Transformational healthcare

Health Informatics professionals should “come out of the back office”, according to the outgoing Chief Information Officer for Health Matthew Swindells in his opening remarks at this year’s Healthcare Computing conference. The Department of Health and the information community needs cohesion, he suggested at the 25th anniversary HC event at Harrogate in April. Moreover, the recently advertised NHS chief information officer position was a way to link policy/strategy and activity.
Referencing the forthcoming Darzi review on the future of the NHS, Mr Swindells stressed that Health Informatics deliverables will help organisations address the challenges they face. Developing an informatics profession and achieving information-literate super-users of the appropriate calibre and numbers, he suggested, required accreditation for solutions, services and individuals. Success will be in engagement, good data and transformed processes. He said: “Adding that we devalue individuals if we ‘dump’ IT onto them - we must inform them, and demonstrate to them, how technologies help staff and patients.”

Sharing information
Maintaining anonymity of patients, accountability and ownership of data belonging to patients were some of the other key themes raised at this year’s event. The topic of sharing patient records across boundaries and professions will also be included in the forthcoming Darzi review, revealed Mr Swindells in his conference talk, which echoed the ‘invitation to the future’ theme of the event.
Another theme echoed was sharing information - from technological interfacing, interoperability and integration of solutions; specialists and super-users working together and decision support for professional and the public. All were in evidence at HC2008.
Mr Swindells also described the direction of the three-stranded Informatics Review he is leading, supporting the key points of Lord Darzi’s report on the NHS in general. Both are to be issued in early summer, by the DH.
Sharing records both between professions and across boundaries will be an issue raised in the Darzi Report (in local sections and overall). Darzi will stress a need to move patients around, within a robust clinical governance framework; requiring information to be equally mobile because “medicine only makes sense when it is in context”, he revealed.
Swindells summarised the information needs underpinning the business of health, indicating that NPfIT will continue (albeit revised) and highlighted a need for greater leadership from the ‘top of the office’ for the health informatics (HI) profession. He presented HI in the ways it will meet challenges faced by those at the top of the NHS in England, driving public needs, clinical factors and quality, access and accountability.
Many of the concepts he described are re-versioned from those previously seen in clinical case mix management, collective care pathways and the Korner principle of the capturing of data as a by-product of care. Touching on the thorny issue of secondary uses of patient data, he stressed that central pooling of data was necessary to improve health processes overall.
When questioned, Mr Swindells acknowledged that concerns over data security required strong solutions. He reflected that “new policy should always be information-assessed before release”.

Data treatment
Conference delegates then heard about operational and research-based initiatives in the plenary themes on all three days. For example: secondary uses of data give cause for concerns about maintaining anonymity of subjects and potential unplanned aggregation with other data sources. In a session on current UK and US treatment of data, questions arose about ensuring ‘like with like’ comparisons, making decisions in appropriate context, and accountability, ownership and ‘end to end’ responsibility for the health information chain.
Calls for adherence to standards and the need for patient consent on the what/when/how uses of their data (personalised or anonymised) were repeatedly made. Benefits from deploying informatics operationally in acute, primary and other care areas were clearly presented; as were aspects of maintaining patient safety.

Other themes
Conference themes ranged from implementing national programmes, understanding priorities and challenges, to using innovative technologies, building (workforce) capability, managing safety and risk, understanding healthcare, cross-sectoral care delivery, supporting access, disability and diversity, research perspectives, and service transformation.
Topics showcased included self-management of diabetes, rehabilitation goals and advertising to patient groups in addition to technical and organisational use cases. In parallel to the congress sessions, short case histories presented by exhibitors gave contemporary perspectives on operational solutions.

Innovative areas including technology in ‘smart homes’, to support mental healthcare, using Internet technologies in cognitive behavioural therapy, patient empowerment and professional decision making were considered. Mainstream NHS technologies across the UK and those in military situations (managed by the Defense Medical Information Capability Programme) could be compared. In addition to conventional configurations in acute, rehabilitation and primary care situations, the DMIC development strategy covers clinical information support to worldwide military bases and mobile/battlefield situations.
Delegates also heard about developments and plans to enhance the available HI resource capability to respond to emerging Darzi health goals and to complex policy targets. it was concluded that steps are needed to rapidly increase the capacity, agility and visibility of the contribution of HI to care and effective service management. Those attending acknowledged need for further professionalisation, and the personal accountability/responsibility they bear in ‘mainstreaming HI’ and facilitating 24 hour, seven days a week patient care. Effective shared operation needs high level championing of HI and integrated informatics working across all healthcare sectors, social care and taking account of other government IT developments.
The ten conference strands provided a focus for delegates with targeted agendas whilst still allowing for those wanting to get an overall snapshot of progress. A significant showcase of England’s National Programme for IT (NPfIT) developments formed a bridge between conference and exhibition. Plenary sessions highlighted delivery today and future directions, from English and Welsh strategic directions; technical and commercial perspectives.

Welsh model
Indeed, a session on the Welsh perspective was summed up as ‘working with the grain’. The Welsh model adopted an incremental approach to (shared) Integrated Health Records, building on international standards and managing pace with risk. They had avoided suggestions of ‘rip and replace’ by working with partners rather than transferring all risk to them. In addition to local audit, the Welsh developments are scrutinised by an International Advisory Group. Of £44m spent to date, the IHC team stated 60 per cent of it has been used by local NHS on programme implementation. Wales proposes a Clinical Portal to provide a consistent front-end with migration of application solutions transparently behind it over time. Analysing clinical data flows produced service improvement plans, they said.
Wales also intends to create life-long primary care level records (‘My Health Online’) where patients share their information under a common protocol. There will be no secondary uses of the IHR for performance monitoring, but there might be for planning. Wales still has Community Health Councils and so can gain a representative citizen view rapidly and effectively.

Half hour case histories provided exhibitor information dissemination for congress visitors. For example, NHS Choices described data available/and planned on their site, parts of which seemed to be reminiscent of NHS Direct and the ‘Hitting the Headlines’ services as well as overlapping with the functionality of Map of Medicine, and NPfIT with regard to Choose and Book options. Whether this was synergy by portal or not will require further investigation, but the concept of a greater decision support context for potential patients and carers is to be welcomed.  
The final futures session reflected on what was being done to bring healthcare into the internet age using a free web-based technology platform that allows individuals to control their own health information, collating it from many sources; a laudable and interesting perspective.

Jean Roberts is Policy lead for the British Computer Society’s health informatics forum and lecturer on health informatics at the University of Central Lancashire.

For more information
Proceedings of the conference are available on CD-ROM from

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