Friday, April 27, 2007

Blood safety project wins top GC Award for Innovation 2007

I was delighted to see on the Kable Government Computing web site that a team from John Radcliffe Hospital had won the top prize for their Wireless Enabled Blood Tracking project.

The judges were impressed by how it dealt with a complex process in the challenging environment of a modern hospital, staying focused on the prime objective of helping to save lives and promising long term benefits for healthcare in the UK.

The project has provided end to end electronic control of blood administration, ensuring safer transfusions, eliminating errors, cutting costs and freeing up staff time. It uses hand held computers uses hand held computers to correctly identify the patient by reading the barcode on their wristband, and to deliver a simple to use transfusion protocol right to the point of care at the patient’s bedside. The system ensures that the blood sample taken for cross-matching is correctly labelled at the patient’s bedside and that the right blood unit is given to the right patient.

This is combined with "BloodTrack Courier" which provides a system for managing blood stock by controlling staff access rights and managing the transportation of blood products around the clinical environment. Blood products can be traced from arrival in the blood bank through to retrieval and delivery to the patient.

The project has realised both cost savings and improvement in patient safety.

Further information is available from their Information Sheet.

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Thursday, April 26, 2007

Health Select committee written submissions published

The written submissions of evidence to the House of Commons Health Select Committee (relating to evidence submitted about NPfIT) has now been published on the committ'es section of the House of Commons website.

See >>> or for all the links. Thanks to Ewan Davis, of the BCS Primary Care Specialist Group, for pointing us to this. The materials present include written submission from the British Computer Society (>>>), compiled mainly by the BCS Health Informatics Forum, and the Royal College of Nursing (>>>)

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Tuesday, April 24, 2007

He@lth Information on the Internet 56(1), April 2007

The latest edition of He@lth Information on the Internet 56(1), April 2007 has just been published and includes some interesting artciles:

Social networking in the health context
Childs, Sue

Online communities for healthcare professionals: when hype meets reality
Sandars, John

Medical Journals Back-files Project
Kiley, Robert

Bookmarks: Infection control
Blenkinsopp, John

Getting Web developers to wear sensible shoes: working with developers to create online user services
Robalino, Shannon

View from the front line: Beyond the PDA
Brown, Harry

Current literature
Waddington, Marina

What's new?
Williamson, Laurian

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Saturday, April 21, 2007

Shared Care Record workshop

Yesterday I attended an "Open Workshop" organised by the NHS Faculty of Health Informatics.

The workshop was led by Dr Gillian Braunold (Connecting for Health, National Clinical Lead for GPs) and provided an opportunity to explore a range of issues surrounding the Summary Care Record which is currently being piloted by Connecting for Health. This will provide an outline record for every NHS patient, initially based on a summary by their GP.

The event was held at Armada House in Bristol which provided easy access for me and was one of the first organised by the Faculty in the south of England.

The day was opened and chaired by Dr Paul Woolman who introduced the day by outlining the case for the SCR by citing references ranging from the US Institute of Medicine Preventing Medication Errors to the New Statesman supplement on IT and Modernisation (Oct 2006).

Gillian outlined her background and asked delegates to describe their role and what they wanted to get out of the workshop. She then described some of the lessons and issues from the early adopter sites (such as that in Bolton which was announced in March). She discussed some of the issues around opaqueness, delays and politics and compared the approach in England with that in Hampshire, The Wirral and Scotland who are "getting on with it". She also raised issues, which ran throughout the day, about consent, opt-in and opt-out models and sealed envelopes, which have been discussed on this blog and elsewhere (eg SCR opt-out sets 'onerous' conditions, says GP EHI).

Of the £12.4 billion budget for the National Programme for IT only a small percentage is being spend on the SCR, but Gillian described it as being one of the keys to making all of the work on sharing records come true.

The rationale for the inclusion of medications and allergies in the first uploads of records was described, and linked to work on security and confidentiality including Role Based Access Controls (RBAC), workgroups, "legitimate relationships" audits & alerts, and aspects of physical security including smartcards.

Issues about data quality within records were briefly touched on along with developments for patient access via HealthSpace, including e-gif level 3 security which is promised for May 2007.

After lunch David Nash gave a demonstration of the Clinical Spine Application (now renamed Summary Care Record) showing the view that a doctor in A&E may get to the data which has been uploaded from a GPs record. This raised lots of discussion about RBAC, overriding dissent etc. Demonstrators (both online and stand alone) of this functionality are being built.

Dr Chris Frith then discussed sharing records with patients in his surgery and gave a demonstration of the ways in which patients can do this via the surgery web site and EMiS access. He described the advantages of patient access as increasing trust and accuracy and reducing errors. The usage figures are still quite low bu8t some useful insights are being gained.

Another demonstration, which had been arranged at short notice, was by Brian Seaton, who showed his own medical record from a credit card USB drive using HealtheCard and discussed the layout and cost issues related to keeping the record up to date and accessing it (especially when NHS computers are having USB ports removed because of data slurping).

The final part of the day was workshop where delegates divided into groups to consider some of the issues around business processes and consent models which are being raised by this work and still being grappled with.

