically robust is a new paper just published by the Open Access Public Library of Science.

The authors point out the necessity for evaluation of eHealth computer systems and the difficulties such evaluation will encounter. "There is a consensus about the evaluation of clinical treatments, such as drugs, in which randomized control trials are state of the art," they say. "No such consensus exists yet for the evaluation of highly complex service interventions such as computer systems." The authors conclude that "multiple methods research" is necessary for eHealth systems evaluation: "Research commissioners and research teams need to recognize the importance of undertaking combined quantitative and qualitative work when evaluating IT systems."

It fits beautifully with the paper I'm currently writing for my DPhil and contains clear and logical arguments about some of the socio-technical approaches needed within NPfIT.

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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 Technology.net - MPs' recommendations to improve NHS IT - in full

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

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Thursday, September 18, 2008

Acess to health records - two major announcements

The last 48 hours have seen two major announcements about changes to access restrictions for patients records in the UK's National Health Service. The first will require staff are to seek patients' specific consent before reading their electronic medical records, the second was an announcement of a consultation with the public and healthcare professionals on the use of patient information for purposes such as health research and managing and planning care.

Connecting for Health, the agency charged with the delivery of the NHS's National Programme for IT has finally bowed to pressure from a wide range of patient and professional groups and changed the "consent model" which will be used in an attempt to protect patient confidentiality when dealing with electronic health records uploaded onto the "spine". As has been noted on this blog and elsewhere the original model assumed the consent of patients to upload and share the information they gave to healthcare professionals, unless they actively "opted out", and proposed the use of sealed envelopes for particularly sensitive information. This has been challenged in various ways and was criticised in the evaluation of pilot projects by University College London, published in May.

According to The Guardian 638,000 patients in the five trial areas were written to about plans to share their GP records, only about 2,500 opted out and 500 said their records could be uploaded with conditions. However many thousands in the trial areas were unaware of the public information campaigns, and NHS staff were often unaware of an obligation to patients who wanted to be notified when staff wanted access to their file.

According to the report on E-Health Insider Professor Patricia Greenhalgh, the lead author of the UCL report, said she was delighted by the decision.

“The most consistent and disturbing finding from the UCL evaluation of the SCR was concern from NHS staff, patients, professional organisations and civil liberties groups about the original ‘implied consent’ model,” she said.

According to the Health Service Journal this new approach provides a simplified model which has the backing of the BMA, Royal College of Nursing, medical defense unions, chief information officers and the General Medical Council.

This change is seen as moving the system in England towards the one chosen in Scotland and Wales, more of a consent to view - however it could be argued that consent to share is still implied as patients will not be asked directly whether they are happy for their records to be shared via the national spine.

The second independent but related announcement, concerns a 12 week "consultation exercise" being run by Tribal Consulting for Connecting for Health giving patients and the public the opportunity to comment on the ways in which their information is used for research and planning purposes and examine the potential benefits, legal safeguards and practical steps available to meet confidentiality and ethical obligations. This follows various criticisms of the ways in which the "Secondary Uses Service/NHS Information Centre" operates, and criticisms of the Care Records Guarantee.

Some of the questions included are:

* Who should have access to patient data?
* For what additional or secondary uses should data be used other than direct care?
* What process should govern access when individual patients can or cannot be identified?
* Who should control and manage access to the information?
* What consent options and safeguards should there be for patients?
* What concerns do people have about secondary uses and how can they best be addressed?

The public consultation covers the use of patient information for uses such as:

* Research into prevention and treatment of diseases
* Improving public health
* Managing and planning future health services
* (Health) planning screening
* Quality control (clinical audit)

It will be interesting to see how much involvement there is from the public and health professionals, although the impressions given by the "experts" on the news release page suggest that the benefits are a given - and runs the risk of suggesting that a decision has already been made to share the information - and that the consultation will only affect how this might be done. According to E-Health Insider Professor Michael Thick (chief clinical officer for NHS Connecting for Health) said people would not give explicit consent to their information being included in the new service, which will collect data automatically from the NHS CRS, Choose and Book, and other national systems. He also indicated that patients would not be able to opt out, although they will be able to apply under section 10 of the Data Protection Act to prevent use of data that would cause them distress.

