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HC 2004

Healthcare Computing Conference

Harrogate 22-24 March 2004

A personal review by Rod Ward

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These reports are written on the fly during the conference and posted on the web on a daily(ish) basis, as there are 5 concurrent themes I can not attend all sessions so these comments are based on my own experiences and views.

The official conference web sites is at: http://healthcare-computing.co.uk/

Day 1

The conference opened with a series of keynote speeches in the main auditorium.

Stephen Kay Professor Stephen Kay as the chair of the HC Scientific Programme Committee opened the proceedings. He celebrated the 21st birthday of the conference, and described new developments and invited delegates to suggest further changes for next year. The innovations include a "poster watch" when presenters will be present for Tuesday lunchtime, and a conference review for Wednesday morning (which I believe I am to be involved in), which should enable those who have attended one theme to catch up on developments in other areas which they might have liked to attend but were unable to.

He handled the domestic arrangements (although mobile phones were still heard going off during presentations) and described himself (as usual) as being on tenterhooks over the planned arrival of the minister.
Dr. Glyn Hayes, chair BCS Health Informatics Committee then formally opened the conference. He looked back to the first one 21 years ago, and commented that many of the issues, highlighted by speakers then, are still unresolved today !

He gave a prelude for the launch of a new book (to be released this evening) "Information in Healthcare" which he described as moving towards the patients journey.

Glyn also talked about professionalism, with healthcare informatics "coming of age" as the myriad of specialist groups working more closely together (& ASSIST considering joining the BCS), and the launch 10 days ago of UKCHIP. He presaged a moved towards evidence based informatics where evidence is available to show how improved IT and information use actually benefits patient care.
Glyn Hayes
Wendy Hall The next speaker was Professor Wendy Hall, President of the British Computer Society, who gave a talk entitled "Missing Links".

She started with some news of developments in the BCS focusing on it's role as a learned society and describing a forthcoming recruitment drive and the development of forums and specialist groups to include a Health Informatics Forum.

She described some of her research over many years with medical staff and educators, and included an old video of her working on videodisc and BBC micro, developing hypermedia systems for anatomists.

She used the analogy of the Mountbatten archives and the linkages between parts of them to relate it to modern medical records systems, advocating the customisation of views for different individuals; patients and health professionals, to provide different answers to the same question depending on context. A more recent example was provided by the application of adaptive hypermedia to the web in JOINTZONE developing user modelling to individual needs. Wendy briefly moved on to taxonomies, ontologies and the rules required to make sense of the information and used the example of a dynamic review journal and eprints to illustrate applications, moving towards the semantic web.

She concluded with some "Foresight" work around cognitive systems and "memories for life", focusing on interdisciplinarity and a forthcoming new journal interface from the Royal Society.

She concluded with a clip from "Bruce Almighty" to make a point about the possibility of a "Life in a filing cabinet or on a video - but avoided discussion of the ethical issues which arise from this.
The next speaker was Rt Hon John Hutton MP, Minister for Health (who had arrived in time). He described government achievements in the last 12 months as "having gone a long way" but admitted there was still a long way to go. He focused on the shift from procurement to implementation and called for a dialogue with interested parties and highlighted the importance of engaging with staff and patients.

He traced current developments in healthcare IT to the Wanless report and wider reform of the NHS, with a carefully selected list of changes since 1997, and recognised that Targets are not enough, stating that IT is the key in areas of safety, choice, convenience and equity of health provision.

He commented about a total procurement of £6.2billion and called for a partnership between NHS IT staff and LSPs with frontline staff to improve safety in patient care, in an incremental implementation for ebooking, the NHS Care Records Service (CRS) and eprescribing.

He also commented how the NHS broadband developments would help a wider society and hurdles in the push to turn vision into reality - and focusing on what stakeholders feel is needed.
He announced the appointment of Aidon Halligan to the NPfIT who will work with Richard Grainger and Richard Bacon, reporting to Nigel Crisp in the run up to the retirement of John Pattison - a senior civil servant in this field for many years.
He hoped for the improvement of clinical leadership for an improved NHS as the largest digital organisation in the world by 2010, handling 5 billion transactions a year.

