News & V

Health Informatics Review –
from words to deeds.
In this Issue
The case for a chief
knowledge officer
5
Additional uses of
patient data
7
Professionalising Health
Informatics
9
Booking into events
10
Bursaries for HC2009
10
Appointment reminders
11
Forthcoming events
12
Attendees were asked to produce a five minute
advertisement for recruitment into the field,
focussing on either apprenticeships or talent
management. Of all the different approaches,
what really shone through was an enthusiasm to
bring health informatics forward as a valid career
path and the pride of the achievements that
have been gained to date. It also emphasised
the importance of IT and information as a
central point to the patient care. Furthermore
the winning team won the dubious honour of
re-enacting the advertisement on camera; for
the creation of a podcast to help encourage the
recruitment of potential HI professionals.
Overall, Brian provided an insightful, thought
provoking view of the Review and its commitments.
There was a real determination from all attendees
to ensure that Health Informatics gains its rightful
place alongside long established NHS career
paths and a recognition of its part in the many
improvements of health services established
through the National Programme.
Craig Grime and Jenny Jackson
Health Informatics Graduate Management Trainees
Jenny Jackson
Craig Grime
The Newsletter of the Association for Informatics
Professionals in Health and Social Care
2
The second half of the morning concentrated
on a recognition within the HIR regarding the
importance of informatics skills and a new
impetus to develop the health informatics
profession. (Being on the Informatics Graduate
Management Training Scheme, we agree that this
is of great importance!)
FEBRUARY 2009
Lean & six-sigma
One powerful message was that IT, on its own,
will not meet the needs of the NHS. Whilst
technology is the enabler and can enhance
efficiency, a person based NHS needs a person
based information infrastructure across healthcare
bodies: not just within the hospital setting but
across community, primary and mental health care
settings. We should learn lessons from projects
such as 18 weeks in dealing with systems that
simply were never originally person focussed.
We should learn lessons from projects that have
suffered due to their lack of ‘person focus’.
9002 YRAURBEF
Interestingly, Brian mentioned another, more
unlikely partner. The media and journalists must
become more responsible in fulfilling their duties
to act in the public’s interest. Writing inaccurate
articles and scare-mongering, on the dangers
to patients, from the failing of information
governance goes no way to helping improve the
lives of patients.
News & Views At the November meeting of the Yorkshire Branch
Brian Derry, Executive Director of Information
Services for the Information Centre, led a morning
examining the key commitments, implementation
and next steps to the Health Informatics Review
(HIR). Keen to ensure the HIR does not sit dusty
on shelves up and down the country, Brian’s
presentation worked towards embedding the
commitments within “business as usual”. He also
emphasised that the world class NHS envisaged
by the Next Stage Review needs an effective IT
and information infrastructure, and therefore the
field is no longer the sole responsibility of the IT
department and a few keen clinicians.
All groups of staff need to embrace the changes.
Executive management needs to see and take
responsibility for the importance of high quality
information in developing the services. Brian
stressed the importance of Commissioning
managers developing their informatics skills,
one World Class Commissioning competency
being “knowledge management”. For healthcare
professionals in general, being IT literate is becoming
as important as reading and writing. As IT systems
become the primary repository and source of clinical
information, inability to use such systems becomes
unacceptable and a risk to the patient.
Assist News & Views February 2009
Lean and Six Sigma
The North West Branch held a seminar on Lean and
Six Sigma in November. Andrew Ruck and Paul
Brady from Health Systems gave an overview of
the subject then Ann Schenk, Director of Service
Development at Bolton Hospitals gave examples of
how it has been applied in health care.
Andrew started by describing Lean as a philosophy,
a mind set, an
approach and
an organisation
wide continuous
improvement
process. It is not a
specific technique
but rather uses
any appropriate
management tool. It
focuses on the value
that people add to
an organisation.
For example sales
and accounting are
necessary overheads
Andrew Ruck, Director,
to a manufacturing
HealthSystems Group Ltd
business but do not
add any intrinsic value.
In health care there are four processes that add value.
1. Diagnosis,
department) whilst
a non-value adding
activity only moves
the product or
operation for internal
use and effectively
creates waste.
So “Lean” is
based on two
main philosophies,
elimination of waste
to maximise flow
and respect for people.
The non-value
adding activities
Paul Brady
are stripped from
the process to eliminate waste. The respect for
people focuses on maximising their potential and
empowering them so they can do their job. This
appears to be the central facet of Lean; enabling
people to make their own improvements to their work
environment rather than imposing change on people.
Andrew identified eight wastes and related them to
health care.
1. Transport, of patients and documents in the
process;
2. Inventory, either physical inventory or waiting lists;
3. Motion, of staff in and around the process;
2. Treatment,
4. Waiting, for people, information, treatment;
3. Care,
4. Prevention.
5. Overproduction, duplication, doing too many
follow-ups, referrals;
If you are not involved in one of these processes you
are part of an overhead that supports the process.
