Health Care Computing Conference 1999

Harrogate 22-24 March

A personal review by Rod Ward

Large Parts of this review were published in ITIN 11(2)
available from: http://www.man.ac.uk/bcsnsg/itin11/cont0699.htm

Day 1 - 22.3.99

Day 2 - 23.3.99

Day 3 - 24.3.99

General thoughts

Day 1 - 22.3.99

The day started with an opening ceremony followed by Sir Alan Langlands (Chief Exec NHS) discussing "The opportunities for information to transform healthcare and improve the health of the nation", and the 1999 Healthcare IT Effectiveness Awards & case histories.

During the morning I explored the exhibition which, once again, had hundreds of stands ranging from the NHSE to small and large software companies and suppliers. The exhibition was quieter than my last visit (2 years ago) and a few significant stands were missing.

Approximately 40 students and a few staff from the University of Sheffield, School of Nursing & Midwifery arrived to visit the exhibition. When I saw them early in the afternoon they were tired and laden down with "freebies". They said that some exhibitors had not wanted to speak to them when they realised they were students, although others were very willing to demonstrate their systems. The students did say that they had found some of it useful and it had opened their eyes about how important computers would be in their future practice.

The first session I attended in the afternoon was based around the importance of Evidence based practice. Dr E.M. (Mac) Armstrong (Secretary BMA) explored "Evidence based practice - the why" in which he explored the legal background of evidence, and the subjective criteria involved in the selection and analysis of evidence. A historical perspective was used identifying the driving forces as cost, priorities and quality this was overlaid with considerations of equity, effectiveness and efficiency. Examples were given of differences in prescribing patterns, mortality etc. The current wider societal discussion of issues such as accountability, transparency and openness was welcomed and highlighted as part of the wider rise of consumerism. A range of factors limiting the greater uptake of technology & evidence based practice were also discussed, with recent increasing scepticism of scientific claims in general and statistical methods. A "Bayesian" approach which recommends consideration of "shades of grey" rather than black/white answers was advocated. The second presentation was by Dr J.A. Muir considering "Evidence based practice - the how". He highlighted the changes towards an informed patient, which have been brought about by the World Wide Web and set out some directions for the National Electronic Library for Health (NeLH). He argued that good health care equals good systems and good clinical practice and explored what is required for each of these. His vision is of a service which provide easy & rapid access to structured abstracts of evidence to support patient care which can be got & read in 15 seconds for busy practitioners and a link to full documentation for more studied consideration. Muir saw this as vital for practice in a "risk management society".

The second session I attended concentrated on Medical informatics education. Jeanette Murphy (Royal Free and University College Medical school) set out the lessons learnt from a study of "How medical students learn about medical informatics" which highlighted wide variations and identified examples of good practice, which included an organised to curriculum issues, teaching, clinical experience and assessment. Helen Tapp (Dept of  Nursing & Community Health, Glasgow Caledonian University) followed with a study of "The use of learning technology in nurse education - a survey of Scottish and Welsh nurse educators" This survey had been of lecturers and students about there use and opinion of a range of applications for their teaching and learning, with generally positive results. She finished with some questions for the audience including the effect of placing IT literate students and newly qualified staff into clinical settings with a a workforce with less IT skills. The final speaker was Prof. Arie Hasman (Medical Informatics Department, Maastrict University) who set out some Europe wide developments in the health informatics curriculum for a wide range of user groups.

The formal sessions of the day were followed with an invitation event with the mayor of Harrogate hosted by First Consulting to launch the plans for MedInfo 2001 which will be in the UK.

Later in the evening was a social event.

The day was good opportunity to meet old friends (including some I only knew "virtually" before, and to make some new contacts.

Day 2 - 23.3.99

Screen grabThe first session I attended was based around the Electronic Patient Record (EPR) and Electronic Health Record (EHR). Phillip Crouch (NHSE IMC) started by presenting the results from the latest "survey of acute hospital patient centred and clinical information systems" (NHS Ref: E5614) examining progress in achieving the level 3 EPR set out as a target for 35% of acute trusts in the "Information for Health" Strategy. It compared the situation now with the last few years and attempted to project this forward. new questions included GP links and Internet/Intranet access and use.

Paul Charnley (Wirral NHS Trust) followed with a presentation on "Clinical Terms in the Electronic Patient Record" which outlines the advantages and difficulties of incorporating "Read Codes" into their EPR. Rick Roberts (Birmingham Dental Hospital) followed by outlining the requirements of an EPR system for his hospital and the advantages of Read Codes for recording of clinical activity. This system used  paper sheets completed by the clinicians processed by an optical mark reader into the electronic system, rather than requiring practitioners to use terminals. Barrie Winnard (Moorfields Eye Hospital) from a similar sized trust had taken a different approach and set out some of the lessons learnt in their strategy and implementation.

The final speakers of this session looked at moving on from the EPR to the development of EHRs. Alan Jones (Winchester & Eastleigh) set out developments in central hampshire to integrate community and hospital services in the production of a summary health record which can be accessed by all staff. Further developments require agreed structures around Clinical Heading format or Document format and the developments in these areas were touched on, along with issues around moves towards social care integration. Dr J.D. Anderson (Burton on Trent) asked the audience to recognise that there "is another way" which emphasised that the EHR is about people rather than computers. Both speakers mentioned the concept of "Natural Community EHRs" and I believe this will be further explored and clarified in the future. A variety of questions raised "what if" scenarios, many of which couldn't be answered however the emphasis was on making a start while keeping the flexibility need to deal with the "what ifs".