As discussed on this blog when the report, entitled the Data Sharing Review by Richard Thomas, the Information Commissioner, and Mark Walport, the director of the Welcome Trust, came out in July, there is a major difference between anonymous and identifiable personal data. When Connecting for Health say that " while patient identifiers will “normally” be removed from the information “sometimes” these will be required", alarm bells should start ringing.

The safeguards provided by NHS Research Ethics Committees need to be very carefully examined if they can grant access to pseudonymised and in some cases patient identifiable data, as well as anonymised records.

According to PULSE the consultation will also raise questions over the extent to which the NHS should be sharing data with external researchers. Last year Connecting for Health’s subcontractor BT suggested in a written submission to the Health Select Committee that pseudonymised patient data could be shared with pharmaceutical company researchers to earn the NHS cash.

The invitiation to consult along with supporting documentation can be found at http://www.connectingforhealth.nhs.uk/systemsandservices/research/consultation and I would encourage everyone with an interest to get involved.

I feel these two announcements suggest that the balance between patient confidentiality/privacy and the demands of governments and other organisations which trawl personal data need to be very carefully observed.

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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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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 http://www.ucl.ac.uk/media/library/screvaluation, 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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Sunday, February 24, 2008

Full text of Downing Street briefing

The 2002 Downing Street briefing about NHS IT discussed below has now been realesed in full text on the wikileaks web site under the heading "Tony Blair 2002 NHS IT briefing" at https://wikileaks.be/wiki/Tony_Blair_2002_NHS_IT_briefing .

Wikileaks is an uncensorable version of Wikipedia for untraceable mass document leaking and analysis. It combines the protection and anonymity of cutting-edge cryptographic technologies with the transparency and simplicity of a wiki interface. Comment and discussion, which can be anonymous, is welcomed on the site.

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Tuesday, February 19, 2008

The meeting which started NPfIT

Computer weekly has several pieces themed around the papers recently released after 3 years of a Freedom of Information Act request. There give some detail about the briefing held in Feb 2002 at which Department of Health staff and industry advisers from Microsoft UK and Cisco laid out plans for IT in the NHS to Tony Blair and several ministers.

* Was NHS IT plan agreed before Downing St meeting?

* Secret papers reveal Blair's rushed NPfIT plans

Coming in the week when we hear that "More than £4bn spent on NPfIT by April 2008" they illustrate the lack of careful planning on which the whole enterprise was based.

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Tuesday, February 05, 2008

Forthcoming release of "Downing Street Papers" re NPfIT

After three years of requests under the Freedom of Information Act Tony Collins of Computer Weekly has finally been successful in his campaign for the release of the briefing papers which led to the creation of the National Programme for Information Technology (NPfIT) in the UK's National Health Service.

A piece entitled "Secrets of Blair briefing on NPfIT to be surrendered" gives further information about the process which has finally led to the release which is expected this week. In a similar way to my own campaign for the release of the report into the NHSu the cabinet office have withdrawn their appeal against the Information Commissioners ruling just before the case reached the Information Tribunal.

I'm sure the papers will make interesting reading.

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Thursday, September 13, 2007

Major reports on NHS & NPfIT

Todays publication of the House of Commons Health Committee into Electronic Patient Records along with yesterdays Report Our Future Health Secured? A review of NHS funding and performance for the King's Fund means I have lots of reading to do - which is getting in the way of preparing a major document for my DPhil.

I've not got all the details from the Health Select Committee report yet but have spotted a couple of conlusions which I think point out some of the problems they have identified in the NHS's National Programme for IT and Connecting for Health approach:

NPfIT is characterised by a centralised management structure and large-scale procurement from private suppliers. This approach aims to offer improved value for money and to address the previously patchy adoption of IT systems across the health service. The Department defended the progress made by NPfIT to date, arguing that the programme is on course to succeed. However, serious doubts have been raised, from sources including the Public Accounts Committee, about how much has been achieved and about the likely completion date. In particular, progress on the development of the NCRS has been questioned.

The input of end-users is vital in planning, design and implementation.

As EPR systems make more personal health data accessible to more people, breaches of security and confidentiality must be regarded as serious matters.

