Speaker programme Abstracts

HC2012 – Abstracts

Day 1 Stream 1 – Assist Conference


Masood Nazir: ‘How a doctor sees the value of informatics improving health care’

Masood will bring a clinical perspective to the concept of benefits and adding value.  The perspective of a clinician delivering care can be radically different from many people who are tasked with ensuring the delivery of informatics services.  Hear how informatics can make a tangible difference to the delivery of care and what you need to do to make that a reality.


John Thornbury, “Informatics as a support to health care delivery”

John will describe how a system change to deliver cost reductions can deliver other benefits, e.g. improved service and better working conditions. He will describe the need to redesign the manual systems prior to the introduction of technology that increased the efficiency of the process. This is an exemplar of informatics reaching into an organisation to stimulate cost reductions, improvement in service delivery, better working conditions and improved management control of the process that bring benefits for patients, staff and the hospital trust. (Speaker agreed; title and synopsis require confirmation)


Mark Blakeman, “Business cases; are they a hurdle or a useful tool?” 

Getting the business case for a project approved can be seen as a hurdle that has to be cleared.  Mark will explore how the process of developing business cases can focus scarce resources on those projects that will bring the most benefit at that time.  Having a business case approved feels like success; but taking the right decision not to proceed with a project at that time should also be viewed as a success.


Lucy Owens, “Identifying cash releasing savings from informatics projects to individual budget lines.”

Lucy will describe how cash releasing savings can be identified by budget line within the whole organisation. This focuses the attention of budget holders (both within and outside informatics) so they ensure these benefits are secured and the added value from the project is fully recognised.


Nigel Guest, “Benefits Realisation Management to extract value from informatics projects”

Benefits Realisation Management (BRM) is about organising and managing programmes and projects so that potential benefits resulting from investment are actually achieved. A fundamental technique used in BRM is mapping to understand interdependencies between objectives, projects, outcomes and benefits in order that the value to healthcare is understood. Nigel will briefly outline some of the theory behind this process and provide some practical examples.

For those delegates who wish to explore benefits mapping in more detail and understand the skills required using it, Nigel will also be presenting in the Skills Zone.


Shane Tickell, Adding value through informatics: a supplier’s perspective”

Suppliers have an interest in their clients adding value from the systems they have supplied.  In this session Shane will draw on his experience to identify the traits in NHS organisations that enable them to add value when deploying informatics products and those traits that impede them.

Day 1 Stream 2 – Changing World of Health & Social Care

Stream abstract: Rising to meet today’s financial and demographic challenges means the health and social care landscape is facing the need to transform on all fronts, reflected in the policy set out in the Health & Social Care Act 2012.  This session, presented by national leaders in this area, is seeking to articulate and discuss some of the challenges and how information and technology can enable and support the change needed through an effective policy framework. 

Day 1 Stream 3 – Care Across settings


Scott Hamilton: ‘Care Across Settings in Action: the North West London Integrated Care Pilot’

Partners from primary care, community care, secondary care, social care and mental health have worked together to improve patient outcomes and reduce unnecessary admissions. Participating ICP practices[1] experienced a 6.6% reduction in non-elective elderly medical specialty admissions between July 2011 and Jan 2012 compared to the same period the previous year.

As of the end of March, the ICP Multi-Disciplinary Groups (MDGs) have held 111 case conferences and discussed 823 patients. Attendees are sharing best practice and increasing their knowledge and skills, leading to better care for all registered patients. Over 10,800 patients have consented to join the ICP and 10,557 care plans have been created using the IT tool (the “Care Integrator”).

This represents a fundamental shift in inter-provider working practices – moving from individual to multi-disciplinary decision-making and from a focus on individual patients to complete patient groups.


Lloyd McCann: ‘Information and Technology Enabled Integrated Care’

An integrated care approach has the potential to improve the quality of health and social care delivery as well as reduce the cost of care. Integration in health and social care can however take many different forms and not all forms of integrated care are beneficial. In this presentation Dr McCann will discuss evidence of the types of integrated care approaches which have been shown to deliver better value health and social care. Furthermore, there is view that information and technology is a critical enabler for integrated care – the evidence in support of this assertion will be reviewed. Finally, using information as an asset in the integrated care approach will be discussed; challenging patients, providers and care commissioners to harness the potential of information as an asset to truly enable integrated care.


Keith Pollard: ‘Healthcare, hash tags and the Facebook generation’

Since the birth of the internet, patients have been sharing their healthcare problems and experiences online. Patient forums were one of the first examples of the use of the internet as ‘social media’. Now the patient’s voice is being expressed through blogs, Facebook, Twitter and the like.  The key to the success of social media for health organisations is in listening and engaging with consumers on their terms.


Mark Harrison: ‘Partnership Approach to the Development of a Single Care Record in Substance’

In this session Mark will describe how the introduction of a single electronic care record influenced and shaped the transition of substance misuse services within County Durham from one of an historic uncoordinated system delivering parallel care in 2007 to the strong partnership work in existence today.


Tony Cobain: ‘IG Rules: help not hindrance?’

We have all seen examples of, or personally heard people quoting, “we can’t tell you that because of data protection or information governance”.

During his presentation Tony will explore some of the myths and realities around information sharing and whether the DPA and the information governance framework is a barrier to effective sharing or whether it is an enabler.

He will describe some of the “barriers” and will challenge whether these truly exist or are just raised to prevent sharing or are quoted through ignorance.