6. Over processing, too many tests or investigations;
The Lean principle is one of relentlessly eliminating
waste. This is achieved by specifying the value,
identifying the value stream (that is what parts of
a department are useful to a patient), investigate
the flow (what is the best process configuration to
gain optimum flow of work through the operation),
determine the pull (the best method of identifying
demand, priority and scheduling work through each
process) and perfection (what else can be done to
improve the operation). There are two types of
activity in the world; those that add value and those
that do not. Value adding activities advance the
process to the value of the customer (patient or other
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7. Defects and rejects, clerical and medical errors,
doing it wrong;
8. Underutilisation, not using your people fully.
He then described how Lean can use tools such
as 6S workplace organisation, standard operating
procedures, visual management, process flow and
streaming. He followed this by describing six-sigma.
This is about understanding and eliminating variation
and defects. The goal is to have only 3.4 (or fewer)
defects per million operations of the process.
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Six-sigma has five stages:
1. Define, the metrics, what is a defect, the
objectives;
2. Measure, identify the variables critical to quality,
map the process, develop and validate measurement
systems, target opportunities and improvement goals;
3. Analyse, measure the processes and benchmark
them, calculate the yield and the variance, ensure the
input variables are controllable and reliable, verify the
time effect and the standard operating procedures;
4. Improve, use design of experiments, isolate the
vital few from the many trivial sources of variation,
test for reduction in variation;
5. Control, set up control mechanisms, monitor
process variation, maintain “in control” processes, use
control, charts and procedures.
The process is iterative so you continuously work
through stages 2 to 5.
Paul Brady gave examples of six-sigma being used
that included reducing the waiting time from referral
to treatment (RTT) to less than 18 weeks, reducing
the waiting time for ultrasound to two weeks and
improving the patient experience in A&E, including
meeting the maximum four hour waiting time.
He explained how it could be use with information
management. Instead of relying on those in
management positions to make big steps forward,
everyone should be empowered to make small
incremental improvements as well as supporting the
big steps, so the organisation moves forward faster.
He also outlined how a Lean approach could be used
to identify the opportunities to automate through the
implementation of new IT solutions.
Ann Schenk described the approach in Bolton
hospitals to a “Lean” approach, which was met with
a retort of, “We are not Japanese and we do not build
cars”. The Trust has a vision of the best possible care
now and in the future. When the Trust examined this
in greater detail it identified four elements to this.
1. Best possible care; there should be no defects and
patients are the stakeholders to whom this is of
primary interest.
2. Improving health; no needless deaths with the local
community as the primary stakeholder.
3. Value for money; no waste, this is of interest to taxpayers.
4. Joy and pride in the work; that is high morale.
For the Trust to survive and prosper it adopted the
approach of “excellence and efficiency”. This meant
there was a need to
• Develop business strategies which have quality
improvement at their heart
• Engage and
inspire frontline
staff
• Have an
organising
framework for
improvement
activity
This is “Lean
Healthcare”.
Lean was
chosen because
it is offered
an organising
philosophy and
framework with
• Powerful concepts
and tools,
Ann Schenk, Director of
Service Development at
Bolton Hospitals
• Evidence of transformation in other sectors
automotive, service and healthcare,
• A safety and quality focus,
• A Lean “buddy” network – people able and willing
to help,
• Respect for people as a guiding principle.
Bolton’s Lean journey began in August 2005 as part of
a “turnaround” both in quality and financially. It was
reinvented as “Bolton Improving Clinical Services”,
which kept the essentials but made it relevant. The
early results are encouraging but have only scratched
the surface.
Some of these early results are:
• In trauma 47% reduction in mortality following
fractured neck of femur, with 33% reduction in
length of stay and 42% reduction in paperwork.
• The sentinel stroke audit score improved from 68%
to greater than 90%.
• In ophthalmology there was 50% reduction in
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patient visits and an early attainment of 18 weeks
RTT.
The role of the leader in Lean healthcare is to:
• Go and See
• Ask Why
• Complications reduced by 85% and length of stay
by 43% for high risk joint replacements.
• Respect People
• Pathology test turnarounds were three to ten times
quicker and a 40% reduction in floor space.
There are some challenges and dilemmas to address.
These include address the time constraints on frontline
staff and create dedicated time to enable them to
work developing improvements. Lean has to be
customised so it is seen as relevant to health care
rather than an externally imposed cost cutting or
efficiency programme. This can be achieved by linking
it with the organisation’s highest priorities. Many staff
perceive changes to working practices as a task for
a service improvement team or other such entity. It
needs to be part of everyone’s responsibility. There is
a temptation to compartmentalise tasks, so there is a
week when people “do Lean”. It has to be made part
of daily work for everyone. The organisation (chief
executive and the board) needs to be prepared for
the long haul. Initially many staff will see Lean as a
passing fad; if it is there will be no benefits.
• Six figure cost savings in laundry, estates and
finance.
There were several insights that have been explicitly
recorded during the application of Lean.
1. The patient is our guest, not the raw material in our
production process.
2. The patient judges us on their overall experience,
not on the technical efficiency of our processes or
even on the outcome.
3. We are completely oblivious to the true nature of
our processes. Staff didn’t realise what they were
doing to patients.
4. Lean Healthcare can provide a common language
and method which builds a bridge between
professions, disciplines and agencies. It can support
a cultural as well as a technical transformation.
