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HC 2005

Healthcare Computing Conference

Harrogate 21-23 March 2005

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. This year I am attending the conference as a member of the press for the journal Computers Informatics Nursing.

Most of my immediate comments/thoughts/photos etc. will be posted on the conference blog which I have pioneered with Peter Murray. You are welcome to comment on items on the blog or register & have more flexibility over what you post.

The official conference web sites is at: http://www.health-informatics.org/

Day 1 Papers & Presentations

My comments on the papers & presentations for day 1 will appear here.

Introductions & administration was handled by Prof. Steven Kay. He covered changes to the venue with the introduction to the Queens Suite, fire exits, announcements via plasma screens etc. The blog got a mention. Two programmes instead of one (one for conference & one for exhibition)
Changes to BCS HI committee to forum.
Overview of keynote speakers including a newly arranged spot to meet the NPfIT clinical leads.

David Keene (keynote speaker) withdrawn due to illness.
Prof. John Macmanus added to this pm
Roger Roycroft & Julie Slater updating their survey of IT in primary care - added to this pm.

Nancy Lorenzi Professor Nancy Lorenzi - Vandebilt University Medical Centre
She expressed respect for people, leadership & analysis in the UK particularly in relation to telling the problems & failures - I wonder if this is what the UK's Health IT innovation would like to be known for.
Her talk was about transformational change, set in the modern (US) hospital - a complex organisation - overwhelmed by paper - but now all electronic - the left hand & right hand not knowing what is going on leads to stress. - moving to electronic hospital=change (workflow, behaviour & culture.

The success of a project is 80% dependent on social & political skills & only 20% on hardware & software. It becomes difficult when you do things that other people care about. Anew system is more than just hardware & software ; it is about people and organisational change - CULTURAL CHANGE.

People are resistant to change - motivated people will make it work - people who are unmotivated and uncommitted will make the most technologically brilliant system fail.

The second keynote speaker was Dr. Peter Homer, Chief Exec of St. George's Healthcare Trust, who provided some refections on past mistakes and changes in introducing change & a PDF Portable Diagnostic Framework - focussing on benefits for patients. "New technology + old organisation=expensive old organisation". He described the need not just for an economic case, but also for an emotional case for change. He suggested that information systems provide the syntax and grammar for improvement. Peter Homer

Charles Hughes Charles Hughes the Deputy President of the British Computer Society set out a series of examples of high profile IT failures and argued that one of the things needed to address these was an increase in IT professionalism. He described the growing membership of the BCS and changes within the organisation to provide education, training, certification and recognition of the skills of the IT workforce.

The HITEA (Healthcare IT Effectiveness) award winners were announced. The awards for Best use of IT in the Health Service and Best innovative use of technology, were won by Good Hope Hospital NHS Trust's project - redesign of a vascular surgical outpatient service using discrete event simulation. HITEA awards

The afternoon started for me with a panel session on health informatics education, with a report of the Education Steps think tank which took place on Thursday & Friday of last week. The session was chaired by Dr. Glyn Hayes & started with some context setting by Prof. Graham Wright, who highlighted some of the difficulties in clarifying the purpose and method for the think tank.

I gave the next presentation describing the process which was undertaken, and then Dr. Evelyn Hovenga kindly gave a delegates perspective on the think tank - confirming that we need to take the work forward on an international perspective to clarify the ontologies, definitions and domains of health informatics. The presentation went through the process - some long words but got the detail across. Pictures showing the process actually happening; the wonders of digital cameras for capturing real-time evidence!

Jean Roberts then described some of the initial results from the think tank covering 14 broad areas in health and social care informatics, highlighting some of the ponds and ducks identified and some of the problems of not having shared definitions.

Peter Murray concluded the presentations setting out how the work is being taken forward via the Education Steps Think Tank web site using Wiki's and various shared documents and reports at various conferences. The intention being to gets lots of people involved in the work to take the debates forward, possibly as a joint development with IMIA & other groups.

