The Go-Between Issue 72 October 2006 Information for Information Users

http://london.assist.org.uk/resources/resources.htm
The Go-Between
Information for Information Users
The Go-Between would like to hear from potential
contributors. Articles should be on IM&T related matters
and around 250-400 words in length. Copy deadline for
Issue 73 is 20 November 2006.
For contributions etc. please write to the Editor
(address on back page).
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In This Issue
Common User Interface
Diary
Education Training &
Development
Information Governance Toolkit
News in Brief
Patient Access to Care Records
Tag – You’re It!
Issue 72 October 2006
Blood product errors: There is a 1 in 14,000 chance in the
US of a patient being given the wrong blood due to human
error. The rate is understood to be worse in the UK.
Mother-Baby
Mismatches:
25,000
mismatches occur annually in the US.
mother-baby
Lost and Stolen Equipment: Large numbers of expensive
medical equipment gets misplaced or stolen annually,
especially medical equipment used in the community. The
increased use of mobile IT – laptops, tablets, notebooks,
PDAs – and the risk of losing patient information.
People: tagging and microchips could be used to manage
vulnerable patients or patients with long term conditions
(subject to consent!).
RFID is an emerging technology, and as such, concerns in
respect of privacy and confidentiality have been expressed.
Future developments are likely to include higher memory
capacity which could enable encryption to be made
stronger. The implanting of microchips under the skin in
humans for medical purpose raises many issues of ethics,
law, and human rights. Before some of the potential
applications can be implemented proper standards and
guidelines in the use of the technology will need to be put
in place.
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Other possible applications will emerge as the technology
develops and becomes more commonplace.
Tag – You’re It!
More Information:
www.connectingforhealth.nhs.uk/ worldview/protti14.
Professor Dennis J Protti has delivered the latest in his
World View Reports, taking a detailed look at the benefits
of radio frequency identification (RFID) in healthcare.
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RFID within healthcare involves the attaching of radiofrequency tags to people or objects, which can help track
said object and increase security, as well as other uses
which come under automatic identification and data
capture (AIDC). This latest report, entitled Tag – You're it!
Pursuing Efficiency and Safety with RFID in Healthcare, is
the 14th in the series.
RFID technology is already used in pet tagging and
tracking, London's new pay-as-you-travel Oyster cards and
motorway tolls. Plans are being made for RFID to be
utilised in various different areas. Professor Protti quotes
Janz who says that the technology provides "just-in-time
business intelligence for the healthcare community, which
can impact positively the quality of healthcare provided".
Within healthcare there is no shortage of improvements
where RFID tagging and tracking could contribute:
Surgical Omissions: In the US 1500 patients annually have
something left in them erroneously by operating staff.
Medication Non-Compliance: Non-compliance depends
upon patient condition but in some cases could have a
significant effect, for example in the treatment of
schizophrenia or management of diabetes.
“You can have any colour you like as long as it is
black”. What does the Common User Interface mean
for the NHS? – see Page 2.
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Common User
Interface
The vision for the National Programme for IT (NPfIT)
includes a common portal or a common user interface
(CUI). What does this mean? Essentially it means that
every NHS computer would have the same look and feel to
the member of staff using it. This would mean that for staff
moving around the NHS from Trust to Trust (junior doctors,
for example) that there is no need to re-train, or time
needed to get used to a different computer desktop set-up.
The CUI would also cover clinical systems, for example,
the Care Record Service. The first challenge to this is the
fact there is not one single system or one single supplier.
The delivery of a CUI is going to take some time to deliver.