5. Lean Healthcare re-energises individuals and
unearths new leadership talent.
• Force Reflection
This was a very enlightening session. The Yorkshire
and Northern Branch is scheduled to re-run this
seminar with local health service input in May.
John Leach
Ann contrasted the way we usually “solve” problems
in the NHS as:
• Retreat to a Boardroom or office
• Involve only managers and “higher ups”
• Speculate and tell anecdotes
• Go with the majority or loudest voice.
She compared with the Lean way:
• Go to the actual workplace
• Involve the whole team of front line staff
• Use data
• Test solutions through rapid experiments (PDCA).
She illustrated how the Trust had used various tools such
as spaghetti diagrams, handover diagrams, value stream
analysis, 6S. Lean is a cultural transformation, its first
function is to build the people then build the product.
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Assist News & Views February 2009
Knowledge management in the NHS:
too important to be left to chance.
Whether you call it “knowledge”, “information”
or “evidence”, finding, using and exploiting it to
improve services has never been more important. In
his next stage review1, Lord Darzi says “the next stage
in achieving high quality care, requires us to unlock
local innovation and improvement of quality through
information – information which shows clinical teams
where they most need to improve, and which enables
them to track the effect of changes they implement”.
Trust within it. This is a Board level role which will
“lead the development, management and sharing of
knowledge within the NHS and partner organisations
to maximise its use in supporting the improvement of
patient care”6. Alongside the CKO, Hill also posits a
Team Knowledge Officer (TKO) for each management
or clinical team, who will “ensure the input of
evidence to enable their team to deliver the best
possible patient care”, as the role description7 says.
This is echoed in the review of library and knowledge
services in the NHS2, where Sir Peter Hill states that
“accountability through basing decisions on good
evidence is a key issue for clinical practice and for
managers, policy makers and commissioners”.
So what benefits are these roles likely to deliver, and
perhaps just as importantly, will these benefits actually
be delivered?
Both Darzi and Hill recognise that knowledge “evidence” in Hill’s terminology - needs to be firmly
at the forefront of both organisational management
and effective clinical practice, and Hill suggests that it
needs a far higher profile within the organisation than
it may have at present.
In their paper on knowledge management applied
to evidence-based practice, Sandars and Heller3
say “Information is composed of a collection of
basic facts but it only becomes knowledge when
there is relevance and context”. Implicit in Hill is an
assumption that this “relevance and context” is found
from the organisation’s strategic planning and its
operational activities, with an organisational knowledge
management framework or strategy ensuring that it is
applied systematically and effectively.
Once again “knowledge management” (KM) is
a term which means different things to different
people. The National Library for Health (NLH)
Knowledge Management Specialist Library4, a parallel
development to the clinical specialist libraries, provides
links to a range of key resources to support these
developments. In their book Learning to fly5 (and
quoted on NLH), Collison and Parcell say “You can’t
manage knowledge - nobody can. What you can do
is to manage the environment in which knowledge
can be created, discovered, captured, shared, distilled,
validated, transferred, adopted, adapted and applied.”
It is this active aspect of KM which Hill recognises
in his report and which underpins much of the
new vision for the NHS as set out by Darzi. Hill
recommends a Chief Knowledge Officer (CKO)
function both for the NHS as a whole and for each
It would be very easy for Trusts to see the
recommendation to designate a Chief Knowledge
Officer as a tick-box exercise, to allocate the role to
a not too unwilling board level director, and then
quietly do very little about it. That would be possible,
cynics may say probable, but it would also be sad
if Trusts as a whole took that approach. If adopted
in spirit as well as in letter, the CKO could have real
benefits for the organisation. There is no one post to
which this role automatically falls; the role description
deliberately focuses on personal qualities and broad
strategic functions rather than professional identity.
Depending on the emphasis in the Trust it could be
undertaken by the Director of Informatics or Chief
Information Officer, but it could equally well fall, for
example, to the Chief Nurse, the Medical Director or
the Director of HR, all of whom have a responsibility in
different ways for effective exploitation of knowledge
in the support of professional competence and
excellence in patient care.
Whoever takes on the role, the anticipated benefits
include a clear and visible statement that the Trust
and its Board recognise that effective knowledge
management is as important as effective clinical
provision or sound financial management to the
operation of the Trust. It provides a high level forum
in which to raise issues around the whole culture of
knowledge sharing and exploitation. It can ensure
that long-term strategic and business planning
includes consideration of knowledge management
as well as workforce planning, clinical capacity
and financial resources, rather than KM being an
afterthought once projects have begun or problems
have arisen. It offers the opportunity for the Trust
to encourage systematic and wide ranging sharing
of expertise and knowledge from top down, and
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generally to develop that culture in which sharing
of knowledge comes to be regarded as an active
and positive process, rather than as something which
threatens and diminishes those who share what they know.
The Team Knowledge Officer role is more problematic.
Clinical Librarians have existed for some time in a
number of Trusts. These are librarians who work
with a small portfolio of clinical teams/specialties to
bring their information/KM expertise into that team
at the point where questions are asked. This may be
on ward rounds, in case conferences etc, but outside
the confines of the traditional library. Their role is to
open and maintain an effective flow of knowledge
(evidence) into those teams to help them work more
effectively. Sound familiar?
