Getting technical

The new format of the premier health informatics event HC2009 was well received by commercial companies, visitors and delegates alike.
    
Organised by the British Computer Society Health Informatics Forum (BCSHIF), the aim was to create a cohesive event where the academic and commercial interest of all participants could combine seamlessly in the interests of developing core interests and objectives.
    
Taking place in Harrogate International Centre on 28-30 April, almost one thousand people attended the revised four-stream conference format and commercial showcase. The latter featured a large percentage of exhibiting companies who were completely new to HC.
    
There was also a well-established poster area and a refined commercial showcase of mainly emerging service and solution providers.  
    
Sheila Bullas, head of the BCSHIF’s organising committee, believes HC2009 has beyond doubt reinvigorated HC, restoring it to its rightful place as the UK’s leading Health Informatics event.
    
She says: “The majority of commercial organisations reported high enquiry levels during the event and as a result have already pledged their support to return for HC2010.”

Industry experts
High profile speakers included Christine Connelly, the Department of Health’s new Chief Information Officer, who emphasised closer links to NHS policy to deliver improvements to patient care, as laid out in the Darzi Report. Also present was Martin Bellamy, head of NHS Connecting for Health (NHS CFH) and director of programme and systems delivery, Department of Health.
    
Connelly provided information which defined the scale of NHS work; £90billion spent on the NHS (2008); a workforce of 1.3 million; 1 million patients seen every 36 hours; 54 per cent of new outpatients appointments booked under the Choose and Book system and over a million prescriptions transferred by e-means to date. Her clear statement was reinforced by the Director of Programmes and Systems Delivery, NHS CFH the next day: “If significant progress is not achieved by the end of November 2009, a new plan for delivering informatics to healthcare will be adopted.” Cerner and Lorenzo solutions’ targets will be readily scrutinised as the declared deadlines approach.
    
Another logical change for NPfIT was more inclusive recognition of the role of local organisations in delivery of operational solutions; no longer central prescription but with space for local flexibility and working with ‘other’ suppliers not previously involved. Connelly announced that a toolkit would be made available to third-party developers to facilitate additional complementary ‘applications’ (like iPhone apps) for systems such as Lorenzo and Cerner and to protect the quality of health data. She indicated that short term aims will focus on the acute sector.

Highlighting success
As plenary on the second conference day, Martin Bellamy, the director of programmes and systems delivery for NpfIT gave more detail on progress so far. He recognised that “It has not been easy, some parts are up to four years late” and there are still particular gaps/opportunities in Summary Care Records, Cerner and Lorenzo. The complexity of HI is indicated by 65 Communities of Interest facilitated by NHS CFH through its web presences.
    
Bellamy claimed that relaunching NHSmail will have saved £100million by 2013. He also announced that a new record for Choose and Book (appointments) was achieved in April (35,000 appointments booked on one day).  
    
Bellamy acknowledged that Map of Medicine-defined Care Pathways are identifying areas for improvements in care. He suggested that over 50 per cent of the 1.3 million NHS staff will use HI tools by the end of NPfIT. These specialists/end-users have many opportunities to develop competences and careers, including EITS and the Wales-led HI Career Framework. He too recognised the contribution of professional registration (UKCHIP) and bench-marking of HI services.
    
Bellamy also outlined progress in the early implementer sites such as Summary Care Records (SCR) in Bury, making medication information available to Out-of-Hours and Accident and Emergency departments, with patient’s information now available to Community Nurses (using handhelds) and in the Medical Assessment Unit. Overall ‘12 Cerner solutions and three Lorenzo deployments and a sizable number of ‘interim’ systems are operating across 200 acute Trusts in England’; however no detail of the scale and scope of what constituted ‘operating’ was presented.
 
Addressing challenges
Bellamy’s analysis of current challenges was refreshing, exploring reasons why deployment has proved so difficult – suggesting lack of local ownership/senior buy-in and scope creep. He urged development of robust business continuity plans, stressing that training of users should take place on a realistic system, with support in place for at least four months after ‘go live’ to allow for working practice change and revision. He encouraged shared experience by saying “Learn from previous projects” and “Steal with pride!” Constructive debate ensued around development and operational performance challenges.
    
