The NeLH and Secondary Health Care Debate
British Medical Informatics Society
National Heart & Lung Institute, Cale Street, London SW3
Thursday 9th September 1999

A personal Review by Rod Ward

The day started with a demonstration of the CSW system by Dave Nurse which uses XML to integrate clinical textbooks with the EPR. No solution had yet been found to issues around a financial model for use of 3rd party publishers material - except on a subscription basis.

Next was a short piece by Muir Gray setting the context related to the DGH & patient information use, this gave pointers to 21st century practice. This was followed by a short talk about the National research register.

The main meeting then got underway and was divided into 3 sections;

The Users  Views Chaired by Professor John Williams, School of Postgraduate Studeis in medical and Health care, University of Swansea,

The Clinical Team - Mr Lawrence Roberts, Scunthorpe & Goole NHS Trust

Lawrence described and demonstrated the development on an intranet for the Obstetrics and Gynaecology unit at Scunthorpe hospital. He highlighted the need for relevance to users, speed of access, coherence of material and the ability to give feedback. In particular local guidelines  and protocols had been made available - although these were not available to the public. There were particular issues about access (number of PCs) information archiving and the training gap amongst staff.

Making information accessible - Pam Kitch, Library Services Manager, Royal Cornwall Hospitals Trust

Pam discussed how this service in Cornwall acted as an information provider to staff on disparate hospital sites and had started to offer a range of services over their managed network. Both advantages and disadvantages and training and technological issues were highlighted , with the need for further research, particluarly to show effects on clinicans behaviour in the use of evidence, and ultimately into the effects of improved information on patient care.

Trainees Questionnaire Results - Dr Jonathon Kay, John Radcliffe Hospital NHS Trust

Jonathon described the system they have used to provide support to practitioners at the point of care by providing context sensitive guidelines in relation to path lab results, over the Oxford Clinical Intranet. This had been studied to examine it's use by clinical staff over 2 years. The full report is available on the web. Conclusions included 15 seconds being much too long for access and the need for thin client wireless network hand held computers. He divided information into Immediate needs (ie needed within a few seconds for clinical decisions) and Thoughful needs (which involve education, reflection and professional development where a longer timescale is acceptable/desirable).

Perceived or actual needs - Dr Jeremy Wyatt, Knowledge Management Centre, UCL.

Jeremy summarised a range of studies trying to identify what information clinicans actually need, as opposed to might want, and what is essential for patient care. He argued that we are in a catch 22 siutuation where you can't p[roperly study infortmation use until a comprehensive knowledge resource is available and yoiu can't create this until yoiu know what users needs are. jeremy will be providing the evaluation of the NeLH.

Making it all work - Dr Simon Weston-Smith, Hastings & Rother NHS Trust.

Simon described the intranet devloped in the trust and moves towards the EPR, and set out what would be needed from an electronic library to support this - however they had not as far as providing many of the services he saw as being useful.

The Providers - Chaired by Mr Nigel Bell, Chief Executive NHS Information Authority.

StartHere - Sarah Hamilton-Fairley

Sarah introduced and demonstrated the start here simple button system for touchscreen access to health information - an attempt (by a charity) to provide a universal portal, partyicularly for the disable and others with a health information need.

Warehouse, Reminder System or Driver of Change? Dr Muir Gray, IHS, Oxford.

Muir outlined his view of the NeLH using a variety of analogies. He described the Atrium and 4 "floors". The atrium will contain knowledge cafes for single professional groups (during the lunch break further work was done on planning the nursing area) and virtual branch libraries.

The network and it's pathways - Ben Toth NHSE Bristol

ben described various possible models for making NeLH available, these included local intranets or VPNs (Virtual Private Networks) and via NHSnet or the Internet itself.

Helping users to assess quality - Kattie Enock Public Health Research Unit, Oxford

katie described various approaches to quality assessment from her perspective with the Critical Appraisal Skills programme, including the work of the CHIQ (Centre for Health Information Quality) and DISCERN

The Value and the Cost - Dr Tony Lockett, Covance, Maidenhead

Tony analysed payment for health information, in the light of his international experience, and highlighted links to a nations GDP and set out guide for which information should be paid for by government and when by the individual.

The Debate - Chaired by Muir Gray

BMJ - Tony Delamothe
Discussed publishing paradigms & providers/knowledge support systems e.g. OVID. He concluded that information provision must be by open protocols & essentially this means the Web.

British Library - Bruce Madge
Presented ideas and developments under the headings of:

He raised issues about the integration of information from various sources and considered the use of classification systems such as UMLS.

Informatics Specialists - Colin Gordon
Set out the purpose and workings of the forthcoming NeLHealth Informatics.

Clinicians - Andrew Roberts
Described developments in clinical audit to encourage all clinicians to use information systems which make knowledge sources inescapable in practice.

Comments from the audience were welcomed particularly in relation to the special needs of hospital based health care (as opposed to primary care) - various issues were raised around trust organisation e.g. information directorates, access issues and education and training - The overall comment was a need for culture/behaiour change.


There were some useful contributions both from the speakers and from the audience, however not as much movement has been achieved since the last NeLH meeting at this venue which I attended, as I would have hoped.

There are lots of good ideas about what the NeLH can and can't achieve, but still some very major barriers to be overcome. Technical issues about the production of the NeLH appear to be less than those at local level which enable users to get access. Human/organisational/cultural issues are still the greater hurdle and the importance of education and training was highlighted.

The intention is top write up the proceedings of the day & place them on the web - A link will be placed here.

Further information about the NeLH can be found from the "Building Site" and if you wish to contribute to it's development you can join a mailing list. The home page for the list is at: or subscribe by sending a message to with the message join nelh firstname lastname

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