He (surprisingly) took 5 minutes of questions;
Q - Mary Hawking - summary records for GPs
A - "wouldn't dream of arguing with you" but explored what this means.
Q - Fleur Fisher - about particularly sensitive information & security.
A - need to explore - but need TRUST.
John Hutton
Richard Vincent The next presentation was by Professor Richard Vincent (head of postgraduate medical school and consultant cardiologist, Brighton and Sussex university hospital trust), who gave a clinicians view. He gave an analogy of the development of information systems to drug development and implementation.

He revisited the history of IT in the NHS and integration into medical practice and used examples from poor mechanised ECG interpretation and the need for free text in medical records.

His positive comments related to the generation of audit data from operational data, the use of handheld devices and the growth of telemedicine.

He provided some prescriptions for culture and change management with an iterative process and partnership in system design, arguing for realistic expectations and building on previous successes for product development.

After lunch I attended another session in the main auditorium..

The session was chaired by Keith Clough
Mark Outhwaite, Director, Technology in Health Group, NHS Modernisation Agency was the first speaker he addressed "Delivering the benefits of NPfIT: challenges and opportunities". He argued that the challenges are not about IT - but about service delivery.

His key point was that investment in IT doesn't equal high performance but thought that making information available in real time has major implications for how the NHS is managed i.e. requiring a real time response !

He gave a varied of studies (often based on work at MIT in the 1990's) about business process re engineering. A major challenge he identified was the NHS Care Record requiring people to standardise what they do and providing a "receptive context" in terms of; leadership, ownership and logistics.
Mark Outhwaite
Peter Hutton The second presentation was by Professor Peter Hutton who examined "convincing (all) clinicians to use IT systems".

He gave some past history and examined common perceptions amongst clinicians of IT applications, including data showing there is little integration and help in everyday clinical practice, no patient access and that the field is dominated by enthusiasts.

He described major progress achieved over the last 25 years and compared the current situation to major trades 100 years ago.
He described the key being about the transfer of information from clinicians to clinicians and from clinicians to patients.

He went on to explore mechanisms for consultation at local and national levels and the involvement of LSPs and the NCAB.

The next session I attended was organised by the BCS Nursing Specialist Group and chaired by Richard Hayward (vice chair BCS Nursing Specialist group) who commented over names for the NSG. He commented that various speakers had said that what the NPfIT needed was someone to make it work - and described that as what nurses do. Richard Hayward
Heather Strachen The first presentation was by Heather Strachen (Chair IMIA-NI & chair BCS HI (Scotland). who gave an overview of the first 30 years of nursing informatics based on work for a chapter in a forthcoming book. She started with a quote from Roper, Logan and Tierney about learning from history and then gave an analysis of the decades and drivers: Optimistic 50's, Pioneering 60's etc.
  • environmental e.g. population & society
  • nursing e.g. decision making & professional recognition, research based, autonomy & patient partnerships
  • economic e.g. greater demands, improved working conditions, improved education and exploration of nurses value
  • technology e.g. real time computing, increased storage, improved communication, reliability and user friendliness
  • political

She highlighted various key reports and legislation and early pioneering systems both home grown and commercial.

A key point was about the importance of education in information skills and clinical rather than managerial imperatives.

Heather closed with some lessons from the history and reflections on how we had arrived at our current point and where we might be going from now.

The second speaker was Helen Sampson who gave an overview of the roles and work of a range of representative groups including; NSG, NPIG, Nursing Expert group etc, UKCHIP, NCAB. Helen Sampson
Peter Murray This was followed by some challenging questions from Peter Murray about any evidence of real impact from nursing informatics over the last 20 years and whether nursing was reactive or pro-active in relation to informatics developments, and the balance between uni disciplinary and multidisciplinary approaches.
A wide ranging debate then took place with the audience touching on nursing consultation with the NPfIT, the uniqueness of the nursing contributions, encouraging nurses within the wider arena, integration between health and social care records, isolation amongst senior nurses with an informatics remit and communication methods.
This session was followed by the Annual general meeting of the BCS Nursing Specialist group

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To discuss any of my comments please mail: Rod.Ward@uwe.ac.uk

Page Created: 21.3.04

Last Updated: 23.3.04