General&Social&Tuesday22 Mar 2006 09:23 am

Tuesday evening saw the main conference dinner, this started with drinks & a reception before the meal and during the meal some strange, muscial and very funny contributions from the Three Waiters. They managed to get everyone laughing and participating – much to the surprise of some of the international delegates and managed to embarress some of the ladies present. This was followed by Tom O’Connor, fake gambling and a disco.

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Conference&Tuesday21 Mar 2006 05:49 pm

The London & South East Health Informatics Specialist Group of the BCS organised a lively and humerous debate, asking the audience to consider the motion: This house believes that real innovation using ICT in healthcare delivery is driven by clinicians rather than informaticians.

Before the speakers were able no put their case for or against the motion a vote was taken – with 18 voting in favour and 4 against the motion.
Simon Dodds, a vascular surgeon and computer scientist, then proposed the motion by describing the charcteristics of an innovator and using his experience (and prizes) to support the case. Ian Hebert countered these arguments by suggesting that clinicians get tunnel vision which limits innovaton & suggesting that good code is needed to enable diffusion of innovation – however being aware of what is possible is key for all. He suggested that C4H is a good example of trying to innovate without clinicians. Mark Outhwaite asked the audience to seriously consider the issues and argued that only clinicans can truely understand the interaction with patients and therefore the innovations that are needed. The final presentation was from Colin Jervis who gave some good examples of poor records and suggested that innovation is not about ideas but about implementation.

The micorphone was then turned over to the audience with varied and very relevant contributions from a range of people, both clinicans and informaticians, to argue various points, before the lead proponents and opponent of the motion summed p.

The final vote was 18 in favour and 9 against the motion.

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Conference&Tuesday21 Mar 2006 03:43 pm

Prof. Reinhold Haux, from the Institute for Medical Informatics, Technical University of Braunschweig, Germany, and President-elect of IMIA, the International Medical Informatics Association (www.imia.org), will be giving an education masterclass as part of the final set of sessions today. His session is titled ‘Specialised curricula in health and medical informatics: approaches, examples and graduates’ job perspectives’.

Attendance was a little disappointing, but Reinhold nevertheless provided a useful session on approaches to and examples of health and medical informatics courses and curricula. He began by explaining that the need to consider developing health and medical informatics curricula is set in the context of changes in society and healthcare due to increasing use of IT, increases in the available knowledge base and the need to manage it, and the need for health professionals and health and medical informatics specialists to be educated in appropriate and responsible application of IT to health and healthcare.

He summarised the aims of the masterclass as being:

  • to introduce approaches for specialised education programmes leading to degrees in health and medical informatics education;
  • to give some examples of specialised programmes; and
  • to discuss job perspectives of graduates from such programmes.
Conference&Keynotes&Tuesday21 Mar 2006 03:28 pm

At lunchtime today there was a press briefing by Connecting for Health at which Dr Gillian Braunold (GP Clinical Lead) and Kerri Adenubi (Programme Director for GP Systems of Choice) announced a change in the mechanisms for GPs who want to use systems which are not those provided by C4H local service providers (LSPs). Gillian talked about a scheme allowing “approved” systems to be used as lng as they meet functionality requirements in the context of the “Ladder of Compliance”, and some of the financial systems to be put in place for this. It was interesting to note that district nurses and health visitors will be using the systems provided by the LSP even though the GP’s caring for the same patients may be able to use different software systems.

The next session was an update on NPfIT system deployment by Richard Grainger (Director general of NHS IT) who gave a very upbeat summary of progress so far and the likely roll out of further functionality this year. He highlighted both the sucesses and failures of GP computing in providing high functionality but being unable to share it. A key part of his presentation seemed to be that the high profile problems with the system before were often due to local configuration problems rather than the services provided nationally, or had been blown out of proportion by the press. He closed with a recognition that issues around consent mechanisms for the sharing of health records and the “sealed envelope” are likely to be high profile over the next few months – an issue highlighted by the report on E-Health Insider from a session yesterday which suggests that many people, once they are aware of proposals will opt out of having their records shared.