References
1. Darzi, Lord Ara
High quality care for all:
NHS next stage review final report
London: Department of Health, 2008
2. Hill, Sir Peter
Report of a national review of NHS health library
services in England: from knowledge to health in the
21st century
NHS Institute for Innovation & Improvement, 2008
http://www.library.nhs.uk/aboutnlh/review
3. Sandars, John and Heller, Richard
“Improving the implementation of evidence-based
practice: a knowledge management perspective
Journal of evaluation in clinical practice 2006 Vol 12(3)
pp341-346
Hill’s TKO seems to come at this same role from
the other side, with a member of the clinical or
management team bringing their own professional
expertise to the retrieval and inflow of knowledge.
It seems significantly less likely that this TKO role will
be adopted wholesale across the NHS. Clinical staff
already need continually to update their clinical skills
and maintain their own professional competence;
management teams are focussed on ensuring that
their service and the Trust as a whole meets its
performance targets. TKO is a role which requires
an additional set of skills which will also need to be
maintained and updated.
4. National Library for Health Knowledge
Management Specialist Library
Hill estimates that to employ Clinical Librarians across
“key specialties” in each Trust would need 800 new
librarian posts across the NHS. He does not rule this
out, but suggests that it needs more investigation to
assess the cost and feasibility. Those who chose to
do so could see the TKO role as one way of bringing
this sort of function into the NHS without the need to
spend additional money.
NHS Institute for Innovation & Improvement, 2008
http://www.library.nhs.uk/nlhdocs/chief_knowledge_
officer_paper.doc
It cannot be denied that TKOs would bring benefits to
teams in terms of increased awareness of, and access
to current information in their specific area. However,
the cynics among us doubt very much whether this
will outweigh the other priorities for either front-line
clinical staff or service managers, particularly when this
information provision function is something they not
unreasonably expect of their local librarian anyway.
[URLs checked 9th December 2008]
http://www.library.nhs.uk/knowledgemanagement
5. Collison, Chris and Parcell, Geoff
Learning to fly: practical knowledge management
from some of the world’s leading learning
organisations
Capstone, 2008
ISBN 1 84112 5091
6. The role of a Chief Knowledge Officer in an NHS
organisation - v3
7. The role of team Knowledge Officers in NHS
organisations - v6
NHS Institute for Innovation & Improvement, 2008
http://www.library.nhs.uk/nlhdocs/2008_05_01__role_
of_team__knowledge_officer.pdf
Paul Twiddy, Library & Information Service Manager,
The Leeds Teaching Hospitals NHS Trust
This is written in a personal capacity and is not
necessarily the view of Leeds Teaching Hospitals NHS
Trust or any part of ASSIST.
If knowledge is information set into a meaningful
context, and knowledge management is all about
creating the right culture and environment, then Hill’s
CKOs and TKOs have the potential to make a real
difference in leading this process at both strategic and
operational level. It remains to be seen how widely
the Hill recommendations are adopted and whether
his vision becomes reality.
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Assist News & Views February 2009
Additional Uses of Patient Data
Consultation
NHS Connecting for Health (CfH) issued a consultation
entitled “Consultation on Public, Patients, and other
interested parties views on Additional Uses of Patient
Data”, see, http://www.connectingforhealth.nhs.
uk/systemsandservices/research/consultation. The
purpose of the consultation is described as, “We are
gathering people’s views to help us make important
decisions about the ways we can use information
we collect about patients when we give them care.
We call this information patient data. Patient data
is mainly used to provide care and treatment but
can also have additional uses such as research,
auditing the quality and safety of care,
management, planning etc.
Although there was a general invitation to respond,
the views of ASSIST were explicitly canvassed. The
substance of the reply is set out below. It is necessary
to read the consultation documents to understand
fully the concept of “information custodian” as
proposed. The BCS health informatics forum also
intended to submit its views separately.
Concept
The underlying information concept is an encounter
between a care worker - whether a health or social
care professional, working in the public, private or
voluntary sectors – and a patient or service user.
These encounters – when combined together –
form the basis of most information flows, whether
in support of direct patient or service user care, or
when used – in aggregate – for the purposes of:
policy development, commissioning, service planning,
operational management and administration, audit,
research and public accountability.
It is paramount that these information flows do not
impact adversely on the provision of direct patient
care. We recognise that there are other legitimate
uses of the data, e.g.
• protecting and promoting the health of the public;
• planning and organising NHS services;
• managing NHS spending;
• developing and monitoring national and local
policies and priorities;
• accounting to the public and Parliament for the use
of public money;
• regulation and assurance of compliance with care
and other standards and good practice;
• dealing with complaints about healthcare;
• teaching healthcare workers;
• clinical audit;
• research.
If the trust, which patients have that the details they
provide to clinicians remain confidential, is broken
the consequences could be dire. Patients could
desist from telling the whole truth and might even
fabricate some elements of their medical history. This
could result in sub-optimal care, deterioration in the
public health and inefficiencies in health care delivery.