A project has been set up by Connecting for Health to
deliver the CUI. In 2004 the NHS signed an enterprisewide agreement with Microsoft. This has enabled Microsoft
to be a key partner in this project. There are four main
deliverables to the project:
Part 1
o NHS Desktop & Infrastructure
o NHS Office
Part 2
o Design Guide
o Software Development Kit (SDK, or Toolkit)
The NHS Desktop and Infrastructure deliverable has the
following themes:
o Managed desktop environment (NHS Windows)
o Electronic software distribution
o Mobility and mobile computing
o Group collaboration
o Identity management
o Network connectivity and services
o Enabled by Microsoft technology in conjunction with
other vendors
NHS Office will cover “Office Professional” – Word, Excel,
PowerPoint, Access, and Outlook – and research pane
integration. It will also answer questions on how should
Office applications support clinical tasks; how should they
integrate with clinical systems and data; and what
configuration is needed to support common NHS
processes? The intention is to provide a technical adoption
programme for Office 2007. A set of common supporting
features will be provided, including:
o Research pane for British National Formulary and the
Map of Medicine;
o An integrated medical spell checker; and smart tags
linking to other applications and data.
The Design Guide and Software Development Kit will
tackle the look and feel of clinical systems across the NHS.
It is recognised that this is in a background of commonality
being addressed late in the National Programme, systems
are already in development and/or being implemented and
lots of work has been done already. However, the benefits
of a CUI still make the initiative worthwhile.
The CUI project will produce a set of standards and
components over a three-year period focusing on clinical
safety, utility and usability, and less on pixel-perfect graphic
design. Compliance to these design standards by clinical
systems will have to be pragmatic and progressive,
maintaining the internal consistency of clinical applications.
What is meant by Common User Interface?
This would include the following:
o
o
o
o
o
o
o
The user model in terms of its organisation, user
input/output and screen layout
Navigation
Components
Nomenclature
Interaction design
Common display components –output/input of data,
buttons, controls, tools, icons and graphics
Accessibility features.
The aim is to produce the “best” interface as opposed to a
“good enough” interface and likely to result in a broader
adoption of standards across the NHS. The SDK will
include user interface code in accordance with the Design
Guide ready to plug into applications, reducing coding time,
preconfigured for easy integration.
Two major releases of the Design Guide are due to be
released before the end of 2006. They will cover:
o Medications management
o Patient administration
o Terminology selection (Snomed CT)
o Consistent navigation, including keyboard use
o Consistent views of the record
o Icons, key messages and labels
More information:
www.connectingforhealth.nhs.uk/crdb/NAGS/common_
user_interface.ppt
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Information
Governance Toolkit
Information Governance – as the name suggests – is the
proper management of information and data in an
organisation with respect to protecting it, ensuring it is
available when needed and ensuring that confidentiality is
maintained as appropriate. For the NHS there is an on-line
Toolkit which doubles up as a knowledge source and a
performance reporting tool.
Version Four of the
Information Governance Toolkit has recently been
released.
The content has been radically updated and migrated to a
new NHS CFH site. Adjustments particularly around
secondary use assurance and clinical information
assurance have been made for Mental Health Trusts. Use
of the Toolkit has been extended to GP Practices.
Key Features of the new release.
There has been a reduction in the number of requirements.
With few exceptions, the reductions are the result of
merging of requirements and the removal of duplications.
These changes have been made in part as a response to
user feedback from previous versions.
There are some new requirements. Key items are included
in support of the NHS Connecting for Health agenda.
Organisations are particularly asked to note the Information
Governance Management module and the standards
surrounding clinical coding and clinical coding audit to be
found in the Secondary Use Assurance module.
Version 4 will provide an “nww” and “www” presence for the
Toolkit; a new URL (access address) with an automatic
redirect from the existing URL.
Other developments still to come include new reports and
benchmarking materials; prison health requirement set (for
consultation) and a social care requirement set (also for
consultation).
Initiatives of the Information Governance Toolkit
The revised toolkit has divided the requirements (or
standards) into six initiatives:
1. Information Governance Management Assurance
Management of Information Governance within an
organisation; responsibilities; strategy, business continuity;
committee structures.
2. Confidentiality and Data protection Assurance
Handling confidentiality, professional code of conduct; Data
Protection Act requirements; consent.
3. Information Security Assurance
Risk management; incident control; IT security; managing
threats from malware, viruses etc.
4. Clinical Information Assurance
Clinical information standards; processes and procedures
for data capture; data retrieval.
5. Secondary Use Assurance
Data quality; benchmarking; data validation; audit.
