Tuesday, May 13, 2008

NHS-HE Forum Meeting

Today (Weds 14th May) I'm attending a meeting of the NHS-HE Forum, which aims to "Co-ordinate and support network connectivity between the NHS and Universities involved with education and research in medicine, nursing and professions allied to medicine", at the Royal Society of Arts in London. Having cracked into the wireless network here I will try to give a flavour of the meetingas it goes along.

The meeting is being chaired by Professor Roland Rosner (Director, Education & Information Support Division (EISD) at UCL) who founded the forum in 2001.

The first speaker is Brian Derry (Leeds Teaching Hospitals NHS Trust & also chair of ASSIST) discussing the Swindells Health Informatics Review
Tricky position related to what he could share as now working on implementing the review - some speculation, some reasoning - but no inside knowledge. He described the current policy context of the Darzi review, free choice & informed patient, plurality & multi-provider etc. The NHS operating framework, including emergency preparedness as a guide to current priorities was highlighted - performance indicators, now being vital signs (about 120) with gaps between inputs and outputs. He highlighted the importance of information as adding value and the risks of measuring the wrong things. Quote - "ad hoc data collection produces ad hoc data quality" - linked to quality of information for payments & the importance of data assurance and audit. NHS systems are out of date & need to be patient centered rather than organisation centered. He moved on to look at the care records service (underpinned by ruthless standards) and accessible by patients, with some of the security and confidentiality issues and standardisation. He then moved on to the tensions between policy and IT. The comfort of clinicians with IT is a safety issue. He argued that complying with patient requests not to store patient information was unsafe. He then moved on to talk about the secondary uses service (a sophisticated bucket) with issues not of scope creep but of scope gallop. "Quote information as a weapon". He used part of the advert for the Chief Information Officer to highlight the importance of information in the future NHS and the importance of professionalism in Information Management, and joining up the different agencies. The capacity & capability issues, CPD & HI workforce development strategy were highlighted as future issues. He believes this will change the landscape when the report is published "in the next couple of months". The Q&A included a comparison with the last few years & the need for clinically based information. The potential for different systems in different places and the effect on staff. The differences between primary care and secondary care (& other settings) and the human interface & the lack of "logical" processes in the patient interaction were described as challenges in bringing hospital systems up to the current level of primary care.

The next presentation is about the Connecting for Health Research Capability Programme by Prof Sir Alex Markham. This new NHS Connecting for Health programme aims to develop the capability of NHS IT Systems to enable research and analysis aimed at improving the quality and safety of care. It is taking forward the recommendations of a report by the UK Clinical Research Collaboration (UKCRC) Advisory Group to NHS Connecting for Health. He talked about the difficulties of achieving things in the complex environment previously described. He talked about the policy context for research around NIHR etc all of which recognised the importance of information and the drivers for the NPfIT & CfH in the research landscape. He wants to change the names of "Secondary Uses Service" (SUS)/ Information Centre (research is not secondary), "Honest Broker" (rest is "dishonest"), "safe havens" (rest unsafe) etc...
The aims are to provide access to data for research with all the issues around annonymisation, developing data sources & dissemination. Demands from pharmaceutical companies & clinical trials etc - highlighted issues around "consent to consent" & patient confidence in clinicians and researchers. Post marketing surveillance through data systems may enable earlier licencing.
The "enabling phase" finishes in June 2008 & he outlined the key deliverables under 6 work streams. He is hoping for sign off so that it can be sent to the treasury for funding for next year. He highlighted further challenges & asked for evryone interested to "engage". Q&A discussed effects of "data losses" on the work. He avoided questions about commercial involvement eg DR Foster & SUS, but said he was not opposed in principle to commercial involvement. The dissemination of knowledge & inclusion of other databases - led to the questioner being volunteered to address some of the work.

Bob Day from JANET, UK is next up with an update on the N3 - JANET Gateway with Marshall Dozier, from the University of Edinburgh talking about their early adopter work, which has now been running for 6 months. Issues of information governance in the NHS are being addressed and more time is needed for further trails and needs to be widened from England to the rest of the UK. Public Sector Networks may provide a better approach that JANET being a customer of N3. Malcolm Teague described the national context and the need for a strategic solution which is better than the Internet, providing a 100Mbps interconnection through the firewall. The Statement of Compliance (SoC) approach was seen as being better that the old Code of Connection limitations. The technical infrastructure and initial partners were described along with some of the "coming soon" developments including video conferencing. Questions about encrypting mail to & from the NHS caused discussion & a future agenda item. Marshall Dozier talked about the Edinburgh early adopter - as an embryo inside an egg - chipping away in the background. They are working on improving access to VLEs (including WebCT), video conferencing & access to other resources eg library resources, ejournals, ebooks & data sources. Astonishing number of IP addresses, proxy server & firewall issues. The Athens - Shibbolith debate caused some delays but helped to think in a more scaleable way - and will hopefully help staff in NHS settings who are also students in HE, better access to resources. Questions were about how the learning from the gateway early adopters could be shared more widely. Future issues around Academic Health Care Centres were also raised.

