Wednesday, March 18, 2009

CfH Learning to Manage conference

Today I travelled to London for a connecting for health conference relaunching the “Learning to Manage Health Information” strategy.

Learning to Manage (LtM) was first launched in 1999 with a refresh in 2002 to set guidelines for the inclusion of health informatics into the curriculum for education for clinicians. It’s effectiveness in achieving it aims was limited and therefore it has been revised and updated. The intention of the new document is to provide guidance for educators, regulators and commissioner of education on appropriate learning outcomes for different professions at different stages of their education.

The day, which was held at the Royal College of Obstetricians and Gynaecologists, was opened by Martin Severs, the chair of the NHS Information Standards Board. He dealt with the housekeeping issues and invited participants to comment during the final plenary – however there were no question and answers sessions for any of the speakers during the day – and the final plenary was managed to prevent “awkward” questions from the like of me – this style seems to be Connecting for Health’s way of managing potential problems at events like this. Martin briefly described some of the relevant history including the launch in 1999 of the first version of the LtM document, which, as he said was endorsed by many but acted on by few. He suggested that the emphasis, and strap line, for the National Programme for IT in the NHS had changed over that time and now was much more focused on patient safety and patient participation.

He introduced a video message from Bruce Keogh, who welcomed delegates to the conference which he considered important – although he was unable to attend in person. He also stressed the importance of good quality information underpinning patient care and suggested that in the past there had been too much data but too little useful information and hoped that today’s event would be helping to change that. He suggested that there should be a clinical information officer in each NHS organisation – although there was no detail about what there role would entail. There was also no detail about whether they would have any ability to change practice, and what sorts of knowledge and skills these people would have and where they would be recruited from. He also mentioned the development of quality observatories in each NHS region which would be able to provide relevant information, in a usable format, for clinical teams to enhance their analytical capacity.

The first keynote was given by Dr Maureen Baker, Clinical Director for Patient Safety, NHS Connecting for Health (CfH). She outlined the increasing importance of quality in NHS IT systems and made the links to the importance of these areas in education for clinical staff as well as managers. The history of the patient safety movement and some of the key documents were presented. She argued that we need to accept that human error and fallibility is inevitable, but that systems should be designed to minimise the effects of these by drawing parallels with other complex and high risk industries. She presented an example from her own practice as a GP of how the potential for errors could be built into IT systems. She leads the board which signs off software being developed for use in the NHS as being safe and outlined how this “baton of safety” is handed over once the new systems are rolled out into practice. I wanted to raise issues about the involvement of front line staff at the design stage but didn’t get the opportunity.

Di Millen, Head of Informatics Development, NHS Connecting for Health then introduced participants to the document being launched today. Learning to Manage Health Information: a theme for clinical education – Making a difference. She outlined the work which had got us to this point but suggested rather than being an end point this was a beginning of gathering examples of good practice and developing a community of practice. The information on how this new version of the document was going to influence the “real world” and strategies to implement it was sketchy – but there was no opportunity at this point to explore this further. She mentioned two key issues which come up every time she meets anyone: connection between the NHS network N3 and the JANET network used in education and the issuing of smartcards to students. She promised more on the second issue later in the day. The full text of the document should be available tomorrow at Although I’ve seen drafts of the document I shall take a little longer to review it and then post some comments on this blog. Di also briefly “dangled some carrots” for the future work including some LtM related research grants – to be administered through the UK Faculty of Health Informatics.

After the coffee break participants were invited to attend one of a variety of workshops. Obviously as I was presenting in one I can’t comment on what went on in others, which included:

• Designing a Health Informatics Teaching Session - Jeannette Murphy, Senior Research Fellow, CHIME, University College London
• Introducing Clinical Information Systems (CIS) into the undergraduate clinical curriculum Sue Clamp, Director of the Yorkshire Centre for Health Informatics
• Finding a solution to Health Informatics Educator/Teacher/Facilitator Paucity - Paula Procter, Reader in Informatics and Telematics in Nursing, School of Nursing and Midwifery, University of Sheffield
• Embedding record standards in the undergraduate and postgraduate curriculum: why, what and how? Prof John Williams, Director of Health Informatics at the RCP
• A theoretical and practical approach to teaching record access – Dr Brian Fisher, GP & Dr Amir Hannon, GP
• Map of Medicine – Ketan Patel, Implementation Manager, Map of Medicine (workshop only delivered in the afternoon)

I would have liked the opportunity to attend some of these – Note to self, must learn to say no occasionally when asked to do these things!

