Healthcare Computing Conference
Harrogate 20-22 March 2000
A personal review by
Papers & presentations;
N.B. I could not attend all sessions - there were 5 streams at any time - so these are my personal perspectives on the papers I attended.
This report is written in short spaces between presentations and meetings (both formal and informal :-). It will be tidied into better English & presentation later - please accept it in that fashion as a daily report. URL links have not yet all been tested. The official Conference and exhibition Web Site is at: http://healthcare-computing.co.uk/HC2000.htm
Papers & presentations
Social activities etc.
Topics raised included; Education & Training, Electronic Patient Records, Patients withholding information, NHSnet links to Government Secure Intranet (GSI), relationships with the private sector & voluntary services. Questions were generally sidestepped - Politicians / civil servants answers.
Implementing Information for Health
Prof. Alistair Bellingham - Chair, NHS Information Authority (NHSIA)
Nigel Bell - Chief Exec NHSIA
Intro to NHSIA & how it works. described purposes & activities over the first year and outlined it's national remit and relationships with "stakeholders". A vision for the future as a group of key people in moving forward the information rich culture within the NHS.
Nigel's cube of stakeholders, capabilities and delivery was described & the executive team at NHSIA.
Information skills were described as core to clinical practice & management. The requirements to make Information for Health (IfH) work at national & local levels, sharing experience and using a modular approach rather than massive isolated projects. The underlying communications infrastructure will be put in place and other necessary components explored.
Nigel explored the various stakeholders involved & described the portfolio management approach and said realistically that risk could not be eliminated if outcomes were to be achieved in a limited time frame. The need for an open and transparent approach to resource allocation was recognised.
The future plans for the NHSIA and how it will work were set out, achievements so far described and future deliverables to be achieved listed. It included developments with NHSnet, nhs.uk. Data sets for various target populations and data quality. Knowledge management and learning including virtual classrooms & learning networks, mechanisms for sharing information, national standards for IfH & the NeLH prototype & virtual branch libraries. patient care including EPR & ERDIP demonstrator sites, & data standards.
Spent year setting up - but when are we going to see some benefit in my
Suggested some benefits would arrive this year - however then debated funding & resources
A key question which was alluded to but not answered was what has happened to the "ring fenced" modernisation money, including IfH - which appear to be disappearing into waiting list initiatives and other work !!
Did the speakers see a need for Independent evaluation of the strategy
and it's implementation?
Supported in principle
Development of EPR (Electronic Patient record) model
Recognising current problems & alternative solutions discussed.
Clinical Protocols - idols with clay feet?
Prof. Richard Vincent, Consultant Cardiologist, Royal Sussex County Hospital, Brighton.
This started with the olden days - where the experience and observation of the expert, based on tradition and experience - but no recognition of normative of expected outcomes. Clinical practice was isolated & rarely shared. He also commented about the changes in the relationship between clinical practice and management with the growth of audit.
He described a change in culture with a growth in clinical evidence, leading to a problem of information overload & incorporating these into practice. A new philosophy of the right way of doing things was explored. This was accompanied by a more inquisitive media and public.
He described a range of responses from professionals some incorporating these initiatives enthusiastically others resisting them. Guidance documents were seen as including; clinical guidelines, protocols, codes of practice, practice standards and patient care pathways. These overlap and have some common features.
Benefits were said to include a distillate of best evidence, educate and give confidence and help to justify clinical actions. they can be seen to promote the uniformity of care, but this is difficult to measure, audit & compare.
Challenges were identified e.g. Design - no agreed methodology, Ownership - a wide range of organisations and individual involved (I.T. may help to overcome this), Accessibility - getting hold of protocols & distributing them (again IT to the rescue), Timeliness - evidence always changing, Authority & legal standing comes from the team issuing them but no legal basis. Application - the patient may not fit the guideline & be on multiple therapies.
This was very much a medical view and perhaps a little paternalistic towards patients, but raised some relevant issues about future directions.
Information for health: progress priorities and plans.
Implementing Information for Health (IfH) - A view from the front line - Richard Gibbs Chief Exec Kingston & Richmond HA.
Richard described the overload for Chief Execs & trusts to implement all of the priorities being set by central government for NHS. He suggested that IfH is part of the solution rather than the problem, and gave examples to support this e.g. PCT EHR & Integrated Care Pathways., direct booking projects, informing the public
He said that IfH is not about computerising what we do now - but it's about re-enginering the way we deliver healthcare. Streamlining the experience for the patient and simplifying it for staff. The importance of clinical representatives driving the process forward was highlighted. This means it is about changing the culture with ICPs & clinical networks & teamworking with people who do not meet face to face. This involves sharing information and exposing clinical practice, which may be threatening, and involves major challenges for everyone from Chief Executives down.