An Update from Northern Ireland by Helen Jenkins, of Queens University Belfast was moved before lunch. She dsecribed the context with a unified health and social care (HSC) system. The university library is also contracted to provide services to the HSC staff. She described issues around delivery via the internet of resources, elearning, teaching & research. The ICT structure wasn't up to the task with very few internet access points & low bandwidth & poor resiliance. The restrictive policies limited access to many useful resources & IT services didn't think used for work & a bit paranoid. Each trust had different It architectures & policies - therefore formed a forum to try to address the issues around the infrastructure & skills & need for strategic emphasis. User needs were unquantified. More recent developments have led to a ICT strategy & better communication between the parties, even if that didn't overcome the funding issues.

Supporting e-learning for the NHS is the subject for the after lunch presentation by Phil Candy, (Director of ETD, Connecting for Health. ) He suggested two key propositions. 1) sucess of NPfIT depends on users learning what the applications do. 2) ETD inCfH is a key player. The context includes the dti, hefce, EU, SCIE, dfes policy etc Modernising Healthcare Training in the NHS & ETD Discussion paper for a national Learning Management System. He outlined the CfH ETD vision & highlighted some of the issues. He highlighted some of the redundancy and duplication of effort in elearning materials. The match of just in time learning might function with just in time learning. He presented a (well worn) rationale for the use of elearning. Some specific projects were described the national repository (see NHS and Social Care E-learning Resources Database), and the TRAMS project which has 5 % of the live environment with fake pateinst & issues integrating this with the frnt ends that users will be seeing. The integration of the national learning management system with the Electronic Staff Record (ESR) (DH not CfH) (Oracle Learning Management (OLM) platform & another solution for those outside the ESR. He also mentioned the move from ECDL (taken by 225,000 & completed by 30,000) to ELITE (Elearning IT Essentials). The discussed the different "levels of maturity" for elearning amongst NHS Trusts & SHAs. In the meantime he advocated the ICCA Toolkit. He suggested we are on an interesting journey & that there are interesting times ahead. Q&A addressed interoperability, the move from ECDL to ELITE.

A quick update by Angie Clark, on behalf of Peter Hill, on the National Review of NHS Library Services. She highlighted some of the headlines & how the work is to be taken into account in the Darzi Report & getting knowledge & Library services into the core of the NHS. Suggestions are that Chief Knowledge Officers should be identified in SHAs & Trusts. More discussion is neede between the role of Cheif Information Officer and Chief Knowledge Office. There are also proposals for "team knowledge officers". Training to get the evidence into the practice agenda was also seen as a vital step for the future. The challenge of changing the culture of all NHS staff was key.

This was followed by a talk on NHS Library Services and the UK Access Management Federation with a talk by Ian McKinnell, of the National Library for Health. The current situation with Eduserve/Athens which NHS England has a 5 year contract with to manage access authentication with local managers. The last tender rejected proposals to use CfH authentication systems and stayed with Athens while work continues to arrive at an Open Standrads solution. The national content eligability contract was described with now includes health students in HE. Future work to open standards was highlighted to achieve one agreement across HE & the NHS.

The final talk on the agenda is an Update on Content Issues by Betsy Anagnostelis, Royal Free/UCL on behalf of Dr Paul Ayris. It described the work of the NHS/HE content group for joint procurement which have so far failed over lack of agreement over content & payment & differences in financial years. They are considering a licence which embraces both NHS & HE was a deliverable. Other work is around open access repositories for funded research eg UKPubMedCentral. The work is informed by the SHERPA project. There is high interest in looking at the copyright issues between NHS & HE for the same individuals. The NHS CLA licence is being renegotiated and may address some of the issues, alongside the JISC model agreement which may help provide reciprocal resources between the NHS & HE. The results of the Peter Hill review of NHS Library services will influence future work. Questions were about alternative (Scottish) models and the justification (Value for Money) for joint agreements.

The day finished with thanks to Professor Roland Rosner who is retiring from his post as Director, Education & Information Support Division (EISD) at UCL, but it is hoped he will find a way to continue his leadership of the forum.

Overall it was an interesting day with a busy and varied agenda and general discussions showed the wealth of expertise and experience in the audience, who were willing to share their knowledge and ideas to improve the situation for thousands of users.

The powerpoint presentations from this meeting are now available at the NHS-HE Forum 14th May.

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