6. Corporate Information Assurance
Freedom of Information Act requirements;
management; audit.
records
NHS organisations are required to use the Information
Governance Toolkit to make self assessments against all
standards in March each year. Information Governance is
included in the Core Assessment – the methodology which
classifies Trusts and reports publicly each year.
More information:
https://nww.igt.connectingforhealth.nhs.uk/
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Patient Access to
Care Records
When the NHS Care Records Service is fully implemented
patients will be able to see a summary of their own health
records though a secure internet site. Some GPs are
already opening their records to patients. These include Dr
Amir Hannan from the Thornley House Medical Centre at
Hyde in Greater Manchester.
The experience of this
pioneering work is being used to inform the National
Programme for IT (NPfIT).
Yvonne Bennett, a patient at the Thornley House Medical
Centre, has given an account of what being able to see
health records means for her:
"As a patient, being able to access your health records
helps you feel confident you will receive the best possible
health care. You are personally involved and able to share
the information you have with anyone who needs to see it.
The benefits are there whether you have a life-threatening
illness or just a routine appointment.
"Recently I had to go to a hospital outside my own area. I
was able to take a paper copy of my health record as I
have access to my live GP record over the Internet. With
the use of my passwords, doctors can see my records –
including things like allergies, past and present medication
and recent consultations – online.
"At the moment not all consulting clinics have access to the
Internet so taking along a printed copy is also a good idea.
My consultant was very pleased I did. He quickly looked
for relevant details and then placed the copy in my file.
This allowed more time for discussion rather than collecting
'routine' information.
"After a consultation I can check online for the letter that
has been sent to my GP. Checking one of my older letters,
I found that after six months I should have had a repeat
Dexa scan which had been missed by the practice.
"This was arranged after I pointed it out to them. When I
received the appointment, there was a questionnaire to fill
in. Normally, I wouldn't have been able to tell them some
of the information without asking the GP receptionist to
look in my notes. But I was able to go online myself and
check.
"And while on holiday in Menorca recently, I ordered my
repeat prescription and arranged for it to be delivered by
the chemist on my return. At the moment, I am checking
my record every day because I am waiting for an
appointment at the minor ops clinic.
"Because the system is very much in its infancy, there are
a few teething problems to be sorted out, but the more
people who use the system, the better it can be perfected.
I have found some minor mistakes in my record but a brief
letter to the doctor meant this was soon rectified."
More information:
http://www.connectingforhealth.nhs.uk/casestudies/pat
ientpublic/sharedhealthcarerecords
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Education Training &
Development
NHS Connecting for Health (CfH) has launched a set of
Education, Training and Development standards. The
standards are a set of documents outlining best practice in
planning, developing, delivering and evaluating training
interventions to support the implementation of the National
Programme for IT. They cover many aspects of the
training cycle, including best practice around developing a
training strategy, end-user pre-requisites for training,
training needs analysis and evaluation and assessment.
The standards are intended for use by anyone involved in
education, training and development (EDT) activity, but
specific groups may include ETD practitioners, training
managers, local ETD leads, and project and programme
managers.
While the ETD standards have not been launched as a
mandatory set of contractual requirements, CfH will be
working with partners and suppliers to embed them in
training activity being delivered to support the National
Programme for IT. It is also envisaged that local NHS
organisations will adopt the standards where this will add
value to their existing activity internally, and will use them
with their own suppliers to help define and monitor service
levels for training.
The standards are based on existing ETD best practice in
the NHS, and are intended to facilitate consistency in the
way that education, training and development is delivered
in the NHS. The standards will be reviewed, updated and
added to over time to ensure they remain current and
relevant as the service changes. In addition, case studies
of standards usage, discussion forums and the opportunity
to share useful documentation to support use of the
standards will be developed and launched by NHS
Connecting for Health in due course.
More information:
www.connectingforhealth.nhs.uk/etdstandards.
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News in Brief
Nurses Explore e-Prescribing
Nurses in Devon and Greater Manchester are taking part in
an exploratory project to investigate how IT could be used
to support prescribing by nurses and improve patient
safety, clinical governance and every day communication.