My own workshop Using simulated electronic health records in clinical education included my presentation on the university perspective but also Nick Jupp, eLearning Programme Manager - South West Strategic Health Authority and Kathy Sienko from Cerner.

We tried to provide different perspectives on the issues surrounding the pilot project we have been implementing using the Cerner Academic Education Solution (AES). The workshop generated quite a lot of interest and discussion with several people thinking about how they would approach similar issues in their own institutions.

During lunch I had lots of interesting discussions with friends and colleagues old and new – and while partaking of a quick cigarette in the sunny and pleasant grounds was filmed for the Vox Pop- although the questions were angled to get positive rather than negative comments.

After lunch the afternoon sessions were c haired by Dr Elizabeth White, Head of Research and Development, College of Occupational Therapists who introduced the two plenary speakers and a video greeting from Gifford Batstone who outlined the importance of informatics for quality practice and the changing role of clinicians from being the providers of information to that of helping patients and clients to understand information they were obtaining independently – primarily form internet sources. As there was no opportunity for a question and answer session on this I wasn’t able to raise current debates about the ways in which disparate information sources may e contributing to reduced trust in the professions and organs of the state and increasing trust in the experiences of lay people who have been through similar experiences.

Dr Mark Davies, Effective Medical Director, The NHS Information Centre for Health and Social Care (previously the Secondary Uses Service) who was talking about Information and Service Delivery. He briefly talked about the role of the Information Centre and set out the principles that management and research data should not need to be collected separately but should be generated from data collected in routine clinical practice. He emphasised the importance of data quality if the information is to be used to support patient care (while almost admitting how poor the information quality has been for years).

He used the three legged stool analogy first used by Denis Protti in which the three legs are Technology, Processes and People and saw today’s event as focussing on people. He should several ways in which data can be displayed to support decision making at various levels including the NHS dashboard of key indicators – see for more information. As with several others speakers NHS Choices was highlighted as the portal for public access – but little comment was made about the coming Patient Reported Outcome Measures (PROMS). I would have liked to raise issues around the use of NHS data by commercial companies (such as Dr Foster) in what he described as the third stage and procedures for anonymisation and pseudanonymisation - but there was no opportunity to do this.

The next speaker was Suzanne Truttero, Midwifery Advisor CNO directorate; Department of Health addressed the topic Measuring the Quality of Maternity Care. She described the myriad of different documents, guidelines, measures etc which have been developed over the years and the work to bring these together. The current use of balanced score cards, dashboards & patient satisfaction surveys were also described.

An extra speaker, Philip Gill, from the registration authority, was slotted into the programme at this point to address frequent queries about students being able to gain smart cards for NHS systems while in training. He set out the two stage process required. The first being identity checks which can be delegated to the universities and the second stage related to specific access rights which, he argued, needed to be done by the trusts. He recognised that some trusts were “being awkward” about this, but described a pilot with Nottingham university which has overcome some of the issues and promised further information and guidance for trusts (which universities would be able to quote) on the NHS Employers web site by the end of this week.

After a refreshment break the workshops from the morning were repeated to give each of the attendees the opportunity to attend a different session.

As I was tidying up after our workshop and talking to lots of interested people I was a little late attending the final plenary. This brought the day to a close with an attempt to enable participants and speakers to engage in dialogue about the ways in which the work from the day could be taken forward. Lots of speakers welcomed the intentions but said that there was a need for commissioners of education, regulatory bodies and others to take it onboard – and for CfH and other NHS bodies to work with the few “lone voices” in universities to raise health informatics up the agenda at all levels of clinical education.

In general the day was quite interesting and it was good to meet others working in related fields, however it has not convinced me that the new version of Learning to Manage… is going to bring about the revolution which is needed – and that despite what was said today we might be at a similar event in 10 years time discussion the same sorts of issues – I’ve already booked my place with Di Millen!

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  • Thanks, Rod, for the thorough (as ever) report on the day. Good (?!?) to see that CfH are still in full control-freak mode as far as allowing any genuine debate/discussion of issues. Plus ca change.

    By Blogger Peter, at 8:50 pm  

  • Hello Rod
    I'm catching up with all of this a little late. This was a great summary. I can't see thatyou have blogged on the document. Will you?

    By Blogger Anne Marie, at 4:23 pm  

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