Document 2850275

ROUND-UP
SHEILA BULLAS
Meetings cover many topics
Sheila Bullas, editorial board leader, HINOW; secretary, BCS Health Informatics Forum; director, iBECK.
In HINOW we regularly report on the
BCS Health Informatics Forum
(BCSHIF) and specialist group meetings.
In this issue Helen Wilcox reports on
the October Forum meeting where Adam
Thilthorpe, Andy Doyle and Carol Hulm
gave updates on the progress towards
professionalism and how the development
of SFIA, the skills framework, and of
ISEB qualifications can contribute to that
progress (p10). Adam notes that there are
18,000 chartered IT professionals (CITP)
02
HINOW December 2008
registered but that it is a pity that this
standard is not demanded by the industry.
The support of employers is essential and
without this a voluntary scheme can only
have limited success.
Each year ASSIST undertakes a
workforce survey. In his report on this
year’s survey, John Leach highlights the
need for accreditation, an important step
in the development of professionalism
(p16). In health, where the safety of
patients is increasingly dependent on a
professional approach to informatics, it is
particularly concerning that professional
accreditation or registration is still not
required before someone is allowed to
practice. The Department of Health and
UKCHIP, as well as the BCS, are all
making slow but steady progress in the
right direction.
The Primary Health Care Specialist
Group held its autumn conference in
October with the theme of ‘Mind the Gap’
and emphasis on maintaining the
continuity of patient care. During the
event, the John Perry prize was awarded
to Kate Warriner of Liverpool PCT for the
work she and the PCT are doing with
EMIS web. Congratulations to Kate.
The October meeting of the Northern
Group heard from Mark Blakeman on how
Choose and Book is working in
Wythenshawe Hospital (p14). He also
recognised the potential risk of ‘gaps’.
Choose and Book is now part of the
normal working of every hospital and,
while there is considerable success, Mark
discussed the challenges as government
policy changes and the use of information
needs to change to meet it. For me, this
highlights the need for local impact to be
considered more carefully when national
policies are being determined and
implemented and the importance of
defining end-to-end process – otherwise
there is the risk of ‘losing’ patients
between the gaps.
The showcase event of BCSHIF,
HC2009, will include more examples of
good practice, good implementations and
how to achieve them than in previous
years. And more to promote understanding
of how informatics can enable modern
health and care practice (p6).
Forthcoming events of all of our
groups are listed at the back of this issue.
HI NOW
HEALTH INFORMATICS NOW
CONTENTS
is the newsletter of The British Computer
Society health informatics community.
It can also be viewed online at:
06
www.bcs.org/hinow
HC2009 ramps up to become new style showcase
HC2009 will replace the previous conference and
exhibition format with an integrated, interactive
enviroment suitable for all interested in health informatics.
HEALTH INFORMATICS NOW
is a quarterly publication. The deadline
for contributions to the March 2009 issue is
2 February Please send contributions to
08
[email protected]
A new visual process mapping technique could help A&E
and other hospital departments meet waiting time targets.
It was devised as a result of a Knowledge Transfer
Partnership.
Forum manager
Christine Mayes: 01793 417 635
[email protected]
Editorial board
Collaboration helps enhance unscheduled care
10
BCS supports professionalism via several activities
Sheila Bullas (leader), Keith Clough,
The importance of professional development and how
BCS is working towards it via various of its activities,
including CITP, SFIA and qualifications, was the subject of
a recent BCSHIF meeting.
Andrew Haw, Ian Herbert
News: Sue Kinn
Editorial team
Editor: Helen Wilcox
[email protected]
01793 417 577
Managing editor: Brian Runciman
Art editor: Marc Arbuckle
Graphic assistant: David Williams
Member and specialist groups
12
The Primary Health Care Specialist Group awarded the
John Perry Prize at the PHSCG Annual Conference to
Kate and the Liverpool PCT for work on EMIS web.
Registered Charity No 292786
The opinions expressed herein are not
necessarily those of The British Computer
Society or the organisations employing
the authors.
13
Copying: Permission to copy for educational
purposes only without fee all or part of this
are not made or distributed for direct
14
notice and the title of the publication and its
date appear; and notice is given that copying is
by permission of The British Computer Society.
To copy otherwise, or to republish, requires
and may require a fee.
A hospital view of Choose and Book
The Northern SG heard a speaker from the NHS
Foundation Trust describe the good, the bad and the
ugly in its experience of Choose and Book at the
Wythenshawe hospital.
commercial advantage; the BCS copyright
specific permission from the address below
Still time to apply for Dame Phyllis Friend Award
The Nursing Specialist Group is inviting entries for its
annual prize donated by Dame Phyllis. The deadline is
31 January 2009.
© 2008 The British Computer Society.
material is granted provided that the copies
Conference prize goes to work on EMIS web
16
Workforce survey reports accreditation need
The annual ASSIST survey included highlighting
the need for formal accrediation of health
informatics, underlining areas of skills shortages,
and suggestions for improving and recruitment
and retention of staff.
Printed in Great Britain by Inter Print,
Swindon, Wiltshire.
ISSN 1752-2390. Volume three, number two.
The British Computer Society
First Floor, Block D, North Star House,
North Star Avenue, Swindon SN2 1FA, UK
17
tel +44 (0)1793 417 417;
Interactive care group looks at health 2.0
The interactive Care Specialist Group is planning to move
its focus from telehealth towards examining how to apply
web 2.0 to health.
fax +44 (0)1793 417 444; www.bcs.org
Incorporated by Royal Charter 1984.
+
4 Industry news 18 Book reviews 19 Events diary
December 2008 HINOW
03
INDUSTRY
NEWS
NHS revises consent model
The Care Records Board meeting
has ratified the decision to move to
a revised consent model for
accessing patients’ summary care
records (SCRs). Under the revised
model, ratified on 17 September,
patients will be asked for
permission before their SCR is
viewed by clinicians or other staff
across the NHS.
Revising the model was
considered important following
extensive consultation among
nurses and doctors and after an
independent evaluation of the SCR
programme, commissioned by NHS
Connecting for Health and provided
by University College London.
Dental hospitals get £11 million
An extra £11 million will be
allocated to dental hospitals across
England to fund new IT systems
that will support the training of
dental students.