‘Better/safer care’ supported by shared records will aid providing information in ambulances to increase the speed of care once hospital is reached. (JR: European Commission-funded project HECTOR, 1999). NPfIT recognised that GP Systems of Choice added considerable value to overall plans, and conceptually would be extended under Additional Supply Capability and Capacity Framework Contracts more widely. Collective working on a care records roadmap, will consider, for example, SCR requirements sourced from GP systems and shared long term aspirations to share Detailed Care Records, would require more consultation on potential benefits.
    
Other speakers included Dr Glyn Hayes, immediate past-Chair of BCSHIF, who stressed the cohesiveness of the event in its new form and Alan Pollard, current BCS President who gave a thought-provoking and refreshing address, which included the impact of technology and how it should go hand in hand with the management of change.

Hot topics
Day one also covered HI policy, use of IT to improve clinical practice and care in different settings, including telehealth tools. Workforce planning records were considered as were socio-technological approaches to effective delivery of technology. The R&D stream gave excellent guidance. Professor Gray, Cardiff University, considered parallels from computer science and reflected on exploration of shared records in 1982; various authors and writers looked at using current/emerging media to communicate effectively and informal feedback was available to researchers on their work from an eminent home countries’ panel.
    
The NHS Information Centre (IC) outlined current work, including review of 3,000 indicators currently used to reduce the number. Data quality is still a major issue; ways of sharing best practice are being examined. IC is to use data experts to work with Primary Care and other Trusts, developing an NHS reporting service, a toolkit which will make available and bring together all existing analysis and reporting information. Hospital Episode Statistics data will then be replaced, with an overall aim to improve ‘discoverability’ and produce an ‘enhanced Google’ NHS search tool.
    
Looking at issues around developing a knowledge-sharing culture, included the work of the UK HI Faculty, the Wellcome Trust, Medical Research Council and the Research Capability Programme of NHSCFH. Challenges as to whether work put into electronic records was ‘worth it’, gave impetus for thought in the stream on Using IT to Improve Clinical Practice; alongside papers on how differences can be resolved, how patient safety is affected by technology-enabled solutions and findings from early evaluations of the SCR and MyHealthSpace. The diversity of opinion exercised all attendees.

Leadership
Several sessions related to HI leadership/professionalism. Discussion centred on how to make health domain IT and information more professional, including the topic of whether accreditation (for individuals/services), needs independent scrutiny, and what leadership was required for information management.
    
A round table discussion on world-class commissioning, concluded that investment in HI should not be seen as IT projects per se (echoing day one) but part of wider business change. Information is essential to encouraging world-class commissioning processes of ‘upstream intervention’ to improve patient care. Discussions also confirmed necessary involvement of commissioners from the start of any HI project to ensure buy-in (reaffirming day two plenary).
    
The clinician lecture on the third day was presented by Professor Martin Birchall, the first person to perform the first ever windpipe transplant using stem cells. Birchall described the innovative area for surgery which was called by the Lancet ‘the start of a new era in medicine.’ He outlined the challenges that exist in integrating data required for such complex work into generic patient records.

Looking to the future
Kevin Fickenscher, Perot systems, considered ‘How technology changed our thinking’; listing several technology streams important in the future. He envisaged care would be provided at home more often. Bio-augmentation devices (e.g. implants), robotics and remote surgery would be part of future healthcare. His observations were congruent with those of John Crawford, IBM, who described devices under development, including Bluetooth-connected weighing scales, that transmit results to a central point for clinical review; a smart pill dispenser which alerted a patient to their medication regime and could elicit other information relating to food intake with medication. The presentation considered emerging personal health records (e.g. Google Health, MyHealthSpace) and increased self-help groups (e.g. www.patientslikeme.com).

Jean Roberts is a member of the BCS HI Forum Strategic Panel and a Senior Lecturer in HI at the University of Central Lancashire.

For more information
For information about how to participate as a presenter, delegate, visitor or exhibitor at HC2010 visit the website at www.hcshowcase.org or call Citadel Events on 01423 526971.