Category Archives: IT-NPfIT

Go figure – the National Programme for IT in the NHS report

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Today’s report on the National Programme for IT in the NHS from the National Audit Office has some interesting things to say about involving staff (see hard copy pages 44-47). I noticed for example that Connecting  for Health’s website is praised in communicating progress, as is the role of the National Clinical Leads; but at the same time it notes that NHS staff want more information from their locality rather than the centre.

Sounds contradictory? Check out the survey result tables below from the report, which put nurses bottom of the list when asked if they have a positive view of the future of the programme, but top of the list when asked whether the programme will have a positive effect in their daily work. Nurses’ opinion is the symmetrical opposite of information managers, who come top in the first question and bottom in the second. Go figure? Well, NHS IT, sounds like it’s about technology, but it’s really about people who use that technology, I guess.

Crisp resigns – Hewitt stays

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Just heard Crsip resigned from chief exec post at NHS. Surely P-Hewitt should have a little think about her role, following on so quickly from the report on Rover which suggested she was very slow in dealing with the problems..?? And I see she is inviting judgement on her financial management of the NHS.

Web 2.0? You ain’t seen nothing yet

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Just done reading the Hansard Society study on parliamentary democracy and the need improve political participation; David Wilcox on his views of a report on democracy; a review of political blogs; and all seem to point to the fact that people get involved in politics when it means something personal to them. So why you might use blogs to spread the democratic word, if the form of politics is still based on an impersonal model then it only going to have a limited impact. Maybe this cultural feature of politics is just more obvious in the reserved, deferential English society? Or to put one’s social scientist cap on for a brief moment – people’s collective silence is correlated with stupidity, when it is first and foremost an adaptive response to an environment where people perceive they do not have a voice.

For me it’s also interesting to think of the parallels with the world of technology, which is struggling with what a people-led Web 2.0 might mean in practice. Yet most people as with their politics think and act in very personal ways. The excitement of social software is that it can tap into this underlying reality and unleash the power of it, what empowerment really means I guess. But lets fact it this is profoundly scary stuff for a lot of people. The dominant model is to articulate the need for this while fundamentally holding onto the tried and trusted ways of doing things. And why not, that’s what power is? And as Brazilian educator Paulo Freire once said said, no one gives up power willingly (..and that you don’t learn to swim in a library).

In the meantime people will get on with their lives, will engage in formal politics when it really matters to them, and technology will continue to place systems before people. Social software approaches are taking steps towards opening up design for the users, which is very inspiring. What is needed now is a real public step forward using the technology in radically human-centred terms which dramatically demonstrate what is possible because it makes a radical difference. Perhaps the demands of that low-tech profession, nursing, in relation to NHS IT requirements will be that breakthrough? Perhaps counter-intuitively more likely it will be a corporate case where the use of collaborative technologies, where sharing knowledge will have a pointed effect on the productivity of an enterprise to effect a ‘tipping point’, or enable access to a new market.

While little is certain, if the reality of people’s untapped potential needs and the potential of social software to deliver that can really connect, then you ain’t seen nothing yet!

Minority Report Medicine

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Liked Doug Krell, M.D’s blog report on HealthNex about how you’d display a whole load of complex information to a clincian. Can you imagien the guys back at the UK’s Connecting for Health grappling with this one?! But maybe there’s a simple solution (I was thinking about this creatively in my post on 13 Feb) which used virtual whiteboard technology?

“Wouldn’t it be great if when a patient came in, I could have all the data literally at my fingertips. Call up the x-rays, the ultrasound reports, the current EKG, order some tests and have all prior data, current data, and all interventions on a big screen right in front of my face and be able to wave my arms around and re-arrange all the information instantly just as I’d like to see it. Then be able to make a decision and document why that decision was made. One of those large computer displays like in Minority Report would be perfect.

“So how do I get one of those “decision boards” like in Minority Report? Right now our computers are so cumbersome. A small screen just doesn’t do it. Typing is time consuming. Even the mouse is less than optimal. You have to click here, close this and open that. Then it’s hard to move data and images all around like a story and put it in a format that other Doctors can understand and it takes too much time. So then what ARE the right devices for physicians for data input, data display, and documentation?

“For one thing, I believe that larger or multiple screen displays would be better for medicine. Voice recognition and transcription software needs to continue to improve. Touch-screen technology needs to be employed. If I could design software for medicine I would develop modules that would mimic the way physicians think and the way we like to see data. These modules would be like elements of a history, physical findings, test results, treatments and outcomes. Any or all elements could be combined at a particular patient encounter to support a diagnosis or treatment recommendation”.