The funding announced by the
Department of Health is part of a
joint initiative with NHS
Connecting for Health and the
Dental IT programme board.
As well as training future dental
care professionals, NHS dental
hospitals and associated dental
schools research ways to improve
oral and dental health and provide
specialist clinical services for
patients. The £11 million will be
divided between the ten Trusts that
applied for funding.
Scheme to accredit health
and social care information
The Department of Health (DH) is
seeking a supplier to operate a
scheme to accredit health and
social care information, to be
launched next summer.
A contract notice was published
in the Official Journal of the
European Union, inviting expressions
of interest by 17 November.
04
HINOW December 2008
CFH consults on wider use
of patient information
Connecting for Health (CFH) launched
a 12-week consultation on 17 September
looking at public, patients, and other
interested parties’ views on additional
uses of patient data.
Patient information could also be
used for medical research, disease
surveillance, screening, needs’ assessment
and preventative activities, according
to CFH.
The consultation gives patients and the
public the opportunity to input into the
way the NHS uses their health information
for these purposes and will explain the
benefits, legal safeguards and practical
steps available to meet confidentiality and
ethical obligations.
Whilst the NHS has always used
patient information for planning and
research purposes, the advent of new
technology with the NHS Care Records
Service offers new opportunities. The
public consultation covers the use of
patient information for uses such as:
research into prevention and
treatment of diseases;
improving public health;
managing and planning
future health services;
planning screening;
quality control.
Professor Michael Thick, chief clinical
officer for CFH, said: ‘Patients, as well as
clinicians, must be involved in these
crucial decisions about using clinical and
patient data. The use of patient
information for research and outcome
measurements, has led to major benefits
in health practice, such as the cure of
duodenal ulcers, prevention of spina
bifida, effective treatment of breast cancer
and the carrying out of hip replacements.’
Standardised records to
improve patient safety
Standards for patient records have been
developed for the first time, by the Royal
College of Physicians in partnership with
NHS Connecting for Health (CFH) and
agreed by the Academy of Medical Royal
Colleges, representing the whole
medical profession.
The aim is to standardise the
information held on patients throughout
their stay in hospital, reducing the
likelihood of mistakes and missing
information at admission, handover
and discharge.
CFH funded the Health Informatics
Unit of the Royal College of Physicians to
develop profession-wide standards for the
structure of the clinical content of
admission records and handover and
discharge communications when patients
are admitted to hospital.
The prototype standards were then
piloted in hospitals and sent out for
consultation to patients, carers, other
medical Royal Colleges and specialty
societies. Over 3,000 doctors responded to
the consultation on admission records
headings, with over 90 per cent agreeing
that there should be structured
documentation across the NHS.
This development comes at a time
when the Healthcare Commission has
identified record keeping as one of the
weakest areas of NHS performance, in its
annual health check, with just 85.2 per
cent of NHS organisations meeting
the standards.
The standards can be used in paper
records or incorporated into online patient
record systems, such as those run by
Cerner and CSC.
The new standards can be viewed at:
www.rcplondon.ac.uk/clinicalstandards/hiu/medical-records
Technology should do more
The NHS is failing to make it more
convenient for the public to receive the
care they need, by not making use of
everyday technology and innovation that
consumers would welcome, according to
two new reports published by The
King’s Fund.
The reports argue the NHS has been
slow to adopt technologies that are already
in widespread use elsewhere, such as in the
financial services and travel industries.
Even well-established technologies, such as
email and the internet, are not being used
routinely in the NHS to help patients, for
example when booking GP appointments,
receiving routine test results, viewing
medical records or having consultations.
By embedding everyday technology into its
services and introducing more advanced
technologies, the NHS could improve the
patient experience, deliver better clinical
outcomes and save money.
One of the reports, Technology in the
NHS, makes specific recommendations for
increasing the uptake of new technologies,
such as clinicians targeting patients most
likely to embrace new technologies initially,
and the technology assessments carried out
by NICE extending beyond a focus on
drugs to innovation more generally.
Encryption message sent out
NHS chief executive David Nicholson has
written to NHS chief executives asking
them to ensure organisations have fully
implemented the policy that all removable
data must be encrypted. He draws their
attention to the report of the Cabinet
Office Data Handling Review as published
on 30 June, which contains mandatory
security standards for the public sector.
He points out that each GP is legally
responsible for holding data securely and
reminds PCTs of the requirement to
conduct a risk assessment for the
transport of patient identifiable data in
general practice. CFH has negotiated
significant reductions on licence and
installation prices under the GP Systems
of Choice (GPSoC) Framework.
Integrated IT required
Integrated care needs more than
good quality information on
population health data, outcomes
and evaluation. Integration of
healthcare can only succeed if it is
supported by integrated IT systems.
That is the message from the NHS
Alliance in a new paper: Integrated
care organisations: the importance of
integrated information systems. It
looks at the systems in use by Kaiser
Permante in the USA, compares them
with the UK systems and considers
the needs of the new Integrated Care
Organisations (ICOs), announced by
the Darzi report in July 2008.
The report’s authors say that
both the Department of Health and
individual PCTs should ensure that
integrated systems are part of the
selection criteria for the ICO pilots.
At the same time, Connecting for
Health needs to make sure that the
National Programme for IT can
deliver support to local ICOs.
Diabetes UK campaign in Second
Life to reach diverse groups
Diabetes UK is running its latest
campaign, Silent Assassin, within the
virtual world of Second Life.
Virtual campaign posters have
been put up in and around the new
Diabetes UK Second Life
headquarters, and elsewhere around
Manchester island. Designated pages
for the campaign have also gone live
on Facebook, Bebo and MySpace.
Tool to benchmark across London
The London Health Observatory has
developed practice profiles to provide
a consistent approach to the
benchmarking of primary care
services within the capital. It focuses
on 89 indicators of primary and
secondary care, providing measures
of practice quality alongside
demographic and estimated ethnic
population data.
The profiles consist of a range of
indicators that can be used by GPs
and primary care commissioners for
commissioning, needs assessment,
monitoring of population health
and service utilisation, performance
management and clinical
governance reviews.