One interesting little procedural problem was highlighted when David Clark (Chief Executive of the BCS) was prevented from entering the auditorium to hear Richard Grainger because of a problem with his badge.

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Conference&Tuesday21 Mar 2006 02:56 pm

Sun sponsered an interesting sesstion “Empowering staff: how identitity and data management can ensure secure, efficient and effective access to patient information”.

This was an interactive hour with very minimal presentations from speakers & lots of audience participation. A key guest Harold Robles started by declaring that this was a human rights issue and provided several challenging questions throughout the session. Drew Wagar, who is described as Sun’s UK “Identity Evangelist”, tried to move everyone from a “post-it” password management system, to a recognition of the complexity of the issues about correctly identifying the individual in their various roles and the delegation of some of that persons’ tasks.

As the discussion moved on to looking at patients and clinicians roles, the lack of checks within the NHS were described as being “less than you need to hire a video”. Several important points were made during a wide ranging question and answer session particularly focusing on GP systems, trust and the importance of enabling patient access to their records to increase confidence and relaibaility of the information it contains.

Very few answers were forthcoming but it was helpful in clarifying some of the appropriate questions.

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Conference&Keynotes&Tuesday21 Mar 2006 12:06 pm

Tuesday already; the opening plenary session of the conference featured keynote presentations on the Scottish and Welsh approaches to developing electronic health records, and generally ‘wiring’ the health services in the two countries. As to expected, neither speaker could resist some comparisons with the English approach – and references to rugby.

Dr Kenneth Robertson, Clinical Lead for IM&T for the Scottish Executive Health Department, started the session with a talk titled ‘Making a different difference’, in which he discussed progress and change on some of the developments he talked about last year, as well as talking about some of the vision and how the Scottish approach would achieve it.

Kenneth talked about the Scottish approach being different from CfH, and of the need to temper the idealism of the Scottish vision with a degree of pragmatism. He focused on the Scottish work being aimed at delivery for health, with patients having access to their own EHR, a drive the increase the use of telehealth, and a need to sharpen the focus on real delivery. He mentioned a ‘big 4’set of issues affecting the Scottish approach, ie:

  • keeping the NHS as local as possible;
  • looking after people’s long-term health conditions;
  • reducing the inequalities gap; and
  • actively managing hospital admissions.

He hailed the use of the CHI (Community Health Index) number as a success, and while there is still some variability in usage levels, they are aiming for ‘universal use of the CHI number by 6/6/6’ – hence the title of this post.

One of the main priorities for next stages of work will be around sign-on and authentification, especially related to medicines prescribing.

In discussing how to get to an EHR, he suggested that the market is not yet ready for delivering the full vision that is held for Scotland, with suppliers not in a position to meet needs because of their products being too domain focused and many of the products being immature.

As with last year’s presentation, this was a useful, informative, and well-delivered presentation.

Dr Gwyn Thomas, Programme Director for Informing Healthcare, Wales, discussed the Welsh experience and approach, and examined how the local context of the country is affecting the decisions made. HIs presentation was also informative and well-delivered. He described how the choices made and to be made for Wales are influenced by many aspects of the local context, including the geography and mobility issues around Wales, but suggested that, due to this, many rural communities would seem ripe for development of telehealth applications and services. He stated that context and culture will determine success, rather than the quality of the IT systems.

Gwyn referred to the two major policy documents, ‘Making the connections’ and ‘ Designed for life’, and said that the principles within both documents would be embodies in the Welsh programme. Among the key influencing issues would be:

  • putting citizens (as opposed to consumers) at the centre;
  • working together;
  • making the most of resources; and
  • engaging the workforce.

While he did not make overt comparisons with the English experience, the messages seemed to be there.

In closing, Gwyn said that the Welsh work aimed, in part through clinical leadership and patient involvement, to support the overall care of the individual – the concept of ‘my health, my record’. He suggested that dealing with the issues was ‘complex, not just complicated’, and that complex systems approaches might provide lessons to be considered.

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