Data death/data lives – Connecting the Dots

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Interesting to see the follow up to the question of medical research and patient data in E-Health Insider, which makes the connection with C4H:

A CfH spokesperson commented: “The electronic care records service will be introduced over the next few years and will create a huge and valuable resource for research, for improving clinical care and patient safety. It can only do so successfully if it has the confidence and support of the public who are rightly concerned about the confidentiality and security of their clinical records as well as supporting properly conducted and ethical research.

“The NHS Care Record Guarantee for England sets out the way in which the NHS will collect, store and share our records, when and how we can limit sharing, when and how we will be asked to consent and what happens if something goes wrong. This is the first such guarantee published by a government department and supported by ministers and sets a new standard of transparency and accountability to the public. Far from obstructing good, ethical clinical research the Care Record Guarantee will support it.”

You ain’t seen nothing yet

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I went to a very interesting meeting on London’s NHS IT last night, very informative, with an interesting point that at present the roll out has been of stand-alone systems. When these are connected up, as is the master plan so to speak, that’s when worries about who will have access to patient records will really take hold. The principle is that it’s based on your NHS work role, but that generally means you will have greater access to records than you really need. And it will be a hugely complicated system to administer and audit. If you think the sex offenders in schools was a tough one then go figure the challenges faced by one of the largest organisations in the world – the NHS. This is why training and education will be as important as physical security measures for records – soft systems as well as hard systems if you like.

On the plus side when the IT system implemented by Connecting for Health does connect up it will provide a national databank of great value to medical researchers – once the problems over data confidentiality have been sorted out!

Data death/data lives

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Saw this report in today’s Guardian having just read the Connecting for Health 05/06 business plan. Surely if there’s one thing that would get the medical profession motivated about the benefits of C4H its that in a few years it will as a result (see Financial Times article on Monday) in an unparalleld national dataset on patient health which can be mined? But that opportunity will be wasted if the bureaucracy issue is not sorted:

“Tens of thousands of lives are being lost every year in the UK because medical researchers are hampered by bureaucracy in obtaining patient data, according to scientists. A report published yesterday by the Academy of Medical Sciences said that large population-scale medical studies are in jeopardy because of an “undue emphasis on privacy” by regulators.”

NHS Connecting for Health Response

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I was interested to read the NHS Connecting for Health response to the Medix survey of GPs on the progress to date. Perhaps CfH should set up a simple feedback site using Blog/Wiki technology, like Patient Opinion for patients, to encourage GPs to give their views? Also check out the Rod Space piece on this story.

“NHS Connecting for Health recognises that communicating with clinicians from a range of disciplines is essential. Our National Clinical Leads have been strengthening links with professional bodies representing clinicians through national clinical advisory groups, speaking at conferences, meeting with their peers and building networks. In addition, they have been ensuring that the views of the clinical community are represented to NHS Connecting for Health.

“Our own MORI research shows that NHS staff want to be engaged at local level. We have therefore been working through the Strategic Health Authorities to ensure that responsibility is shared and delivered at local level. For example, over a million leaflets went to NHS organisations last year to distribute to their clinicians and staff about the NHS Care Records Service. Further communications to NHS staff are planned.

“MORI work surveyed a range of NHS staff not just doctors and overall, the findings are positive:

  • Staff are supportive of what the programme is trying to achieve and consider it an important priority for the NHS.
  • Around half of staff are favourable towards the programme and around a quarter are neutral.
  • According to MORI, NHS staff awareness levels of NPfIT are as high as could reasonably be expected given that it is a relatively new initiative.
  • Staff agree on the benefits of the National Programme for IT (NPfIT) – that it will improve patient care, improve access to information and release more time to be spent with patients.

“It is well known that there is usually a dip in confidence in IT change programmes as early implementation gets underway – this is the phase that NHS Connecting for Health is in. Once people become familiar with new systems their confidence rises. For example, the Quality Management and Analysis System (QMAS) – delivered by NHS Connecting for Health – that enables GPs to get paid for the quality of their care is now ubiquitous and the survey shows that 75% of GPs think it is important.

“Media reporting tends to pick out the negative items. But there is much to be positive about in the full survey:

  • 59% of GPs and 66% of hospital doctors say that clinical care will be significantly improved in the longer term by NPfIT.
  • Over 50% of GPs and 40% of hospital doctors say they have had some / a lot of information about the NPfIT.
  • The majority of doctors are either neutral or think NPfIT will improve their working lives in the longer term.
  • The majority of doctors agree that NPfIT is a priority for the NHS.
  • Half of GPs and the majority of hospital doctors are neutral or positively supportive of NPfIT.