December 2008 HINOW
05
FORUM
HC2009
Presents a new style showcase
Next year, HC2009, subtitled Shaping the Future,
will take place on 28-30 April at the Harrogate
International Centre. For the first time in over 20
years the HC event will be totally overseen by the
BCS Health Informatics Forum.
HC2009 will replace the previous conference
and exhibition format with an integrated, interactive
environment suitable for anyone interested in
health informatics.
The event will provide the best possible
opportunity for you to confer, learn and network
with others interested in health informatics in all
manner of different ways. Whether you are looking
for information or wanting to share something that
you and your organisation have done, then there is
an opportunity to do so.
While the general call for participation has
closed, that does not mean that there won’t be
further opportunities for truly excellent projects to
be on show.
The full programme will be set out at the end of
January and even then there will be room for
important late developments to be included. From
national policy to local use, the focus is on using
information to bring benefits to patients,
professionals and organisations and to shape the
future of health and social care in the UK.
CFH is participating
Connecting for Health (CFH) is a major stakeholder
and leader of the community and we are delighted
that they are participating in HC2009. Both
Christine Connelly, Department of Health CIO for
health, and Martin Bellamy, director of programme
and system delivery at CFH, will be speaking.
As the programme develops, details will be added
on our website.
06
HINOW December 2008
HC2009 is the
premier health
informatics
showcase of the
BCS Health
Informatics
Forum. Sheila
Bullas, who is
chairing the
organisation of
HC2009, outlines
the plans for next
year’s event.
There will be opportunities to discuss and learn
about a variety of important topics including
telehealth and interactive care, transformation of
services, policy and strategy developments,
supporting healthy living, and emerging technologies.
For newcomers to the NHS there will be a
series of talks about understanding healthcare,
whilst for researchers there will be support sessions.
Additionally there will be numerous examples of
practical experiences gained during the
implementation and use of a variety of systems
and technologies.
Most people involved in HC have both something
to offer and something to learn. Our community
includes those who are directly involved in public or
private sector health and social care organisations
with an interest in the use of information or
computing. You may be involved directly in defining,
implementing, supporting or using information in
one way or another: as a clinician, a manager, a
health informatics professional, an academic,
a supplier of goods and services, or in some
other capacity.
This will only truly be a showcase event if all
interested parties get involved, where the best in
health informatics is on show and those who are
seeking knowledge and solutions come along and
challenge those who have some of the answers.
We intend to provide an exciting programme
comprising presentations, debates, discussions,
demonstrations and of course plenty of opportunity
to network. With your participation, HC can remain
the premier UK health informatics event and ‘the
place to be’.
For further information visit
www.hcshowcase.org
HC2009 - SHAPING THE FUTURE
THE UK’S SHOWCASE HEALTH INFORMATICS EVENT
28 - 30 APRIL 2009, HARROGATE
ORGANISED BY BCS
PRESENTATIONS FROM
LEADING EXPERTS ON:
Policy and strategy
Implementation of programmes
Leadership, professionalism, training
and education
Care in different settings
Process and IT enabled
transformation of services
Understanding health and care:
how services are delivered
Emerging and future technologies
Health promotion and healthy living
Tele-health and care / interactive care
Supporting research and
Grand Challenges
Use of technology and evaluation
NEW STYLE SHOWCASE
This year’s event will have a new look: an integrated
environment for health and social care professionals
and informatics suppliers, presenting latest developments
and best practice.
www.hcshowcase.org
FEATURE
WAITING TIME TARGETS
Collaboration helps enhance
unscheduled care services
A new visual process mapping technique which could help A&E and other hospital departments meet waiting time
targets has been devised as a result of a Knowledge Transfer Partnership (KTP) between NHS Fife and the University of
Stirling. Jo Wheeler of Knowledge Transfer Partnerships explains.
The project saw a gifted computing
graduate, Mike Ghattas, work full-time
with NHS Fife for three years, who was
closely supported by Professor John
Bowers and Gillian Mould at the
University of Stirling.
Ghattas, alongside Ken Laurie, director
08
HINOW December 2008
of strategic change at NHS Fife,
developed a new approach to mapping
constraints and bottlenecks within the
Accident & Emergency and other
departments which uses graphical icons
and symbols to promote a user-friendly
interface. The work helps to promote the
Lean approach to transforming services
and supports the national service
improvement collaboratives aimed at
enhancing the delivery of clinical services.
Drawing on the University of Stirling’s
previous experience in systems analysis
and modelling Mike developed digital
simulation models with a stylised, visual
user interface which clinical staff can
easily use to identify improvements in
service delivery.
What if scenarios
In particular, the tool allows users to
generate ‘what if’ scenarios and see the
cumulative impact of small incremental
changes at various points in the chain of
operations. Because the tool is used
online, crucial information can be easily
embedded – speeding up the time it takes
clinical staff to generate useful results.
Ghattas has also led on a
complementary project to redesign the
health board’s intranet portal relating to
service transformation, improvement and
delivery. This has provided increased
access to performance monitoring
information for clinical staff – and is the
first of its kind in Scotland.
Laurie, who has been closely involved
with the three-year KTP, says: ‘This work
has allowed us to tap into a valuable local
knowledge base at the University of
Stirling who are at the cutting edge of
thinking in this area. Having Mike working
directly with us has also allowed a
significant amount of interaction with
existing staff and a great deal of
knowledge sharing.
‘It has certainly contributed to us
achieving improvements in throughput and
capacity within A&E and other clinical
settings and is helping us to achieve
A B O U T K T Ps
Knowledge Transfer Partnerships (KTP) is an initiative
working to bring the business together with the higher and
further education sectors to facilitate effective knowledge
transfer in the UK. Driven by the specific needs of each
participating business, the scheme takes a structured but
flexible approach. Each partnership employs one or more
high calibre associates (recently qualified graduates) on a
specific, strategic project.
The associate works within the company for the lifetime
of the project – normally between one to three years – and
from the start is charged with the ownership and delivery of
the project. The knowledge base partner (academic
institution) develops a relevant and improved understanding
of the challenges encountered by companies, which, in turn,
stimulates business-relevant teaching material and new
research themes.
national waiting time targets.’
Professor Bowers at the University of
Stirling says: ‘This work really has been
characterised by collaboration and a
commitment to team work from all the
different people involved.