Generally the day was quite a useful opportunity to learn about the latest developments and explore some of the ongoing issues, which are important for everyone whether healthcare professionals or patients. It will be interesting to see what the effects of the public information campaigns in early adopter areas will be and how many of the current proposals are still in place ina years time.

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Thursday, April 19, 2007

Public Accounts Committee Report on NPfIT

I only noticed today, when this week's 'Computer Weekly' popped through my letterbox (yes, the dead tree version) that the Public Accounts Committee's latest report into NPfIT was published on April 17.

Some points from the report's Summary, which has four conclusions, include:
- no firm plans have been published for deploying software to achieve the vision of a shared electronic patient clinical record;
- the suppliers to the Programme are clearly struggling to deliver, and ... the Department [of Health] is unlikely to complete the Programme anywhere near its original schedule;
- the Department has much still to do to win hearts and minds in the NHS, especially among clinicians;
- four years after the start of the Programme, there is still much uncertainty about the costs of the Programme for the local NHS and the value of the benefits it should achieve.

Computer Weekly say that 'The government is expected to respond to the report and its recommendations by July.'

I don't think any comment is needed on the above - but may feel a need to provide some when I have been through the full report.

The report is available via the the House of Commons website >>> and the Computer Weekly report on their website >>>

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Tuesday, April 17, 2007

DoH makes Wells report into NHSu available

The Department of Health has now made available the full text of the Wells report into the NHSU you can get it at: Review of NHSU

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Monday, April 16, 2007

More on NHS University

Since putting the Wells report on the web at the end of last week, I've had lots of interesting conversations mostly with journalists but also with people who used to work for NHSu.

I've noticed coverage on:
E Health Insider - Report warns of embarrassment over NHSu's £72m
Doctors Net (which I can't access)
Busynurse - Sir William Wells' Review of the NHSU
Dr Grumble - £72m down the drain?
Dr Rant - NHS Univeristy: waste, lies, and spin
Save Bedford Hospital (Vote4barry) - Another £72million wasted

If you know of others please let me know.

While checking out these sites I did a search for NHS University - many of the old web sites about it exist on domains but I was slightly surprised when I clicked on & found adverts for lingerie and gambling - the domain appears to be for sale to the highest bidder - I thought domains were strictly controlled by Connecting for Health to ensure the corporate brand and quality was maintained?

Thursday, April 12, 2007

NHSu - Wells Report full text

Following my post earlier today giving my comments on the Wells Report on the NHS university, I have been contacted by several journalists, asking for more information.

Several have also tried to corroborate my comments by getting access to the full text on the Department of Health's FOI releases web page. This has still not appeared and one of the journalists was told that the Departments copy was locked in a cupboard & the person who has the key has gone away on leave - you couldn't make it up!!!

Therefore, as the Department now agrees with me that it is in the public interest for this document to be in the public domain (see covering letter attached), and an officer of the Information Commissioner told me that I could put it on my web site, I have decided to help them out by scanning in the document they sent me and attaching it to this post.

Covering Letter

Volume 1 Progress and Performance


Vol 2 Looking Forward


NHSu - £72m & no clear role

I have today received a copy of the report by Sir William Wells into the NHS university which I have been trying to obtain since 2004. It paints a damming picture of an organisation lacking in clarity of purpose, and failing to engage with stakeholders while managing to spend 72 million pounds of taxpayers money.

As readers of this blog will know, the NHS university was proposed in the labour manifesto of 2001 and established as a special health authority in 2003. It's demise was announced on November 30th 2004 by the then Health Secretary John Reid, following a report into it's progress and performance by Sir William Wells.

I asked for a copy of the report in October 2004 and my MP received a letter from John Hutton in November 2004 saying that it was the Department of Health's intention to publish their findings "shortly".

When the Freedom of Information Act came into force on 1st Jan 2005 I wrote, under the new mechanisms, requesting that the report be disclosed which the department of health refused to do. I then appealed to the Information Commissioner who ruled in Nov 2006 that the department should disclose the document. The Department of Health then appealed against that decision to the Information Tribunal. Last week, just before the hearing, they withdrew their appeal.

The covering letter, which I received with the report today, suggests that "the Department has undertaken a full review of the determination of the public interest in this case". They argue that release in early 2005 would "prejudice any future reviews which might be conducted by the Department into the economy, efficiency and effectiveness of sponsored bodies", but that two years later this has changed. There is no explanation of what has changed since they appealed against the Information Commissioners ruling in November 2006.

The report itself is in two parts, the first detailing progress and performance and the second forward to the creation of the "NHS Institute of Healthcare Innovation and Education".

It starts by setting out the original concept behind the NHSu, but even on page one criticises the lack of clarity about where the NHSu fitted into the "already crowded healthcare education and training sector" and what its role should be. It goes on to describe tensions between strategic objectives and potential roles as a provider or broker of training. The lack of understanding of the wishes of customers (eg Strategic health Authorities) , is highlighted as a reason for the lack of support and integration with the wider NHS.