Further the data would be of poor quality and thus
compromise any additional uses.
Patient Envelopes
There is a need to understand the concerns that
patients have about sharing all their data. At present
it appears that there is a mechanism to stop some
clinicians being able to access part of the health care
record. Research aimed at understanding patients’
concerns could help devise methods to retain their
trust whilst allowing their data to be used for the
public good. For example the needs of someone who
has suffered a sexually transmitted disease might be
different from someone who has suffered a mental
illness and these could be different from those of a
minor who is able to consent to treatment and who
has sought contraception. The needs of someone
who has a new identity as part of a witness protection
scheme could be more demanding.
Consent
There must be an agreed protocol around consent for
the records to be used. In mental health law there is
a distinction between those who refuse consent and
those not able to give consent. Such a distinction can
also be made for those people with learning disorders
and those whose mental capability is impaired,
temporarily or permanently, by disease or frailty.
There is a need to address if a young person is
sufficiently developed to give consent to treatment
and to consent to the health record being shared.
Small Numbers
We can envision that there will be reasonable pressure
to link the findings of relatively small scale clinical trials
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and academic studies to health care records. There
could be many benefits, such as long term follow-up
or later review to identify possible side effects. The
risk of being able to identify individuals would be
considerably increased.
It seems clear that gaining consent for this long term
research would rest with the original research team.
However there should be a mechanism that will
enable patients to withdraw their consent at a later
date should their circumstances change.
Information Custodian
The role of the information custodian needs greater
thought. If the role is to minimise the risk of
individuals being identified the tasks involved include:
• designing rules and standards for the publication of
tables, including how to handle small numbers;
• determining whether specific projects and
specific researchers can have access to the data
(with potential overlaps with other information
and research governance bodies and control
mechanisms);
• reporting to Parliament on the effectiveness of the
controls;
• reporting on the societal benefits gained from the
additional uses of the data.
It is unlikely that one custodian for England would
be sufficient. A national custodian could determine
some national guidelines (rules) but there will need to
be local and regional custodians, who can authorise
additional uses.
The skill set required by the custodian is different from
that required by the organisation that holds the data.
At present personal datasets are generally held or
accessed nationally by NHS Connecting for Health and
the Information Centre (IC) or their agents, national
audit bodies (e.g. the Audit Commission), systems
suppliers (e.g. BT for the Secondary Uses Service, and
some front-line primary care and hospital systems
suppliers); and locally by Health informatics services,
PCTs, systems suppliers, NHS and private sector care
providers, GPs, some academic research centres and
some partner organisations.
This appears as a pragmatic approach. However it is
not apparent whether a systematic assessment of the
risk of a breach of confidentiality has been made.
Approval for Additional Uses
There are various approvals that are required for
additional uses of patient centred information,
whether anonymised, pseudonymised or identifiable.
There should be consistency between the diverse
reasons for additional uses and the authorisation
process. For example, research studies require
full ethical approval whilst clinical audit projects,
administrative use, public health issues, service
planning and management uses continue as part of
the everyday health service operations.
Currently there is a perverse incentive to disguise
research as clinical audit so it is not subject to such
rigorous scrutiny during its early stages before any
data is collected.
There should be a systematic process to assess the
risks and benefits of all additional uses and not just
some of them.
Trust
It is imperative that the trust between patients and
clinicians is maintained. Any haste that leads to over
use of the data and the dissipation of that trust could
result in risk to the patient, lost opportunities to
improve patient care, inefficiency and an inability to
gain any of the visionary societal benefits.
There must be a culture of confidentiality throughout
all organisations that handle personal data. This is not
restricted to those clinicians who are in contact with
patients but must be pervasive; though inculcating
this could be more challenging the further information
processors and users are from direct patient contact.
There must be sufficient, continuously-updated
training so all staff are aware of their responsibilities
and know how to raise issues that they believe
might compromise confidentiality. Staff should be
positively encouraged and supported in highlighting
circumstances where they believe confidentiality
could be compromised, not least as this might
highlight inadequacies in the guidelines set out by the
information custodian.
While also reasonable technical aids should be used
to protect the security and confidentiality of patient
information, there should also be robust sanctions
that are rigorously enforced against people who
breach confidentiality, with adequate safeguards to
ensure that individuals are not made the scapegoats
for system failures. There should be consideration
whether these are employment sanctions (i.e. could
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lose current employment), professional sanctions (i.e.
could be prohibited from working professionally again)
or criminal sanctions. It is likely to be appropriate to
have a combination of all three.
We believe there is considerable level of suspicion
about bureaucrats and public service bureaucrats in
particular. This is partially fuelled by the high-profile
losses of data from government departments. A loss
of personal health data would probably and rightly be
vociferously condemned. Sanctions should match the
harm caused to the patients concerned and to public trust.
Efforts should be made to have better informed
media commentary on this issue. This is a serious
issue requiring balanced debate and political
balance. Undermining public trust inappropriately
through “punch and judy” politics or “red-top”
scaremongering can create unnecessary anxiety, lost
opportunities to use information and IT to improve
public services, consume resources that might be used
for direct care, and can bring clinical and other risks.