‘Through the Knowledge Transfer
Partnership and working with Ken and
Mike, we have not only been able to
source the latest data in this field for
research purposes – but more
importantly get an insight on the people
behind the numbers.’
Ghattas has now been offered a
position with NHS Fife and it is hoped
that the tools they have developed
together will be adopted by other health
board areas in Scotland.
A sample of the new simulation model
developed by NHS Fife
Illustration of care service targets following the
development of new mapping tool
For further information, visit
www.ktponline.org.uk
A sample of the new online clinical pathway developed by NHS Fife
December 2008 HINOW
09
FORUM
PROFESSIONALISM
BCS supports professionalism
via a range of activities
The importance of professional development, and activities conducted by BCS HQ in this arena,
was the topic of a series of presentations by BCS managers at the BCSHIF meeting in October.
The role of IT has moved from providing
technical solutions to powering business,
according to Adam Thilthorpe, manager,
BCS Professionalism in IT Programme.
IT is now a business focused profession,
partnering business in transformation.
IT is also moving away from being
used only to cut costs and now also has a
role in revenue generation. Technology is
at the heart of businesses, with companies
that have embraced it, such as Amazon,
Tesco and Visa, reaping the rewards.
The scope of the profession covers
education and training providers,
professional organisations and interest
groups, R&D professionals, as well as
members of other professions such as
accountants who specialise in IT, and
library and information professionals.
The profession, however, is still
relatively immature. On a scale of 1 to 5,
IT ranks between levels one and two;
levels one to three being described as
developing levels, while four and five are
seen as established (see model below).
‘To put the BCS chartered standard on
a par with other professions, it needs to be
recognised more widely,’ said Adam.
‘Currently, approximately 18,000 BCS
members are chartered IT professionals
(CITP). Everyone has their own reason
for applying to become chartered and it’s
a pity that it’s not usually because the
standard is demanded by the industry.’
To make CITP more widely available,
BCS members were asked to vote on a
resolution to allow BCS to license other
associations to award CITP. This has since
been held and the proposal was endorsed
by 91.2 per cent of the members who
voted. The changes can now therefore go
to the Privy Council, which oversees royal
P R O F E S S I O N M AT U R I T Y M O D E L
A profession’s goal is to attain an established level
charters, for approval.
However, for take-up to really grow,
Adam believes CITP needs to be seen as a
pre-requisite for employment in certain
roles. He suggested the adoption of CITP
would be helped, for instance, if a CITP
was required to sign-off on contracts.
A question was raised about how the
developing professionalism in health
informatics, being led by the UK Council
for Health Informatics Professions
(UKCHIP) and recognised by the BCS
Health Informatics Forum, could be
aligned with the wider BCS
professionalism programme.
Adam suggested that the most
important thing was changing the
perception of IT and informatics in
general regardless of domain. In the same
way as chartered practitioners in other,
more long established professions are
understood to work at higher levels and
carry certain levels of responsibility,
convincing the public that IT and health
informatics are professions in the same
way was probably most important.
SFIA and SFIAplus
5
The profession is regulated by
law for the benefit of the public
4
The nine tests of public obligation
for a profession are satisfied
3
The industry field is governed by a
framework of professional institutions
2
A qualification
regime is defined
1
The industry field is
recognised as a community
Statutory
Governed
Organised
HINOW December 2008
Developing
levels
Qualified
Profession maturity model derived from the Carnegie Mellon University Capability Maturity Model.®
10
Established
levels
Public
Improving competencies and skills is one
strand of professionalism, so Andy Doyle,
UK corporate sales manager, ran through
the latest changes to the government
backed competency framework, the Skills
Framework for the Information Age
(SFIA) and to BCS’s linked, added value
product, SFIAplus. The SFIA Foundation’s
members, BCS, IET, IMIS, e-skills UK
and itSMF, run SFIA, which sets out a
framework of 78 skills and seven levels of
competence in each skill. BCS supports
SFIA, as well as developing and
offering SFIAplus which contains all
the SFIA definitions, plus six additional
task components.
‘The main difference between SFIA
and SFIAplus is that the latter sets out
what an individual needs to do to move to
the next level – in terms of background,
work experience, qualifications and
development’, said Andy.
The not-for-profit SFIA Foundation is
in the middle of updating SFIA to version
4 – it is regularly updated to reflect the
changing roles in the industry. An open
consultation period was held from May to
September 2008 where individuals could
comment, and corporate users and other
stakeholders were invited to give input.
As a result, a lot of new detail has
been agreed. Some of the more interesting
changes, according to Andy, are that
compliance and audit have been split into
two categories. And management and
operations have also been split into two
separate areas. Four new skills have been
added: business modelling, requirements
definitions and management, IT
governance, and portfolio management.
The new framework will be launched at
the SFIA conference on 4 December.
SFIAplus will also be updated in
December and BCS customers will receive
a dynamic update.
A member of the audience pointed out
that the Irish Health Service is planning
to use SFIA. Another comment was that
where health authorities have already
used it, it has identified huge skills gaps in
their area.
The question was asked how the HI
profession could be represented in SFIA,
and whether it should not cover the wider
area of informatics, rather than just IT.
Andy suggested the BCS HI Forum should
give input to the next review.
Another issue for those in health
informatics, someone pointed out, is how
you decide which professionalism scheme
to follow. It’s a particular issue if you
have a clinician’s background and
therefore wish to retain clinical
accreditation, as well as achieving a
recognised IT or informatics standard.
Post-meeting comment: UKCHIP is
developing enhanced standards by which
to recognise professionals in health
informatics which are expressed in
National Occupational Standards terms
drawn from nine Sector Skills Councils,
demonstrating the synergy between
domains. Activities are ongoing to
partition the HI definitions into generic
and specific categories, and further
discussion with SFIA will ensue.
ISEB qualifications
Carol Hulm, BCS programme manager,
explained how qualifications offered under
BCS’s examination board, ISEB, could
contribute to professionalism.
In the NHS people move around a lot
so it is important that their knowledge
and skills are transferable, qualifications
W H AT I S I S E B
The Information Systems
Examinations Board (ISEB) is a
division of the British Computer
Society. ISEB was created in 1990
from the Systems Analysis
Examinations Board (which was set
up in 1967). ISEB administers
examinations and issues certificates
in a variety of subjects in the field of
information systems engineering.
