Report of;

conference organised by the British Medical Informatics Society and the Royal Brompton & Harefield NHS Trust. Held on 19th January at the National Heart & Lung Institute, London.

By Rod Ward, Lecturer, School of Nursing & Midwifery, University of Sheffield, UK

Speakers;

Peter Drury (Head of Information Policy, NHS Executive)

Peter, who was appointed to his new post the day before this conference, gave an overview of his perspective of the "Information for Health" Strategy. He described the political and social context of the strategy and related it to recent governmental initiatives, including more fluid information transfer and even the "lowering of the Berlin wall" between health and social services.

He briefly addressed the tensions between central policies and guidance and Local Implementation Strategies (LIS) which was returned to by several speakers during the day. The importance of clinicians and increasingly well informed patients and their demands and expectations of the health service was seen as one of the drivers, with a target of making the public sector as responsive as the private sector to public desires.

He concluded by saying that he saw the implementation of the "Information for Health" strategy as an exciting challenge which has the potential to completely transform the way the NHS works and interacts with patients and the public. He saw the "aggressive" timescale for delivering cultural and technological change as only being achievable through a range of partnerships between varied stakeholders.

Ben Toth (Information Manager, NHS Executive South & West)

Ben, who was deputising for his boss Muir Gray, described current work in progress towards the National Electronic Library for Health (NELH), comparing it to "portals" on the Web. He examined the likely data structures, using XML to provide rapid short answers to clinical questions generated by users and/or clinical information systems. These would then link to further evidence supporting these recommendations for care.

He identified 4 groups of users and explored the analogy of floors in a traditional library to examine how the different needs of these user groups might be met. The relationship between the NELH and national guidance, pathways and protocols of care emerging from the National Centre for Clinical Excellence was highlighted.

Wayne Mills (Head of IM&T, Royal Cornwall Hospitals NHS Trust)

Wayne described the work which has been ongoing in Cornwall for the last 7 years and how it fitted with the proposals from "Information for Health" with no change in direction needed. The method described of separating information to be held in "data warehouses" from clinical systems, was held up as a model for others and enabled changes in one data set to be automatically passed to other components of the system.

The unique geographical situation and the structural system of health care in Cornwall was seen as a benefit in reducing the number of trusts and other organisations with which data sharing was needed.

Paul Cooper (Integrated Medical Solutions)

Paul attempted to give the suppliers side view. He welcomed the recognition of suppliers as stakeholders, and some of the changes in funding arrangements for I.T. procurement projects, but described his worries about the development of standards and specifications. This he felt limited the opportunities to develop systems capable of being used to take the strategy forward.
 

David Robinson (NHS Centre for Coding and Classification)

David described, in some detail, the history and working of the NHS Clinical terms implementation (Read Codes). This included an explanation of coding structures and quality control mechanisms.

Paul Charnley (Head of Informatics, Wirral Hospitals NHS Trust)

Paul followed David’s exploration of the structure of the NHS clinical terms with a more practical (and understandable) description of how the terms have been implemented into their hospital information system. He pointed out both advantages and disadvantages in practice. Sample screens illustrated the pathways used by doctors in some specialities to ease their patient management.

Jo Milan, (Head of IM&T, Royal Marsden NHS Trust)

Jo described the implementation of the Electronic Health Record (EHR) and it’s relationship to the Electronic Patient Record (EPR). He argument for limiting the amount of coding of data, concentrating on coding events while allowing clinicians to use free text for the record itself. This was, perhaps, the most coherent, and best thought out presentation of the day. This seemed to give many of the other speakers and delegates food for thought.

Anne Sutcliffe (NHS GPnet Project)

Anne finished the formal presentations with an overview of the GPnet project linking GP surgeries with pathology laboratory systems, particularly concentrating of the hospital end of the links. She described how all GP systems had agreed and implemented a common standard to enable this information to be exchanged, but each hospital had implemented a different system. The negotiations with the bodies representing the clinicians involved was also considered. She outlined some imminent guidance which will lay down the ways in which hospitals need to transmit this data, and how the implementation of this may require totally new systems to be put in place

The day concluded with a general plenary session to consider some of the issues raised.
 

General themes of the day

A recurring theme of the day was "Joined up" information and health care, this was interpreted in different ways, but shows an admirable objective for future developments, however many of the speakers also highlighted many of the difficulties which will be encountered along the way.

A recurring theme on the technology side was the significance of XML as a way of coding information to enable its recovery from databases, whether this was from "the literature" or patient records. Another area commented upon by several speakers, and in question and answer sessions, was the integration architecture and the level of standardisation of records to allow information exchange between the disparate parts of the NHS.

The wide range of well informed individuals attending this conference enabled some good sharing of information, but  highlighted the fact that there is still a great deal of confusion about the route we will be taking over the next few years to implement the "Information for Health"  strategy, and debates will continue about the balance between central guidance and policies and Local Implementation Strategies.

It appears that there is the political will, and technical capability to drive the strategy forward, however we are still awaiting the definitive evidence of the benefit for patient care.

Page Created: 19.1.99
Last Updated: 30.8.03