Openness and transparency is a necessary
pre-condition for informed debate.
New Online ‘One-Stop Shop’ for
HI Professional Development
An online ‘one-stop shop’ portal supporting personal
and professional development in Health Informatics
(HI) has been launched by NHS Connecting for Health.
‘Professionalising Health Informatics’, or PHI for short,
is a reliable and comprehensive source for all your HI
development needs.
Comprehensive portal addresses unmet needs of
many working in health informatics and of those
looking to work in this area
As the profession of health informatics has matured so
have development and resource materials multiplied.
A growing need for an online ‘one-stop shop’ facility
for development opportunities was identified in the
Health Informatics Review report (July 2008) and
also by many working in the NHS including senior
managers and chief information officers.
All the resources and links at your fingertips
through PHI
PHI links you to a plethora of information about HI
professionalism, including development opportunities,
professional bodies and reference materials.
The Learning Web, visually representing the many
facets of development, links to personal and
professional development opportunities such as
leadership and management resources.
Rather than duplicate information available elsewhere,
PHI pulls relevant information together and links
you to the original sources. Unique sources are also
included – the library links to 15 years of archived
news on health informatics not reproduced elsewhere.
PHI will be regularly updated and reviewed as
development opportunities and needs change
PHI will be regularly reviewed and information kept
current. The Learning Web has been designed to
enable further sections to be added as development
opportunities evolve. Health informatics professionals
are also encouraged to contribute by using the online
Feedback form or by emailing the team at:
[email protected].
Discover PHI for yourself and see how it can
help you to develop your career and your
organisational capacity
http://www.connectingforhealth.nhs.uk/phi
Please use the online Feedback form to tell NHS
Connecting for Health of any developments in your
area or any additional content or links that will help
others. You can also email the project team:
[email protected]
PHI Project Team
Capability and Capacity
NHS Connecting for Health
Continues on page 10
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9
Assist News & Views February 2009
Booking into Events
Continues
from
page
10 9
Continues
from
page
The BCS has a system for booking into events, which has
now been offered as a resource to ASSIST. It is possible for
both BCS members and non members to use this system.
BCS members (all ASSIST members are affiliate members of
BCS) will be asked for a password. If you have not logged
onto the secure area of the BCS web site before you will
have to register using your membership number. This was
sent to you when the administration was transferred to the
BCS or when you joined ASSIST, if that was later than the
BCS taking on the administrative function.
forward. It has the advantage that non-members who
wish to attend ASSIST events will automatically be invoiced.
Most ASSIST events are free to members
The first event for which this will be used is the one on HIS
Benchmarking and the NHS Infrastructure Maturity Model.
If this works satisfactorily, it will also be used for the annual
conferen ce. It is also being explored for booking onto
branch events. Just follow the links from the ASSIST web site.
John Leach
If you have forgotten your password or are unable to locate
your membership number you can request a reminder to be
sent to your email address. However, if your email address
has been changed since you first registered with BCSASSIST and you have not updated your membership details,
please contact [email protected].
On the test that we ran the process seemed straight
Bursaries for HC2009
The BCS HC2009 Conference is offering bursaries for
NHS & Social Care staff to attend the Health Computing
Conference and Exhibition at Harrogate, from Tuesday, 28
to Wednesday, 30 April 2009. Postgraduate students of
Health Informatics are particularly encouraged to apply.
Previous successful applicants have come from PCTs,
Hospitals, Primary Care, and the Voluntary and Social care
sector.
The bursaries cover:
1. Conference fees, and all fees for the Social program
2. A contribution to travel expenses to the conference,
within the UK (inc. N. Ireland) by the Award Holder. No
travel costs outside the UK can be considered, nor costs
of partners.
3. Single accommodation for 3 nights at a hotel, close
to the Conference event, nominated by the BCS in
Harrogate (Monday, 27 to Wednesday, 29 April 2009).
No other accommodation claims will be entertained.
Candidates are required to submit a brief essay (not more
that 2,000 words) on the topic,
“Shaping the future with World Class Telehealth”. Selection
of Bursary awards will be made on the basis of this essay by
a BCS panel.
Successful award holders are required to present a Poster at
the Conference. The poster can cover local research, audit,
or service delivery in the Telecare and Telehealth arena.
nhsdirect.nhs.uk) by 09:00 on Monday, 2 March 2009
and the successful applicants will be informed by 16
March 2009. This will allow time for travel and other
arrangements to be made.
All essays will be published on the HC2009 Website after
the conference
All essays should be submitted via email, and contain the
applicants name, address, and email address. The required
format is Word .Doc. Please number the pages and ensure
that your name is in the Footer on every page.
Please note the following:
• Candidates are invited to attend an introductory dinner
on Monday 27th April 2009 in Harrogate (8pm) to meet
their colleagues and representatives from the Bursary
Committee.
• Previous HC bursary holders are not eligible to enter.
• Decisions of the BCS about Bursary Awards are final.
An official application form, which can be obtained from
the ASSIST web site, should accompany all entries. Further
details are available from Dr Robinson.