December 2008 HINOW
11
that are internationally recognised is one
way for the NHS to get assurance that the
people they employ have reached a
standard and assists with consistency
within the required job roles for their IT
teams. It’s useful for managers to have a
basic understanding of what you know,’
she said. It was a noted by a contributor
after the meeting that in order to meet
one of the key aims of a profession, that
of maintaining public safety, professionals
working with the NHS should work to the
same standards whether working ‘in or
for’ the NHS. All should be health domain
aware to avoid risks to patient care from
inappropriate practices. These
requirements are outlined in the UKCHIP
Code of Conduct www.ukchip.org.uk
The ISEB wheel
The ISEB portfolio is displayed as a wheel
(see p11), explained Carol – designed to
give a clear view of the qualifications, and
break down into four areas: project and
business change; legal, compliance and
security; solution development and
delivery; and IT infrastructure, assets and
services. Within each area, there are
qualifications at Foundation level
SPECIALIST GROUP
(equivalent to SFIA 3), Practitioner level
(SFIA levels 4 and 5), and Higher level
(SFIA level 6). There are around 42
qualifications, but the number is
changing regularly as ISEB develops
new qualifications.
Different levels
The Foundation level gives a broad base in
a subject and is examined by multiple
choice questions. Practitioner level focuses
on more detail with scenario-based
assessments. Most of the ISEB
qualifications are at this level and require
experience in the sort of role being
studied. The Higher level is the basis of
subsequent role based professional awards.
The ISEB Professional Award
recognises individuals who have achieved
qualifications outside their specialism, as
well as in it. Candidates have to have had
capability in: demonstrating
professionalism: formal education,
experience, ethics and code and conduct,
mentoring or leadership. ISEB
Professional Level is based on job roles
using SFIA or SFIAplus. A candidate has
to have: a higher level qualification in
their own subject area; BCS or equivalent
membership; Foundation level in two
areas; one of more additional Practitioner
certificate.
‘Other benefits of ISEB qualifications
are that they are vendor independent,
vocational, relevant and current,’ said
Carol. ‘They are consistent with SFIA and
SFIAplus, and have been mapped to the
NHS Knowledge and Skills Framework.’
ONLINE INFO
BCS Professionalism initiatives:
www.bcs.org/professionalism
SFIA Foundation: www.sfia.org.uk/
SFIAplus: www.bcs.org/sfiaplus
ISEB qualifications:
www.bcs.org/iseb
National Qualifications Framework:
www.qca.org.uk/qca_5967.aspx
UK Council for Health Informatics
Professions: www.ukchip.org.uk
PRIMARY HEALTH CARE
Conferences of the recent past
and not so distant future
Following the autumn conference run by the Primary Health Care Specialist Group (PHCSG), the group’s next event is
its summer conference. Jill Riley, administrator for the group, gives an outline of both.
The recent PHCSG Annual Conference
had the theme ‘Mind the Gap –
maintaining the continuity of care’. This
two-day event was held on 17-18 October
at Eynsham Hall near Oxford.
The programme stimulated a number
of thoughts and discussions, and copies of
the presentations will be available on the
PHCSG website soon.
At the event, the John Perry Prize was
awarded to Kate Warriner of Liverpool
PCT. Kate is primary care IM&T
programme manager and won the prize
for the work she and Liverpool PCT are
doing with EMIS Web. The award was
presented by Dr Joan Trowell, John
12
HINOW December 2008
Perry’s widow. John donated profits from
Oxmis to the group prior to his death in
order to create the computing prize. John
presented the first prize in March 1985
only weeks before his death. The prize
continues in John’s memory and is
awarded for innovation and excellence in
UK primary care computing.
The group has secured Chesford
Grange again for their 2009 summer
conference, which will be held over two
days on 30 June and 1 July.
Further conference information will be
available from the PHCSG website soon
or contact Jill on 01905 727461,
email [email protected].
Kate Warriner and
Dr Joan Trowell
Further information: www.phcsg.org
SPECIALIST GROUP
NURSING
Apply now to enter for
Dame Phyllis Friend Award
The Nursing Specialist Group is seeking entries for the annual Dame Phyllis award, given in recognition of the work of
nurses using information and communications technology to support care.
Dame Phyllis Friend was Matron at the
Royal London Hospital between 1961 and
1971. She was heavily involved in work by
the Royal London to install its own
computer, the first to do so in 1964. The
award results from a donation by Dame
Phyllis to the Nursing Specialist Group.
There is only one award made each
year. Along with a citation, the prize
winner also receives a cheque for £250
and this year we are delighted to announce
that the prize winner will also receive a
laptop courtesy of Viglen.
In addition, the paper will be published
by BCS and the author offered the
opportunity to present their work at the
group’s next conference.
The award is open specifically for new
authors to help them to share information
and communication technology
developments in their care area. A
dedicated panel undertakes the review of
all entries and gives constructive feedback
to all entries.
All that is required to enter is that you
are a member of the Nursing Specialist
Group and submit a paper of up to 2,500
words, not including a bibliography.
The deadline for submissions for the
current award is 31 January 2009.
For more information and to apply
for the award, see:
www.nursing.bcs.org/dpfaward.htm
READ ABOUT PAST EXPERIENCE
TO HELP CURRENT THINKING
UK HEALTH COMPUTING
Edited by GLYN HAYES, DENISE BARNETT
Technology that works for patients and staff has been the guiding principle of
developing and deploying IT and computing in the UK health sector. Hayes
and Barnett’s detailed history of this process draws upon the experiences of
those involved, whilst referencing many published documents of the time. The
result is a fascinating and thought-provoking glimpse into the world of health
computing, which holds lessons for future generations.
Published: April 2008
ISBN: 978-1-902505-99-2
£29.95
648pp
Available in all good bookshops and online.
Order from Turpin Distribution tel: +44 (0)1767 604 951.
BOOKS08
www.bcs.org/books
December 2008 HINOW
13
SPECIALIST GROUP
NORTHERN
The good, the bad and the
ugly of Choose and Book
The impact of Choose and Book on the Wythenshawe Hospital
was described by Mark Blakeman at a Northern Group meeting in
October. His presentation is summarised by chairman Professor
Bernard Richards, based on a meeting report by Phil Paterson.