The discussion started with consideration of whether Health Informatics should be a discipline - as in other sectors it has become a part of everyday work. The importance and safety aspects for healthcare delivery was raised. Delegates who had been at the think tank added in their own perspectives about the learning and debate which had taken place, and gave examples of the use of information systems in healthcare & whether lessons were being learnt by the national Programme for IT in the NHS. Emphasis was given to the complexity of information from the patient clinician and identifying the needs of different groups.

Interesting and interested audience - for example academics and their students, health AND social care colleagues.
Duck juggling has become an art form, understood or at least recognised by many.

During a session on surveys, Dr Jim Briggs from Portsmouth University presented the results of a survey of the ISABEL system. He started by describing the service and it's purpose and use, initially for junior doctors for the diagnosis of children, which has now been expanded to include adults.

The evaluation included log data analysis, which showed the number of pages visited and who had used it and when over an 18 month period. The logs showed little use by most users but less than 10% used it on a regular basis. Most UK users were accessing via .nhs.uk IP addresses (but firewall problems limited further analysis.

It also included a 24 item questionnaire survey to over 4000 UK based users, which asked about the users role & work setting & IT facilities, & familiarity with IT & frequency of use. 518 responses were received (12%) & included most of the regular users & a few who didn't use it on a regular basis. They compared paediatric specialists with non specialists, it included measurements of how frequently they used it and what they used it for - most were for "difficult" cases - and ease of use factors.
Interesting findings included the differences in IT & Internet access depending on their grade, specialism & whether in primary or secondary care.

Conclusions were that at the time of the survey there were a small number of dedicated users - but provided a useful tool for many more, and that to encourage use IT access needed to be addressed and to make it a part of clinical protocols and highlighted it's use in education.

The report is available from http://www.disco.port.ac.uk/hcc/projects/ISABEL
Jim Briggs

Dr Charles Docherty Dr Charles Docherty from the School of Nursing, Midwifery and Community Health Glasgow Caledonian University then presented information about a collaborative project in preparation for electronic health records. He described a project which looked at skills, software etc. for nurses which were not present. They also used observational research looking at who used hardware & when.

They looked at how computers could be used to reduce the bureaucracy in a 6 months project to highlight issues, with a literature review and consultation with experts and site visits.

Differences between the English NPfIT & differences in Scotland & Wales was highlighted, and disconnected systems in Scotland criticised.

he then went on to consider the engagement of nurses in comparison with other professions (e.g. Drs) and gender differences in relation to IT, which is significant as 90% of nurses are women and he provided an overview of the literature to support this view.

The need for education and training was discussed, including the ECDL - which is not available in Wales & Scotland - need political drivers & to get IT & Health Informatics into the curricula - perhaps with the NMC specifying IT skills in competencies for registration.

He finished by looking at projects being undertaken in Glasgow and in the wider nurse education fields to address some of these issues.

Questions suggested that he ECDL wasn't necessarily appropriate & that the profession could come up with their own competencies.

Rosemary Currell finished the afternoon session presenting results of an on-line survey of nurses and their views of NHS information developments, by the Royal College of Nursing. The context was set out and the aims of the survey to find out about nurses views of the importance and then the training needed. It was carried out by Nursix and is closely related to a similar study by Medix of doctors.

The sampling issues and representativeness of the survey conducted on-line were mentioned but not really dealt with - with justifications made about speed and cost.

2020 responses were received 15% male 85% female with all 4 countries represented, & various specialities, levels of experience etc. represented.

The questions about awareness of IT developments showed few saying that they had little awareness and only 2% saying they had fully adequate information. Examples were given of respondents comments highlighting problems of information management. and suggesting what they wanted from informatics services - perhaps summarised by wanting improvements in communication and shared information including with social care services.

Nurses described having to enter data into systems for managerial purposes without seeing anything back which helps them with the care they are delivering.

The demands of nurses who answered the survey were represented; equipment & access, 24 hour support, and education and training were high on the list. Issues around standardisation were also addressed demanded by survey respondents, and equity across all areas of the NHS.

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My reports of HC 2001 conference , HC 2002 conference & HC 2004 are also available

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To discuss any of my comments please mail: rod@rodspace.co.uk

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Last Updated: 21.3.05

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