Please submit applications by email to: nicholas.robinson@
nhsdirect.nhs.uk
Dr Nicholas Robinson
BCS Bursary Manager
HC2009
The best paper may have a presentation slot in the
Workshop on “Commissioning World Class Telehealth”
Details of poster presentations and further advice on
preparation are available if required.
Essays must be submitted by email (to nicholas.robinson@
10
www.as s is t .or g.uk
Assist News & Views February 2009
Appointment Reminders
Do appointment reminders reduce the proportion of
patients who do not attend (DNA) appointments?
It is intuitive that anything to remind patients of an
appointment will reduce the DNA rate. This initiative has a
pedigree of several years. There is much published evidence
lauding their effectiveness, yet some studies draw opposing
conclusions from others; why is this? Does the introduction
of Choose and Book at the same time make it difficult to
know which initiative caused which effect?
In 2006 a Health Accolade was awarded to Dr Masterton
and Partners 1 for their work implementing a texting
service to patients to remind them of appointments,
cutting DNAs and delivering closer personal contact for
more controlled management of long-term conditions.
The citation stated, “If a patient has an appointment the
following day a text reminder message is sent automatically.
If the patient can’t attend they can reply by text and the
message is automatically converted into an email and sent
to appointments staff so lists can be kept up to date. The
new service has cut DNAs by 38% overall – the most recent
check, comparing a week this year with the same week last
year, showed a 80% reduction.
“Surgery staff say patients are benefiting too – being able
to text the surgery with a cancellation instead of spending
time trying to get through on busy phone lines and often
failing and eventually giving up.
“For patients with long-term conditions, text messages
remind them of their next care review and the need to
make an appointment. This increases the surgery’s figures
for the Quality and Outcomes Framework and so benefits
the practice. Saving money is another benefit – texts cost
6p compared to £1 a time for patient letters.”
In October 2007 The Go-Between 2 reported one of the first
population wide deployments of text messaging services
across Lewisham Primary Care Trust in South London
leading to a year on year reduction of DNAs of 27%.
On EHI there was a report 3 that, “Island Communications
has announced that trusts are using its Managed
Appointment Reminder Service to cut DNAs. University
Hospital Birmingham NHS Foundation Trust and Hull
and East Yorkshire NHS Trust are using the two-way text
messaging service, and a consortium of midlands trusts
is planning to take it up shortly. The service sends a
text message reminder to patient mobiles. On receipt,
patients can note the reminder and send back a “yes”
or “no” response to indicate whether they can make the
appointment.”
In October 2007 NHS Connecting for Health 4 (CfH)
reported that five million patients had been booked using
choose and book. In the same report it was noted that:
•There was 60% reduction in DNAs at Doncaster &
Bassetlaw Hospitals NHS Foundation Trust
•DNAs reduced by over a third at both Kettering General
Hospitals NHS Trust and Ashford and St Peter’s Hospitals NHS
Trust when referrals were made through Choose and Book
So, there are two actions that both claim to reduce DNAs,
but which of them is most effective is not clear. Note also
that text messaging can be used to remind patients that
they need to make another appointment rather than merely
remind them of an existing long-standing appointment.
There was a report in the BMJ 5 that stated, “Nonattendance at general practice and hospital outpatient
appointments wastes time and money. Patients who
miss outpatient appointments tend to be young and,
when asked why they did not attend, give simple lapse of
memory as the commonest reason. Sending text reminders
(about appointments) does seem a sensible way of reducing
non-attendance. Unfortunately, a controlled trial in an
inner city general practice found it made no difference.
(Quality and Safety in Health Care 2008; 17:373-6)”
There is less clarity than one would have wished. Anyone
considering installing a text message reminder service needs
to consider the robustness of a business case that has a
reduction in DNAs as one of the stated benefits. There
is a need to understand how the various studies were
conducted and whether there were multiple stimuli such
as Choose and Book and texting together, to reduce the
number of DNAs. The ability to link cause and effect is
difficult at the best of times and there could be (probably
are) several compounding factors that have contributed to
the reduction of DNAs.
The contradictions could be in the details of the studies.
There should be sufficient evidence available to indicate
whether the controlled trial was one aberrant result or if it
reveals a contra-intuitive truth. It is unlikely that NICE will
find the time and resource to ascertain if the deployment
of this particular piece of technology is cost effective.
Perhaps it is a reflection on the maturity of IT compared
with medicine, that the discipline of double blind controlled
trials is not yet applied to the introduction of supportive
technologies. So organisations considering such initiatives
will still have to do their own business case and their own
subsequent benefits realisation. What works locally could
be due to the enthusiasms of the people involved.
This is not advocating that sending text reminders should or
should not be implemented. Rather I advocate a cautious
approach as there is contradictory evidence.
John Leach
1
http://www.connectingforhealth.nhs.uk/newsroom/newsstories/accolade_scheme_2006.pdf?searchterm=missed+ap
pointments
2
http://www.bcs.org/upload/pdf/assistgobetweenoct07.pdf
3
EHI Issue 355 dated 27 November 2008, note this was not
on the EHI web site on 15 January but a search for “DNAs”
revealed many similar reports.