Mark Blakeman, director of informatics,
University Hospital of South Manchester
NHS Foundation Trust (Wythenshawe),
reminded the audience that Choose and
Book (C&B) was supplied as part of the
National Programme for IT in the NHS.
Initially it was going to be an
appointment booking system but then the
politicians decided to add ‘choice’. The
14
HINOW December 2008
idea was that it should be like an airline
booking system – a central, national,
standard system to be used by all the
NHS – but at the same time the NHS was
encouraging the establishment of
independent Foundation Trusts. So there
were elements of conflict associated with
C&B from the start.
Blakeman explained how Choose and
Book operates across three physical
entities – the GP surgery, the national
C&B system, and the Trust’s own Patient
Administration System (PAS).
At the GP surgery, C&B is used via a
web front-end to book an appointment and
send a referral letter. The patient gets a
unique booking reference number
(UBRN). The patient, however, may not
wish to make the booking straight away
and can do it later using the UBRN.
The national C&B system holds details
of the directory of services for all the
hospital Trusts and where available
appointment slots are located. The
availability of slots is updated every night
but it is not maintained up-to-date in real
time. Hence slots appearing ‘vacant’ to a
patient may have been taken during
that day.
Trusts will typically choose some
appointment slots to make available to
C&B, but of course some slots against
each consultant will have already been
taken for in-house use. The PAS will
automatically accept GP referral letters
into the system.
The sequence of events is that:
a) C&B looks for an appointment slot.
b) C&B checks the PAS to see if the slot
is still free.
c) If the slot is still free, C&B reserves it.
d) On receiving the request, the consultant
might accept, reject, or amend the referral.
C&B ‘remembers’ its own bookings, but
does not know about any bookings made
locally by the Trust’s own call centre staff
who make changes in response to patient
telephone calls. Throughout the day the
variance between the C&B and the
hospital PAS increases until the next
overnight update of C&B’s information.
There are some different ways of
working. The GP may ‘delegate’ the
process. Blakeman pointed out that
patients can refer to the web via NHS
Choices, Dr Foster, or the individual
provider organisation’s own website – but
there is usually no time to do this during
the GP consultation. Another option is
that PCTs may have set up booking
centres for manual referrals, which is
really against the spirit and the aims of
C&B. Patients can leave the surgery and
use their UBRN later with a national
booking service, by telephone or online;
likewise for appointment changes.
The GP can look further afield if the
right service is not available locally,
whatever the local PCTs may have
commissioned or not commissioned.
The booking element of C&B can work
well but choice (of a provider) is harder.
However, it was noted that choice of date
and time (with a chosen provider) is a big
benefit to patients.
The current position at South
Manchester (Wythenshawe) is that C&B
has been fully implemented across the
Trust and almost all GP practices. About
33 per cent of referrals are through C&B.
GPs generally don’t like C&B – they find
it ‘slow and hard to use’. ‘Did not attend’
(DNA) rates are unchanged. However, as
waiting times have come down, curiously,
DNA rates have gone up over the last 12
months, from around 18 per cent to
23 per cent.
time and scope to vary waiting times to
cope, but with the 18 weeks RTT the
hospital needs to be run so that it can
respond to demand. Tariffs affect the use
of resources and income, so capacitymodelling, which Blakeman uses, has
become very important.
Things can go wrong. There may be no
The booking element of C&B can work well but choice of a
provider is harder... choice of date and time (with a chosen
provider) is a big benefit to patients.
Linked to RTT target
Choose and Book is now linked to the
government’s 18 weeks Referral-ToTreatment (RTT) target. As recently as
five years ago it typically took about 13
weeks for a GP referral to be processed
and a first appointment held, followed by,
typically, another 13 weeks from the
consultant deciding what treatment a
patient should receive to actually starting
the treatment. In between, the patient
might have to undergo various
nterventions (e.g. scans), all with waiting
periods, which could easily extend the
overall timescale for Referral-toTreatment to three or four years. Knowing
this, GPs would often refer patients
knowing that their condition might only
require treatment in a few years’ time.
The good aspect of linking C&B with
18 week RTT is that paper-based referrals
can easily take up three to six weeks of
the 18 weeks before the appointment is
agreed with the patient. Now, with C&B,
the clock starts when the appointment for
a UBRN is triggered. However, this is
about to change following a political
decision to start the clock from the date
of issue of the UBRN, irrespective of when
the patient actually uses their UBRN to
make their appointment.
There are several bad aspects of the
link between C&B and 18 week RTT.
Hospitals originally expected to be able to
close a speciality to referrals if they had
used up all their capacity and had none
left to deal with further referrals. Despite
some increase in commissioning contracts,
this is not the case.
Waiting lists have traditionally been
used by the NHS to cope with seasonal
variations. Demand can vary by up to
three wards between summer and winter,
and even more so on a daily basis due to
emergency admissions. There used to be
appointments available at a patient’s
chosen Trust. This is very annoying for the
GP. It is very common, affecting up to 33
per cent of bookings. The GP/patient can
force a booking using a TAL (Telephone
Appointment Line) service.
Service providers need to allow free
capacity for patients to book into, which
has an impact on efficiency. It is timeconsuming to make ad-hoc clinics
available to C&B.
Failing bookings
The ugly side of C&B is that about 33 per
cent of bookings were failing. The Trust
took action and made all consultant slots
available to C&B. This resulted in a
temporary improvement, but then demand
quickly rose and now even more than 33
per cent of attempted bookings are failing.
A major issue is that the hospital can
increase the number of available slots but
then more people are seen. How can the
Trust keep putting on more capacity? Is it
C&B or is it the 18 week RTT that brings
this about?
Another issue is that an appointment
slot may have been used by another GP
since the overnight C&B update: very
annoying for GPs. Secondly, patients may
cancel appointments – resulting in an
inflated number of referrals to the Trust.
Or the patients might delay appointments.
The hospital Trust has to consider what
it can do to be more attractive. South
Manchester is considering providing
outreach services close to the patient’s
own GP surgery. This would get the Trust
to the top of the ‘Selection List on C&B’
(which lists providers by distance, as the
crow flies, from the patient’s postcode).