Initially the project will consider how nurses currently
prescribe and how technology could improve this in future.
Nurses taking part will then have the opportunity to use
current hardware and software to support their prescribing,
including both mobile and desk top technologies.
GP Engagement Forums
NHS Connecting for Health (CfH) is running a series of GP
Engagement Forums for local GPs to learn more about
CfH, the National Programme and to provide up-to-date
information about current, relevant developments. Dates:
24 Oct 06
Southampton Football Club
06 Dec 06
Gatwick
07 Dec 06
Nottingham
14 Dec 06
London
Delegates may book to attend either the afternoon (12.30
to 15.30) or the evening session (18.30 to 21.30). See:
http://www.informatics.nhs.uk/download/3193/GPEngagement-Forum-Delegate-Flyer.doc
New National Service Desk Prices
Expected costs for the new National Service Desk to
support national applications (provided by Fujitsu) have
been released. Volume related price bands per incident
are in the range of: Telephone call (£20 - £10); web
(including Open Technology Interface (OTI) where
appropriate) (£10 - £5); and e-mail (£10 - £5). As an initial
guide, it has been estimated that the fixed charge payable
for the service, if apportioned across all existing service
desks, rather than apportioned per incident, would result in
an overall average fixed charge of £8,000 per annum, per
LSD (Local Service Desk). The Management Information
Charge is a fixed charge, which if apportioned across all
existing service desks results in an average charge of £200
per annum, per LSD. Contact: [email protected];
see: http://nww.connectingforhealth.nhs.uk/servicedesk/.
Statement of Compliance for N3
Organisations connected to the NHSnet had to sign a Code
of Connection in order to use the service. Now the NHSnet
has been replaced by N3 (NHS National Network),
organisations will be required to sign up to a revised
Statement of Compliance. The new requirement will be
communicated to the NHS during November.
New London BT Chief Executive
Barts and the London trust chief executive Paul White is to
join BT as chief executive of its London NHS programme.
He will take up the post in the New Year.
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Human & Organisational Issues
It is one thing to deliver a robust and reliable clinical
system. It is quite another for it be used by healthcare
professionals to improve the quality and efficiency of
patient care. The achievement of these benefits depends
upon the readiness of staff to adopt and exploit electronic
systems in the normal course of their work and upon
organisational practices changing to take advantage of the
new opportunities. An ASSIST seminar is being held on 21
November 2006 to explore the human and organisational
obstacles that make the realisation of benefits difficult and
to examine the strategies, methods and tactics that are
available to work through these issues. This exploration will
be undertaken by reference to evaluation studies and
through practical examples of work done in case studies.
There will also be an opportunity for delegates to exchange
experiences and views in group activities. Programme and
booking forms from [email protected].
Internet Explorer 7
Connecting for Health (CfH) has issued the following
advice about IE7.
If you use NPfIT applications:
•
Don’t install IE7 yet
•
Install the Blocker to prevent WU automatically
upgrading systems to IE7
•
Test all your own critical applications with the latest
version of IE7 available
•
Wait until your LSP confirms that all NCRS/NPfIT
applications are compatible
If you don’t yet use NPfIT applications:
•
Don’t install IE7 yet
•
Install the Blocker to prevent WU automatically
upgrading systems to IE7
•
Test all critical applications with the latest version of
IE7 available
Diary
27 Oct 06
Health Statistics User Group
Conference, London.
(http://www.rss.org.uk/hsug)
20 Nov 06
London CfH Acute Change Network.
London SW1A
(//etdevents.connectingforhealth.nhs.uk/378)
21 Nov 06
ASSIST: “Managing the Human and
Organisational Issues of Clinical
Systems”, London WC2
([email protected])
23 Nov 06
“Your Care, Your Record” Care
Records Development Board
Conference, Islington, London
(www.connectingforhealth.nhs.uk/crdb/)
___________________________________________________________
Address for correspondence:
The Go-Between,
c/o David Green, Head of IM&T,
SW London & St George’s Mental
Health NHS Trust, Springfield
University Hospital, Tooting,
LONDON SW17 7DJ
020 8772 5602
[email protected]
London & South East