This massive conference and exhibition took as it's theme the use of information, its management, and the technology to support it, in clinical practice. The word challenge should, perhaps, have been written in capital letters as many major and ongoing difficulties were explored and recognition given to the paucity of information used to support clinical practice.
Key issues sessions covered many areas but the majority were related to the electronic patient record (EPR), its potential benefits and "real world" problems faced, not least issues around confidentiality. These were tied to the future of the health service and the relationship between primary and secondary care. Also high on the agenda was a debate about the effectiveness, or otherwise, of the private funding initiative (PFI) in major information systems projects. Perhaps the most upbeat of the presentations was one surrounding the use of Robotics and Virtual reality.
The electronic patient record is an attempt to produce a multimedia record, built around each patient rather than hospital departments or GP surgeries, which would be accessible to any staff in the NHS. Several speakers, including Prof. Martin Severs (Medical Director, Portsmouth Healthcare NHS Trust) described the potential benefits of immediately accessible, and usable patients' records, in reducing duplication and improving patient care. Potential and existing problems were identified, and related to a history going back 20 years. Technological issues were seen as being less significant than human and organisational difficulties.
A major theme which connected to discussion around the EPR was related to the confidentiality and security of electronic records. The medico-legal status of the record was examined, from UK, European and world-wide perspectives, including a paper by Elizabeth France (UK Data protection Registrar). Delegates were exhorted to maintain accurate and complete audit trials of changes made to records. A consequence of this was the inability ever to delete patient records.
Effectiveness/cost of IT
The massive cost of the implementation systems on local, regional and national levels were considered, and measured against potential benefits which are still difficult to quantify. The importance of measuring the effectiveness of IT was discussed by Dr Jeremy Wyatt (Consultant in Medical Informatics, Imperial Cancer research Fund), who summarised a range of studies looking at cost benefit analysis and, most importantly, benefits to patient care. The potential for qualitative studies related to systems design and user interface were accepted but randomised controlled trials were still seen as being the "gold standard" in evaluating systems.
The changing face of UK healthcare, including the merging of FHSAs and DHAs, were cited as examples of organisational processes which complicate the use of information systems to support patient care.
Some examples of benefits were provided in a range of healthcare settings e.g.. Midwifery (Helen Betts, School of Health & Community Studies, Winchester) and primary care where examples of electronic patient record systems (Dr Michael Bainbridge, BCS Derby) ways of presenting data (Dr Glyn Hayes, BCS Worcester) and quality control (Margaret Falshaw, St. Bartholomew's) were discussed.
Several papers addressed issues relating to education and electronic information systems. The needs of staff for education and training, not just about particular software applications, but also about the whole process of information management were considered, e.g. Christine Allen (Norwich Community Health Partnership), Sue Kinn (Nursing Research initiative for Scotland) & Dr Shaharudin bin Mohamad (Medical Development Division, Ministry of Health, Malaysia). My own paper addressed the use of the World Wide Web in the provision of education for health care staff. The current levels of access and use were considered by Christine Urquart (Health information Management team, University of Wales)
The acceptability of computerised information systems, and the development of improved interfaces, for patients and clients were also considered (Fatima Al-Barwani, Department of Public Health, University of Glasgow).
Telemedicine, Imaging & Virtual Reality
Some of the more forward looking and optimistic papers centred around the use of networks in the sharing and distribution of information and using cutting edge technology to improve patient care. The World Wide Web, Video-conferencing, teleradiology and Virtual reality were discussed or demonstrated, illustrating some present and potential applications, which we may see growing over the next few years as compression algorithms and data transmission improve.
A wide range of satellite sessions were held during the conference, many hosted by exhibitors, which addressed a very wide range of related issues and technologies.
I found the launch of the British Medical Internet association particularly interesting. It is an example of "bottom up" rather than "top down" development. A group of interested and enthusiastic practitioners from a range of clinical disciplines, banding together to provide a lead in this expanding area.
The exhibition had stands from a wide spectrum of health related technology firms. Ranging from Microsoft to Ordinance Survey giving visitors the chance to evaluate and explore a variety of products. Whether any sales were actually made I don't know but the ability to fill 4 large halls with exhibitors, when stands cost thousands of pounds shows that the healthcare technology market is massive and, it appears, still vibrant.
The varied papers and exhibitors at the conference and exhibition represented many interested, and interesting points of view in relation to healthcare computing.
Examples were available of how we are moving towards information-led healthcare, but there were also many areas in which that clinical challenge is still to be overcome.
The full proceedings of the conference are available from:BJHC Ltd., 45 Woodland Grove, Weybridge, Surrey KT13 9EQ, UK firstname.lastname@example.org