For example, outpatient clinics could be
held at GP practices in future. In this
Trust some are already being held at
satellite hospital.
December 2008 HINOW
15
MEMBER GROUP
ASSIST
Workforce survey finds
that pay is still an issue
The annual ASSIST survey highlighted the need for formal accreditation of health informatics,
underlined areas of skills shortages and raised suggestions for improving recruitment and retention.
John Leach summarises the survey report below.
The objective of the survey was to provide
current information on the health
informatics workforce in the NHS to
support future workforce planning,
including identifying capacity, capabilities
and skills gaps. The report is an update on
the 2007 survey. ASSIST is grateful to
NHS Connecting for Health (CFH) and
Tribal Consulting for supporting these
surveys. The survey looked at:
the size of the informatics workforce
in the NHS;
staff turnover and vacancy rates;
managers’ views on future demand, by
specialist category, and the prospects
for recruitment.
Size and make-up
of the workforce
Dependency on computer-based systems
and information in health and social care
increases year on year; informatics
specialists are increasingly responsible for
business and clinically critical
infrastructure, systems and information.
Workforce planning measures need to
ensure that informatics staff work to clear
professional standards, both technically
and ethically.
Formal accreditation of informatics
services is embryonic and appears only to
be applied with NHS CFH accreditation of
local service desks. Accreditation will need
to be applied to a wider range of
informatics services and there will need to
be a structured approach to the
development of benchmarking criteria.
It has not been possible from the
survey to reliably estimate the size of the
health informatics workforce. The
Electronic Staff Record (ESR) has the
potential to do this directly if the coding
and classification of informatics posts
are refined.
16
HINOW December 2008
Challenges to recruitment
and retention
There are some considerable challenges in
the recruitment of informatics staff. The
percentage of vacant posts is greater in
this survey than in 2006. Pay was still
cited as the most significant challenge, by
40 per cent of respondents.
As pay is seen as the biggest issue in
the recruitment of all types of informatics
staff in the NHS, a strategy to address
this needs to be identified and
implemented. This might include the
following:
review of recruitment premiums
under Agenda for Change;
improved marketing of the benefits
of the whole package of working in
the NHS;
improvements in other aspects of
the employment package.
Pay remains the most significant factor in
the retention of staff but, unlike
recruitment, career prospects and staff
morale are also perceived as significant
aspects. The development of health
informatics as a formal and recognised
profession would go a considerable way to
address the perceived lack of status and
might lead to improved working conditions
and improvements in the culture. Further,
the assurance of individuals and of
informatics services would improve
informatics service delivery and patient
safety, as well as the career
prospects and morale of
informatics staff.
The Health
Informatics
Review, published
in July 2008,
includes
commitments
both on supporting the assessment of
recruitment and retention premiums and
on the assurance of informatics services –
see table 2, p19 on the website:
www.dh.gov.uk/en/Healthcare/
OurNHSourfuture/index.htm
Skills shortages
Current skills shortages exist in
key areas, such as:
system and business analysis;
project and programme management;
clinical coding;
information analysis.
Such shortages underline the need for
early planning for the impact of policy
changes on the informatics workforce.
Effective workforce planning is needed
together with efficient action to address
the expected changes in demands for
certain skills sets. Again, the Health
Informatics Review includes some positive
actions, on assessing the informatics
impacts of new policies (section 8.2) and
workforce planning (table 2, p19).
There is a need to achieve a more
robust understanding of the health
informatics workforce and to make better
provision for its future development. It is
gratifying that a key recommendation
from both ASSIST workforce surveys –
that there should be an annual collection
of data on the health informatics
workforce – is another one of the
commitments in the
Informatics Review.
The 2008 informatics
workforce survey is
available on the
ASSIST website
via a link from
the front page:
www.bcs.org/assist
SPECIALIST GROUP
INTERACTIVE CARE
Group moves from telecare
and telemedicine to web 2.0
The Interactive Care Specialist Group is switching focus, as its chair Mark Outhwaite explains.
The past six months has been a quiet period
for the group. Established to provide a focus
for discussion and learning around
tele-medicine and telecare applications,
we have seen these technologies and the
associated services become more
ubiquitous through the DH whole
community demonstrators and the gradual
spread across the NHS. Whilst by no
means mainstream, we are beginning to
see much wider acceptance of the
technology and its application.
The SG has been largely Londonbased with events held at the BCS in
London and as such our audience has been
limited. We have used web-based
conferencing technology to make our
seminars more accessible, courtesy of the
Health Technologies Knowledge Transfer
Network (KTN) but ironically, for a group
interested in remote care, the uptake has
been low. The opportunity to be part of a
seminar from the comfort of your own
home or office does not yet seem to appeal.
Our view now is that the regional
groups are better placed to promote
discussions on the topic – most will have
local implementations within their areas
and a supply of experienced speakers from
front-line staff and industry who can
speak with authority to a larger audience.
We will be encouraging these groups to
use the web-based conferencing
technology to make their seminars more
widely accessible – and providing advice
and support on the best way to use it
based on our own experience. Hybrid
seminars combining a local audience and
a remote audience are perfectly feasible
with a good internet connection and low
cost radio microphone system. We can
provide advice to any groups wanting to
explore this approach, and the KTN
sponsored service is currently free.
As we switch the focus to regional
groups, the SG will review its own role, in
particular a switch towards examining
the application of web 2.0 to health –
health 2.0 and the use of the internet to
provide support and advice from peer
groups, clinicians and a wider range of
potential providers. This will depend on the
approval of the main BCS Health
Informatics Forum, but we anticipate that
a new blend of health 2.0 themed events
will be in place in the New Year.
www.hiicsg.bcs.org
December 2008 HINOW
17
BOOK
REVIEWS
Book of the month
IT-Enabled Business
Change
The IT Value Stack: A Boardroom
Guide to IT Leadership
Sharm Manwani
BCS
ISBN: 978-1-902505-91-6
Ade McCormack
Wiley
ISBN: 978-0-47001853-8
£29.99
Rating: 10/10
Many IT
professionals will
agree that IT is
not properly
represented in most corporate
boardrooms. Author and consultant
Ade McCormack has a great deal of
experience in advising businesses on IT
value optimisation and has created the
IT value stack model to communicate
his approach to a wider audience.