4
http://www.connectingforhealth.nhs.uk/newsroom/newsstories/cabfivemillion?searchterm=missed+appointments
5
Minerva BMJ 1 November 2008 p1062
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11
Assist News & Views February 2009
Forthcoming Events
National
5 Southampton St. London
Tuesday, 28 to Thursday,
30 April 2009, HC2009 at
the Harrogate International
Conference Centre. Further
details at http://www.
hcshowcase.org/index.
php Conference topics will
include: Wednesday, 6 May 2009,
Clinical Dashboards at local
and SHA level - making
information available to
support decision making
(with Branch AGM), BCS
Office 5 Southampton St, London
• Policy and strategy:
latest developments
• Implementation of
programmes: national
progress and local experiences
• Leadership, professionalism,
training and education
• Understanding health and
care: how services are delivered
• Tele health and care /
interactive care
• Supporting healthy living
• Process and IT enabled
transformation of services
• Outcomes of
leading/exemplar projects:
what was achieved and
how Health Informatics
grand challenges
• Using emerging
technologies and future
relevant technologies
• GIS and mapping for
health promotion and
other applications
• Supporting Health
Informatics research
Thursday, 4 June 2009,
ASSIST National Conference
2009 at the National
Exhibition Centre,
Birmingham
London and South East
Branch events are open to all
and normally run from 10am
- 4pm, unless otherwise
stated, and include a buffet
lunch.
Thursday, 12 March 2009,
Predictive Modelling to
support acute admissions
and primary care
commissioning, at BCS Office
12
Tuesday, 29 September
2009, Measurement for
Quality – a joint conference
at a Central London Venue.
Wednesday, 18 November
2009, Looking into
the future – emerging
technology and its use in
supporting healthcare, at
BCS Office 5 Southampton
St, London
Membership enquiries
should be sent to
by ASSIST Thames Valley,
Oxford HIS and South
Central SHA. Further details
from Mik Horswell mikh@
micklefield.demon.co.uk
West Midlands
Tuesday, 10 February
2009, 10.00am for
10.30am – Joint event with
North West Branch – HIS
Benchmarking and the
NHS Infrastructure Maturity
Model – at BT Yarnfield Park,
Staffordshire. Book via the
ASSIST web site.
Yorkshire & Northern
February 2009, How the
National Strategic Tracing
Service is changing, in Leeds
North West
Tuesday, 10 February
2009, 10.00am for
10.30am – Joint event with
West Midlands Branch –
HIS Benchmarking and the
NHS Infrastructure Maturity
Model – at BT Yarnfield Park,
Staffordshire Book via the
ASSIST web site.
Thursday, 26 to Saturday,
28 February – HfMA/
ASSIST conference at Hilton
Hotel, Blackpool. There
is a diverse mix of national
and local speakers covering
finance, informatics and
general management issues
relevant to aspiring health
informatics practitioners.
Further details are available
on the North West pages of
the ASSIST web site.
Tuesday, 21 or Wednesday
22 April 2009 – Workforce /
Career Development event.
April 2009, Bench Marking
& National AGM, in
Harrogate during HC2009
May 2009, Lean Ways of
Working & Branch AGM, in
Leeds
June 2009,
Pseudonymization and what
it will mean to you.
September 2009, Going
Green, at the John Charles
Centre for Sport, Leeds.
This event will be a full
day launch to the 2009/10
season with a suppliers
market place, and case study
presentations.
Details of the Yorkshire &
Northern events will be
available from Carole Archer,
[email protected].
uk
Thames Valley
Wednesday, 6 May 2009,
day conference entitled
“Delivering the paper-light
hospital over 10 years”.
Venue Academic Centre
John Radcliffe Hospital,
Oxford. Jointly organised
www.as s is t .or g.uk
Elly Stimpson-Duffy,
BCS-ASSIST Group
Co-ordinator,
British Computer Society,
1st Floor, Block D,
North Star House,
North Star Avenue,
Swindon, SN2 IFA.
Tel: (01793) 417731
E-mail:
[email protected]
Change of address
(geographic and electronic)
details can be updated via
the web site http://www.
assist.org.uk/ and following
the link on the home page
‘Updating your contact
details’ or by writing to Elly
Stimpson-Duffy. Previous
issues of the newsletter and
the up-to-date Branch event
programmes can be accessed
via this web site.
ASSIST officers act in a
voluntary, personal capacity.
They operate independently
of their normal working
roles and their views and
opinions, as ASSIST officers,
are not necessarily shared nor
endorsed by their employing
organisations.
Copy date for April 2009
issue of the newsletter is 1st
March 2009. Please contact
the editor as soon as possible
regarding any contributions.
Editorial Board
Pam Hughes
Siobhan Roberts
Adam Drury
Dave Miller
Ian White
Jason Bradley
Brian Derry
Andrew Haw
Editor: John Leach,
Greenways Informatics, 17,
Prospect Drive, Hest Bank,
Lancaster, LA2 6HZ.
Tel. 01524 822398.
E-mail:
[email protected]
Print/Design:
MTP Media (2008) Ltd
The Sidings, Beezon Fields,
Kendal, LA9 6BL.
Tel: 01539 740937
www.mtp-media.co.uk