He identified some risks as with Korner data used for management rather than clinical work. "Hitting the targets but missing the point".
The chief executives information forum - representing the service ?? A survey has shown a need to avoid reinventing the wheel in each trust - therefore the building blocks & standards need to be set centrally, with demonstrator sites.
A positive and upbeat presentation, which, while recognising the inherent
risks, painted a positive picture for the future.
Information for health: progress priorities and
Head of NHS Information Policy Unit - Peter Drury
Partnerships - National bodies formed, networks & regional forums emerging
Progress - NHS on net, project connect, IM&T procurement review, Cancer information strategy, Electronic Records Development & Implementation Project (ERDIP) - announcement soon, Security & confidentiality, information sharing, SNOMED clinical terms,
Priorities - Information underpins Sec of states 13 priorities
Plans - delivery over next 12 months, learn form LISs, intercept strategies with e-Government (published early April), focus on EHRs
People - behavioral & cultural change, joined up approach; continuing professional development, NHS leadership programme, local education consortia - develop over time, Education & Development (EDAs) - each LIS should include ETD strategy. - Nationally - developing information & information management skills (ECDL approach), learning networks & virtual classrooms & learning zones - making sure they support service.
Problems with local variations, & agendas - wait for the pilots but do it now !!!
"Notionally" Ring fenced money for IfH & being taken for waiting list initiatives etc.
Serious problem - caused some discussion & comments from audience.
The Nursing and Education papers started on the Tuesday morning;
My own paper "What UK nurses, Midwives & health visitors want from an internet service" kicked off.
Nursing and Health informatics education and training: problems disguised
Examined a paper by
Nelson from 5 years ago which identified 5 problems areas in getting
informatics into nursing curricula. Peter then updated these areas with a UK
bias. Highlighting where we had moved on and those areas where we haven't.
Are IM&T educational resources effectively used to underpin the
training of students for managing clinical information.
Graham reported on a survey looking at informatics in nursing curricula at all levels and examined why many of the resource available are not widely used (or even known about) in schools of nursing.
Are nurses excluded from the Web
Prof. Denis Anthony
Definitions of exclusion were discussed and then applied to the Web since 1993, and examined some of the barriers to web use. Most data was both UK & US based.
Gender difference was seen as a significant factor for nurses. He also examined ethnicity among online users but this was less significant than income. Variations around the world were highlighted.
Specific issues related to Nurses in the UK were also examined primarily based on the users of Nursinng-Standard Online, including access issues and seniority. A major issue for national nursing organisations having internet access was GDP. He concluded with a moral question suggesting who research & government monies etc. should be focussed.
accuracy of data, interface issues etc.
Access in mental health trusts, lack of education & training (basic skills), & access restrictions in sites.
Discussion of training issues & best ways of doing things.
Quality - The Patient perspective
Bobb Gann Centre for Health Information Quality & Help for Health trust
Bob set the case that "Information works" particularly in relation to quicker recover and participation in care. He described the quality triangle used by CHIQ and the development of the DISCERN instrument for the evaluation of patient information leaflets and other resources.
The major initiative described was the development of
NHSDirect Online. The launch was
described and the 1.5million hits in the first 24 hrs !!
The current 2 year Phase 2 development was outlined including the context, commissioning of resources, new redesign (launched today), and new functionality's e.g. online chats being included. The user feedback already received was openly explored. The most popular section so far being conditions and treatment rather than the self care algorithm. The major demand from users is for an email inquiry service. The developments generally fell into content, access and interactivity.
Perceptive questions from the audience further explore some of the areas raised.
I then spent some time with the BCS stand and met several people from a range of backgrounds and projects. We also watched the key points from the Budget speech via a range of "tickertapes" on news sites and compared the technologies involved in providing instant news services.
My final formal session of the day was
E-learning in the NHS : value for money?
The Platform for Delivery: is it ready
Jean Roberts Phoenix Associates
The levels on which e-learning can be used were described as: Awareness, Training & Education.
Questions were asked around in the areas of :
Virtual Classroom Scoping
Gary Nestor Sowerby Centre for Health informatics
Methods and results from the NHS sponsored Virtual Classroom Scoping study.
A Training Needs Analysis in the NHS needs to be linked with the technological
status and resources developed tasking appropriate account of the Data
Protection Act (DPA)., copyright and intellectual property rights.
The validation and assessment issues for E-learning were briefly touched on.
NHS Learning Jigsaw Puzzle
Alan Drury Salford Royal Hospital
A currently under development project as a collaboration between the trust, university & IHI. Initially addressing mandatory training ( e.g. Fire & manual Handling) delivery in limited time. Importance of coherent Education & training strategy
The Key URL for these papers is: http://www.hop.man.ac.uk/NTDLNet
This session concluded with a panel discussion from the speakers and other
experts and did explore some the the issues raised with the audience.