The arrangements for the SCR will be strengthened when "sealed envelopes" are made available to protect sensitive information and when patients can access their record via the HealthSpace website... Connecting for Health must ensure that both "sealed envelopes" and HealthSpace are introduced as soon as possible, particularly so that their effectiveness can be assessed during the independent evaluation of the early adopter programme.

The sharing of unique smartcards between users is unacceptable and undermines the operational security of DCR systems. However, we sympathise with the A&E staff who shared smartcards when faced with waits of a minute or more to access their new PAS software. Unless unacceptably lengthy log-on times are addressed, security breaches are inevitable.

I'm sure there will be more to follow and that this report will generate wider interest - but if others have comments please add them.

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Wednesday, August 22, 2007

IBA bidding again for iSoft

The continuing saga of troubled iSoft had another twist this morning (& those of us in Australia probably got it a few hours ahead of colleagues in the UK). IBA has put in another increased bid (available from the Australian Stock Exchange by searching announcements for IBA at http://www.asx.com.au/asx/statistics/announcementSearch.do
to buy the company, following it's controversial previous attempt, and the iSoft boards acceptance.

It has certainly generated some discussion at the Medinfo conference and it will be interesting to see the response from CompuGROUP and the NHS NPIT.

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Tuesday, August 21, 2007

CW FOI case for Downing Street NPfIT papers

I was very interested to read about this attempt by Tony Collins of Computer Weekly to obtain the Downing Street papers about the creation of the National Programme for IT (NPfIT).

There are so many parallels with my long Freedom of Information request to obtain the report into the NHSu - I just hope that my eventual success is securing release of the Wells Report is able to provide some precedent in opening up the government/Connecting for Health secrecy about the whole process.

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Thursday, April 26, 2007

Health Select committee written submissions published

The written submissions of evidence to the House of Commons Health Select Committee (relating to evidence submitted about NPfIT) has now been published on the committ'es section of the House of Commons website.

See >>> or tinyurl.com/3yggw8 for all the links. Thanks to Ewan Davis, of the BCS Primary Care Specialist Group, for pointing us to this. The materials present include written submission from the British Computer Society (>>>), compiled mainly by the BCS Health Informatics Forum, and the Royal College of Nursing (>>>)

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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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Thursday, April 19, 2007

Public Accounts Committee Report on NPfIT

I only noticed today, when this week's 'Computer Weekly' popped through my letterbox (yes, the dead tree version) that the Public Accounts Committee's latest report into NPfIT was published on April 17.

Some points from the report's Summary, which has four conclusions, include:
- no firm plans have been published for deploying software to achieve the vision of a shared electronic patient clinical record;
- the suppliers to the Programme are clearly struggling to deliver, and ... the Department [of Health] is unlikely to complete the Programme anywhere near its original schedule;
- the Department has much still to do to win hearts and minds in the NHS, especially among clinicians;
- four years after the start of the Programme, there is still much uncertainty about the costs of the Programme for the local NHS and the value of the benefits it should achieve.

Computer Weekly say that 'The government is expected to respond to the report and its recommendations by July.'

I don't think any comment is needed on the above - but may feel a need to provide some when I have been through the full report.


The report is available via the the House of Commons website >>> and the Computer Weekly report on their website >>>

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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 | 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?

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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:

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

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

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Friday, December 08, 2006

Digital healthcare: the impact of information and communication technologies on healthcare

Digital healthcare: the impact of information and communication technologies on healthcare

The influential Royal Society has today published it's long awaited report into "The impact of information and communication technologies on healthcare."

I'm still making my way through its 59 pages but it does seem to provide an interesting contribution to current and future debates.

A few of their comments and recommendations jumped out at me as being particularly significant and useful:

"The single most important factor in realising the potential of healthcare ICTs is the people who use them. The end
users of any new technology must be involved at all stages of the design, development and implementation,
taking into account how people work together and how patients, carers and healthcare professionals interact.
"

"We recommend that the higher education institutions and professional bodies responsible for the different disciplines adapt their curricula to integrate the use and understanding of healthcare ICTs into the basic training and continuing professional development of healthcare professionals."

A long with various recomendations about implementations and research needed to underpin future developments.

For further commentary see:
EHI Existing ICT underused, Royal Society finds

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