“However, the survey did not give doctors the opportunity to comment on some NPfIT services. For example 94% of GPs’ premises have had a new high speed, backed-up broadband connection installed at their surgery under the N3 programme. This is a foundation stone of NPfIT and the N3 programme is ahead of schedule.

“Concern was expressed on expenditure on NPfIT. However, the aggregated buying power via NHS Connecting for Health of the combined NHS has delivered huge savings over previous piecemeal approaches to IT procurement. Central purchasing of core systems will save the NHS an estimated £3.8 billion over ten years.

“We accept that the NHS has found it challenging to implement Choose and Book, due to the complex technical integration of old and new systems and the organisational and cultural change that is required. We have worked with the NHS to support their implentation efforts. Once people start to use it they become more supportive. Most importantly, Choose and Book is really valued by patients who have used it, they like the certainty of getting an appointment and when it suits them.

“A majority of doctors say there has not been adequate “personal” consultation with them about NPfIT. This is unsurprising given there are nearly 100,000 doctors in England. There has been significant consultation and discussion with doctors’ leaders and representatives and many, many clinical reference groups and user groups. In any case, 5% of responders are satisfied with the level of personal consultation. In aggregate this suggests some 4500 doctors have been personally consulted.”

Good news for patients

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Some good news – the national launch of Patient Opinion took place on 3 January:

There’s lots of official information about the NHS available on the Internet. You can find out which hospital got 2-stars and – if you’re persistent – what the MRSA infection rate is. But what people also want is to find out what other patients thought.

Patient Opinion, (www.patientopinion.org.uk) which launched nationally this week is an independent website where patients can do exactly that. It represents a revolutionary exercise in public feedback on health services that takes free-form patient stories about their experiences and creates structured data that can drive service improvement.  So a patient being referred to a particular speciality can review what previous patients at a range of hospitals thought about the services – for example did they think the wards were clean? And they can add their own experience to help future patients.

Patient Opinion’s founder Sheffield GP Paul Hodgkin says: “Although our start up funding comes from the Department of Health and South Yorkshire SHA, Patient Opinion is structured as an independent, not-for-profit social enterprise and we generate income by selling collated themes and reports to Trusts and PCTs. Subscribing Trusts also get the ability to direct data feeds of interest to relevant managers and clinicians.” He added it has been developed in support of the NHS Choose and Book programme in order to help patients decide where they want to be treated. It complements official NHS statistics and star ratings and as well as being independent, it is confidential and free to patients.

Livio Hughes, director of Headshift, the UK’s leading social software internet consultancy says: “We were determined to avoid turning the Patient Opinion site into yet another token ‘patient’ website. Instead, the communication model uses a range of social software tool and techniques – from patient weblogs to feed aggregation – to create reliable patient-generated reputations for individual departments and services, and shares these with prospective patients at the point when they are choosing a provider.”

The site’s system is simple, easy to use and requires patients just to tell their story in their own terms – it uses a specially-designed social tagging system to learn from the informal language used by patients, rather than forcing them to use official medical and healthcare terminology. Patients are given a treatment diary and the system will help them prepare for consultations with doctors. It is also the first major application to achieve real-time web service integration with NHS.UK to ensure information is up-to-date and relevant.

The NHS opens up to Linux

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Novell has announced a £21.8 million contract with the NHS for a new identity management, application management and Linux-based server infrastructure that will improve the delivery of health services to UK citizens.

The overriding benefit of the switch to open source is significant cost cutting. “It secures the NHS an enterprise class open source platform along with, more importantly, affordable support” said Richard Granger, director general of NHS IT. The open source software will support the NHS’s infrastructure, covering more than 600,000 workstations, used by more than 100,000 doctors, 380,000 nurses and 50,000 other health care professionals.

It marks an encouraging step forward since last year’s ‘disappearance’ of the NHS White Paper on converting systems to open source. The NHS withdrew this document from public scrutiny after reverting to a more conservative stance on open source. The big fear then apparently, was that open source meant no guarantee for the maintenance of information systems.

Novell has managed to allay the unfounded fear that Open Source would leave public services (and one as crucial as the NHS!) without support. It will provide consulting resources to deliver the National Programme for IT and ensure best practices throughout all divisions.