This model is a layered methodology
that helps business leaders to properly
develop an organisation’s strategic
approach to IT, whilst emphasising the
importance of the CIO as a boardroom
entity. In developing this model,
McCormack is encouraging IT
departments to grow up and recognise
that the days of technical and analystbased approaches to IT are over, and
that today’s IT strategy needs to be
providing maximum business value for
the IT investment.
The book is very well written in an
easy to read format. The target
audience is CIOs, CFOs and other
organisational decision makers, but this
book is of value to anyone aspiring to a
senior managerial position.
McCormack continually underlines
the relationship between business and
technology. I found this book to be
hugely useful, and a superb guide to
anyone who has responsibility for IT
management. From a boardroom
perspective, it should be required
reading for all CEOs, especially those
who are unclear as to why IT needs
representing on a company’s board.
Anyone looking to improve the value
of their IT investment will find this
guide invaluable.
James Poxon MBCS CITP
18
HINOW December 2008
£24.95
Rating: 9/10
Dr Sharm Manwani lectures
and directs programmes in
IT-enabled business change at Henley
Business School. He has previously been
the European CIO of two multinational
companies where he directed international
IT-enabled change programmes.
His premise is that most IT projects
should be viewed as IT-enabled business
change projects. This changes the way they
are approached and increases the benefit
they bring to the organisation. With this
book, he aims to help those involved in
such projects to understand the issues and
become more successful as a result.
The book is aimed at all those involved
in, or affected by, IT-enabled business
change projects. It is intended as an
introductory text, with no specific prior
Making Things Happen;
Mastering Project
Managementt
Scott Berkun
O’Reilly
ISBN: 978-0-596-51771-7
£24.99
Rating: 9/10
This book is a revised
edition of the author’s bestselling
book The Art of Project Management.
The book is intended not just for software
project managers, but also for team
leaders, developers and students. It
describes a practical, people-centred
approach to managing all aspects of
software development.
The chapters are grouped under three
headings: plans, skills and management. A
few example chapter headings give a
flavour of his style and coverage: The truth
about schedules; How to make good
decisions; How not to annoy people; What
to do when things go wrong; Why
leadership is based on trust; End-game
strategy; Power and politics.
The author was formerly a project
knowledge assumed. The
book follows the life cycle of
change, starting with an
overview that considers the
major tasks and roles involved
in the complete cycle.
At the end of each chapter
there is a handy summary and
multiple choice questions with
a discussion guiding the reader
to the correct answer.
This book succeeds as an introductory
text, most particularly in its description of
the entire scope of an IT-enabled change
project in a manner that seamlessly
integrates organisational and technical
discussions. Those not having a basic
understanding of some of the techniques
(e.g. SWOT or value chain analysis) or of
models (e.g. ITIL or SFIA) may find it
helpful to access other sources as they
come across the terms. The notes and
references at the end will help in locating
such sources.
Sheila Bullas MBCS CITP
manager at Microsoft. This helps
to explain his perspective:
large-scale, in-house software
development. This leads me to my
main criticism: there are several
topics in contemporary software
development that are just not
covered. No mention of subcontractor management,
outsourcing or offshoring. No
discussion of formal processes such
as Prince2, ITIL or similar.
The book is well written and produced.
The advice he gives is intelligent and
insightful. The emphasis is on practical,
situational techniques to solve common
problems. The book reads well and lends
itself to skim-reading or specific problemsolving. It works well as a mid-level text.
If you need detail, say on estimating, you
will need to look elsewhere.
Overall it’s a good book giving useful
and practical advice. What is described is
done well, but beware of its gaps. For its
size, it is good value for money.
Recommended.
Simosn Clarke CEng FBCS CITP
FORTHCOMING
EVENTS
December 2008
ASSIST North West Branch with West
Midlands Branch
ASSIST North West Branch & BCS Merseyside
10 February
Tribal event around HIS benchmarking and the NHS
infrastructure maturity model
BT Yarnfield Park, Staffordshire
10 December
Health Informatics R&D
Liverpool John Moores University Centre for Health and Social
Care Informatics – CHaSCI
www.bcs.org/assist/northwest
www.bcs.org/assist/northwest
ASSIST North West Branch with HfMA
Northern Specialist Group
10 December, 7.00pm to 8.15pm (preceded by buffet from 6.15pm)
The Summary Care Record
Speaker: David Sellars, Bolton PCT & NHS North West
Manchester Conference Centre
www.hinorth.bcs.org.uk
January 2009
ASSIST North West Branch
14 or 21 January (date to be confirmed)
Logical record architecture
Wrightington
www.bcs.org/assist/northwest
London and South East Specialist Group
26-28 February
Blackpool
www.bcs.org/assist/northwest
March
BCS Health Informatics Forum
17 March 2009, afternoon
Topic to be confirmed
5 Southampton Street, London
www.bcshif.org
April
21 January, 6pm to 8pm (buffet at 5.30pm)
Microsoft and the NHS (exact format to be decided)
Speaker: Brian Painting from Microsoft
HC2009: Shaping the Future
www.hilsesg.bcs.org
www.bcs.org/hc2009
28-30 April 2009
Harrogate International Centre, North Yorkshire
Northern Specialist Group
22 January, 6.15pm for 7.00pm
An update on CFH technology
Speaker: Paul Jones, chief technology officer, NHS CFH
Weston Conference Centre
www.hinorth.bcs.org.uk
BCS Health Informatics Forum
June
BCS Health Informatics Forum
16 June 2009, afternoon
Topic to be confirmed
5 Southampton Street, London
27 January 2009, 1.30pm (12.30pm for lunch)
EHR debate
www.bcshif.org
www.bcshif.org
ASSIST
February
4 June (provisional date)
ASSIST National Conference 2009
NEC, Birmingham
www.bcs.org/assist
Northern Specialist Group
PHCSG Summer Conference
10 February, 6.15pm for 7.00pm
Drug prescribing and patient safety
Speaker: Dr Robert Treharne-Jones, GP, medical and IT consultant
Weston Conference Centre
29 June - 1 July 2009
Chesford Grange, Warwickshire
www.phcsg.org
www.hinorth.bcs.org.uk
December 2008 HINOW
19