The quest for University title is highlighted as a major problem which was not understood by senior staff in the NHSu or ministers and added to confusion over the NHSu's role.

A major part of the report is devoted to delivery and value for money, which deals with a range of issues including; the staff complement of 412, learning services, and academic partners. It gives some numbers of the limited take up of NHSu courses and predicts that these would not meet the projections, particularly once the courses had to be paid for. Comments from a variety of stakeholders about the lack of a clear business plan caused Sir William concern as did the processes for governance. The 30% of staff involved in corporate services "seems disproportionately large" especially when viewed in the light of comments about the "culture and style of a start-up enterprise" and the lack of focus on structure and systems. Frequent changes of structure and individual roles were seen as another barrier to the establishment of effective working.

The report concludes with some answers to crucial questions about whether the investment was appropriate and over what timescale it is likely to bear fruit. The answers are damming and relate to lack of clarity of purpose, the absence of market surveys or prices, governance, pursuit of the University title, and engagement with stakeholders.

It suggests that in the light of the £72 million investment up to March 2005 "the Department of Health is exposed to significant embarrassment if the value for money delivered by the NHSU were to be probed".

I suspect this might be the reason that the report has taken so long to see the light of day - but I hope that now it has, it will be used to inform future decisions and avoid making the same mistakes again.

I hope that a full copy of the report will soon appear on the DoH FOI releases page.

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Thursday, April 05, 2007

Southern Institute for Health Informatics Conference

The Southern Institute for Health Informatics will be holding it's 9th annual conference on Friday 21st September 2007, Richmond Building, University of Portsmouth, and are inviting contributions.

The theme for the conference is the way that health informatics can facilitate the collection, fusion and dissemination of information about a patient. The conference will be used by the Department of Health as part of a scoping study for a possible future programme of research in this area. The conference will also be one of a number of Telecare Knowledge Network events this year.

The conference will consist of a number of keynote speakers and other oral presentations. In addition, the "Infomart", an informal information marketplace area, will allow vendors and researchers to set out a stall to meet people and exchange information. The conference is supported by Fujitsu (the lunch sponsors) and SEHTA (through TKN).

If you would be interested in attending or participating in any way, please email Proposals for presentations should be accompanied by a 100-150 word outline and reach them by 20th April if possible.

XML summer school

The development and application of emerging technologies in healthcare continues with XML emerging as a key method for patient-centred health records systems.

The XML summer school to be held in Oxford 22nd -27th July this summer has a focus on XML in Healthcare with a two-day course is aimed specifically at healthcare IT professionals, planners, managers and clinical IT users who need to understand the way in which XML is being applied in healthcare markets, across the world.

The course surveys XML and other related open standards, including HL7, that are being applied to the management and exchange of information in healthcare.

Module 1: XML and Open Standards in Healthcare

· XML and Open Standards Applied in Healthcare

· HL7 Implementation Practice

· Anatomy of a Shared Care System

· How XML supports Clinical Governance in Shared Care

Module 2: Architectures for Health Records

· Information Models for Health Records

· Local, Regional and National Architectures for Health Records

· Towards Clinical decision Support

· A Global Market for Standards-based Health Records

If I wasn't saving all my time and pennies for the Medinfo conference in Australia in August I would consider going myself.

Wednesday, April 04, 2007

Wells report on NHSU - DoH withdraws it's appeal

I traveled to London today for the hearing by the Information Tribunal, under the Freedom of Information Act, into the appeal by the Department of Health against the Decision Notice by the Information Commissioner which ruled that they should disclose the report by Sir William Wells into the NHS University.

The DoH had withdrawn their appeal before the hearing (unfortunately no one had told me - otherwise I wouldn't have had to take the train).

I have not yet had an official confirmation of this, or been given any reasons, although I have been verbally promised a letter imminently.

In the absence of anything official I can only speculate that the appeal was withdrawn because they realised they wouldn't win!

I'm also still trying to find out the timescale the department now has to disclose the report. The ICs ruling on 27th Nov 2006 gave them 35 calender days & the department appealed on 20th Dec (23 days). I don't yet know the date on which they withdrew the appeal, but I'm assuming the clock starts ticking again at that point. (I'm not aware of any other case where this has happened & I can't find anything in "the rules" which clarify this)

My cynical mind means I am speculating that the disclosure may come over a bank holiday weekend, when it may receive less scrutiny than if it was published on a normal working day. Unless, of course, there are some other tactics to avoid or delay disclosure which I haven't yet thought of.

It is now two and half years since I first wrote to my MP about this & received a reply from John Hutton (then Minister of State at the DoH) stating that the department intended to publish the results "shortly". The long and convoluted process which has taken place since to obstruct access, makes me more and more convinced that the report must contain something which someone in authority doesn't want published.

I've already been offered a celebratory drink following today's experience - but I shall refrain from drinking it until The Wells Report is finally published.

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Monday, April 02, 2007

An interesting post on the Trusted.MD Blog YESTERDAY under the headline Trusted.MD Network Jumps on Health 2.0 Bandwagon describing current and future developments - perhaps this truely is the start of the move from Health 2.0 to Health 3.0?

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