Further information on the EPR programme is available on the NHSnet at: nww.epr.nhsweb.nhs.uk and a restricted version will "soon" be available on the web at: http://www.epr.nhsweb.nhs.uk

The second session of the morning I attended started with Elizabeth France (UK Data Protection Registrar (soon to be commissioner) "The Data Protection Act 1998: countdown to commencement - implications for healthcare professionals" . This primary legislation has been passed and must be implemented by 24th October 2001, and the secondary legislation is promised soon. She saw this as being in harmony with the Cauldicott report and the appointment of guardians and other legal and social changes eh Human Rights  and Freedom of Information legislation. The advantages of multiagency care and electronic records needs to be balanced against the risks e.g.; proliferation of "sensitive" data, inappropriate or unlawful uses/disclosure etc. The importance of both technological and human approaches (e.g. staff training) to eliminating risks were stressed, including a cultural shift in the NHS to recognise patient rights and ensure fair obtaining and processing of records. Three key factors were emphasised;

A wide range of searching questions touched on the interface between health care, screening, audit and research in the use of data. Elizabeth suggested that the new legislation sets out a role for "Codes of Practice" which while not binding in individual cases, can provide guidance for good practice. It was suggested that this might be a role for the Academy of Royal Colleges, perhaps other bodies should also be involved. Some examples of good practice from the health care system in New Zealand were also highlighted.

The final session of the morning was Felix Redmill (Independent Consultant) considering "Human factors in safety critical systems" however the message of this session seemed unclear and the presentation disorganized.

The afternoon started for me with an informative and humorous session introduced and chaired by Prof Brancko Cesnik examining "Information to knowledge to care: a challenge for informatics". He started with a model which grows from data (which has been collected, and often unused, for years) is analysed into information and applied into knowledge to support informed care and then added the feedback loops between the different levels which he defined as the remit of informatics. The stages and developments in all of these areas over the last few years were described and then valid questions identified (paraphrased) To tell us;

The effects of these questions and current developments in informatics was applied to health care systems. Recent computer developments where subsumed under getting sand (silicon) to remember ! and more important issues were considered with a heuristic approach which considers people issues (or Wetware in Brancko's vocabulary), about information use at the point of care, and making that information relevant in the context of care and now moving to "informed consumers".

ProdigyThe second paper was "Realising the benefits of Practice Nurses in primary Care Informatics" by Cheryl Cowley (SCHINN, Newcastle University in which she presented the results of a survey of practice nurses and GPs related to IT use, prior to the implementation of the PRODIGY project. The project looked at practice nurses and their IT skills in their current role and looked at where they got their information, education and training related to IT. Some interesting comparisons were made between the nurses and GPs particularly in the light of the vastly greater education in this area the GPs had received.

Heather Heathfield (Manchester Metropolitan University) then fed back from another project looking at the "evaluation of embedded knowledge bases" which had looked at the effects on GPs practices of alerts produced by their clinical information system. A significant comment was that the electronic alerts made the consultation longer, and where used could be shown to have changes in clinical practice to enhance patient care. The next speaker Ian Young (Faculty of Informatics, Ulster University) "Uptake of evidence based techniques" described an informatics module on their first MSc in Primary Care, which involved a medline and web searching exercise. The final paper was given by Dr Jon Rogers (AAH Meditel) who described a formative evaluation of phase 1 of a PRODIGY implementation and the changes made for inclusion in phase 2.

My final session of the day was facilitated by Gerry Gold (NHS S&DP Programme) and further explored "protecting the confidentiality of electronic records". He started by reviewing the context and how we have got to the current situation. Dr Anthony Griew (Independent Consultant) gave some discursive scenarios to illustrate issues surrounding "need to know"  , one of the controversial comments was that decisions about what information should be shared was the responsibility of the receiver rather than the sender. Jim Langstaff presented some information security modelling and a "mock up" of the confidentiality permissions possible. Anthony then tried to clarify some principles to apply. The session produced some controversial approaches and the following discussion was wide ranging.

Tuesday was rounded off a buffet dinner with a pirate theme. The cabaret was disappointing but they did manage to get various senior people to make fools of themselves and the gents toilet in the Majestic hotel was an "architectural masterpiece!".

Day 3 - 24.3.99

Wednesday started for me with a session examining "Primary care and the electronic patient record" which started with  an overview of "Information for Health" and some of the key targets by Peter Drury (Head of Information Policy NHSE). This was followed by Leo Fogarty (RCGP & ScopeEPR project manager NHSE) describing the "scoping the primary care EPR", which started with the current (1996) state of GP computing, and carried out a varied scoping study and came up with "Recommended Action Areas" covering a wide range of issues,

A "Satellite session" organised by the BCS Nursing Specialist Group entitled "Professions, patients and publishing: issues in quality assured information on the Internet" included my presentation "Sites & Information on the net : Relevant to patients and professionals".  A paper by Sally Tweedle (CRC Senior Fellow in Cancer Information and Education) assessed issues around the development of the knowledgeable patient and was followed by Denis Anthony (Editor Nursing Standard Online) who looked at the users profiles for this electronic journal. The session was followed by the BCS NSG AGM

General thoughts

Some of the main issues which emerged for me;

EPR -> EHR & the issues surrounding this
Information management & knowledge bases relevant and accessible for care
Informed consumers (Internet related)
maturity of information systems available (from trade stands)
needs for multiple methods & approaches to evaluation & development.
Lack of evaluation of many NHS IT projects

General information about the conference from the organisers is available from: http://healthcare-computing.co.uk/

Any comments or questions mail Rod@RodSpace.co.uk

Page Created: 22.3.99
Last Updated: 30.8.03