Wednesday started for mke with;
Working Together with Health Information: information management,
education, training and development in the new NHS
Working Together with Health Information: next steps
Strategy "Working together with health information" published in
December (after being promised for April).
Developments & focus now on enabling behavioral change and development. A overview of the models being adopted.
Developing the right information and IT skills
Di Millen & David Miller
Basic IT skills for all & ECDL. part of modernising agenda & adoption of national standard (ECDL) - current pilots & likely recommendation for all NHS staff.
IM&T Professional Awards - work based academic qualification for both IT & clinical staff in the NHS - awards at Certificate, Diploma & Advanced diploma levels.
Learning to Manage Health Information - sets Expectations for learning - but does not say how it will work in the NHS. A range of supporting tools and documents were described - available from the web site;
Finding the Right Help
David Miller & Di Millen
Regional learning networks (Trent pilot) objectives described, supported by action learning, along with the scope, membership & benefit.
The Virtual Classroom
Potential for this project outlined & targets for the next year. Target groups include: clinical information project leads, Caldicott Guardians, Clinical governance leads. Close ties with NeLH, but separate project. Currently researching existing e-learning & identifying future directions of internet based learning likely to evolve over the next few years.
Role of Education and Development Advisor described at national, regional & local level.
Discussion of some of the issues with speakers and the audience.
The Future of NHSnet
Bob Grindrod NHSE
Bob focused the near future of NHSnet, he described the achievements over the last year and put down recent criticisms in the preess eg "A climbdown over GPnet" but included some honest comments on those areas that haven't done so well.
He described Project Connect which was launched by Alistair Liddell on Monday - highlighting Establishing needs - and then meeting them.
Issues around Email/messaging (X400 is not being got rid of), Directory and
address book services and Cryptography for the protection of Patient
information were discussed.
NeLH - progress and plans
Ben set out an overview relating to conatnt, local delivery & VBLs (Virtual Branch Libraries)
Comments about the diversity of branch libraries - but also the underlying structure.
Management of depression in primary care
Andre Tomlin & Karin Dearness NeLMH
collecting of good quality resources for the library & the tools to access & use the branch library.
Currently prototype running, will be in 5 langauges (using Babelfish from Alta Vista), patient friendly summaries of evidence, Bobby approved, WAP enabled, VXML, audio & video clips. touch screen & digital TV & Dreamcast
15 second summaries, 2 minute CATsummary, list of links to full text
MeSH heading + ICD 10
Variety of search options
NeLH for Diabetes Branch Library
Dr CK Khong
tied to antional service framework (NSF) for diabetes
Bulding the knowledge platform
The NeLH for Primary Care (NeLHPC)
Simon de Lusignan
Experience with Drs desk project
Hypertext Hierarchy (deisgn & indexing)
Moving between systems
context specific information
NeLH Guidelines databse - An intrroduction
6 month project - just started.
deliverables - XML DTD, criteria, fit to NeLH search engine & report
lessons learnt for future policy.
The exhibition was massive as always at these events with a range of
businesses selling hardware, software and concepts for health care development.
The halls were well signed & a hum of discussion, and a wide range of presentations.
This year the University of Sheffield School of Nursing & Midwifery "bussed" in several hundred students over the 3 days. They seemed a little overwhelmed but enthusiastic about they things they saw (and they got lots of pens & notepads etc.), perhaps without a clear idea about what they were supposed to be getting from the experience.. I have also seen several staff from the school.
I wonder about the commercial model for exhibitors, with costs starting at £300 per square meter. But as one put it to me if you weren't at HC it would be noticed and questions asked about the future of that IT company.
The conference dinner on the Tuesday evening, at the Majestic Hotel, was a very friendly and lively event. The Abba and Village People tribute bands put on good shows and the sight of various senior people doing the actions for YMCA was worth the entry price. the DJ recognised that the Seventies was not just about Disco and found some Rock & Roll discs. The bar had sold out of Black Sheep (the only decent real ale available) again ! A Roulette table, at which Graham Wright made a fortune (fake money), handed it to Peter Murray who made even more and then lost the lot ! provided an interesting distraction. The entertainment went on well into the night although I know od at least one professor who had to be put to bed before midnight.
The theme which hit me from day 1 was about the loss of the ring fence around IfH monies.
Tuesday seemed to me more positive with reports from various development and showed a convergence between technologies and the realities of healthcare.
Several people commented that they were actually having to set time aside to visit the exhibition because of the quality of the presentations - surely a compliment to the organising committee and scientific programme committee.
It is perhaps more realistic than last years
conference, which was buoyed by positive optimism about the publication of
Information for Health, and now reflects the work involved in making the vision
in IfH a reality.
During the conferences I invited other delegates and visitors to give some comments or thoughts on the conference.
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