Professor David Peters: ‘The Self Care Information Library’

The session will cover:

  • Future NHS sustainability is predicated on health improvement, engagement and enablement.
  • Self-care and self-management will be of huge significance
  • Therefore health professionals must engage, enable and facilitate patient-choice.
  • User-friendly evidence-based information well-presented on-line could facilitate better self-management and encourage ‘engaging’ conversations between patients and GPs
  • R&D at the University of Westminster produced a prototype Self-Care Library
  • The first 12 conditions constitute common (‘minor illness’) ‘effectiveness gaps’
  • The options include OTC purchases, lifestyle, ‘mind-body medicine and, where there is evidence for them, complementary therapies

This session will also demonstrate the SCL and outline its development and challenges.

Day 1 Stream 4 – Clinical Leadership


Simon Thorogood: ‘Importance of clinician-led workflow analysis’

Implementation of an informatics project is an opportunity to change workflow and end unproductive and disparate practises that inhibit effective working. To do this you need to empower staff in the decision process and not simply impose change. This can only be achieved with senior clinicians leadership ensuring staff participate in service redesign.


Tony Cartwright: ‘Leading Change in a tribal environment’

His talk aims to show how tribal attitudes are clearly evident and how they can influence leading an IT project.  He will go on to describe some of the techniques that can be used to help overcome this and particularly some of the lessons that, as a clinician, he learned whilst leading a major IT project in the South West.


Gordon Caldwell: ‘The Challenges of improving the pace of work’

Hospital Doctors’ work must easily outpace the progression of the illnesses in their cohort of patients. Well-designed IT systems can accelerate the pace of work, but poorly designed processes both slow care and increase the chances of harmful errors. The challenge is to introduce only time releasing IT processes


Angela White: ‘Messages for Clinicians & Management from a Clinical Leader’

My perspective that the nature of change in which healthcare is engaged is revolutionary thus clinicians must make an equally radical shift in their thinking and responses to the challenges.

‘What do I want as a clinician from my clinical leader in order to engage my support for and involvement with their clinical transformation program’?

Day 1 Stream 5 – Applying Health Informatics Research in Practice

MATCH

Public Interest Forum

The Multidisciplinary Assessment of Technology Centre for Healthcare is a research collaboration between four leading UK universities (Birmingham, Brunel, Nottingham and Ulster) and a cohort of industrial partners. It aims to transform the medical devices sector by using research to develop, test and make available methods that cut the time, cost and risk involved in introducing innovations at every stage of delivery, from original concept to continuous improvement of products and services.

Their session at HC2012 is entitled: Health Technologies – can they develop national wealth as well as population health? The Chair and Lead presenter for this is Professor Terry Young, Chair of Healthcare Systems, School of Information Systems, Computing and Mathematics at Brunel University

Terry describes the relevance of their session in the context of many of the challenges currently facing the NHS:

“The introduction of economic evaluation to prescribing and treatment options has profoundly impacted the NHS in terms of articulating value-for-money cases and in terms of reigning in spend.  However, the question remains as to whether health, which is a significant government budget should be generating wealth as well as health.  Sarewitz argues that in the US, the defence budget, through research funding and major procurement programmes, has spawned technology industries from jet engines to computers.  This talk will explore the role of health as a stimulus for growth and looks at areas of technology and system development that might drive such cycles”.

Following the introductory session 2 examples of the application of the work of the MATCH Forum will be shared.

Professor Richard Lilford, Professor of Clinical Epidemiology at the University of Birmingham and Vice-Dean for Applied Health Research will focus on:  “Using simple economic evaluators in the development, production and procurement of medical devices”.

Dr Julie Barnet, Reader in Healthcare Research at the Brunel University will then finish with a session entitled: “Understanding User Perspectives: is there a role for Social Media?

UK Faculty of Health Informatics (This session is sponsored by Philips)

The UK Faculty of Health Informatics is a Community of Practice, established in 2005 made up of over 600 practitioners, researchers, clinicians, suppliers and patient groups who have a passion for ensuring that informatics makes a real and practical difference to care.

The Faculty’s purpose is to stimulate the uptake and application of Informatics research and development within UK Health and Social Care services in order to improve the quality of care for all. Their session at HC 2012 is focused on:

Applying Usability and Human Centred Design principles in health and social care information systems – are we unique? – (chaired by Dr Peter Murphy) This session will look at how we can avoid the pitfalls and problems that have beset many recent Informatics Projects and ensure that in the future Clinicians, Patients, Service Users and Carers really can be assured that “No ‘ICT’ decision about me without me” is applied in practice. The contributors to this session include:


- Libby Morris GP, Clinical Lead (Primary Care) Scottish Government eHealth directorate – who will share some of the lessons learned from the Scottish Emergency Care Summary

- Kit Lewis – Director – Space Around People and former User Experience Lead ePrescribing NHS Connecting for Health  will share experiences and key principles gained from ePrescribing

- Professor Jonathan Hassell – Director of Hassel lInclusion, Lead Author of the UK Code of Practice for web accessibility across all platforms from the British Standards Institute and former Head of Accessibility at the BBC’s web and new media division will focus on applying usability principles in web design.

The Faculty’s later session will be highly interactive and is entitled:

Is evaluation really that hard when it comes to Informatics in the NHS?  – (chaired by Dr Philip Scott) This session will look at evaluation studies undertaken on recent Healthcare Information Systems, such as the Emergency Care Summary, Summary Care Record/HealthSpace and the Whole Systems Demonstrator Action Network. It will look at how effectively lessons learned from such evaluation studies can be applied in practice to ensure that the Return on Investment of Health Informatics is clearly understood in an era of austerity.

This lead presenter for it is Jeremy Wyatt DM FRCP ACMI Fellow, Professor of eHealth Innovation & Director. Institute of Digital Healthcare at Warwick University and he will be joined by an expert panel who have attempted to apply lessons learned from past evaluation studies in practice made up of Faculty Board members Paul Curley, Consultant Vascular Surgeon at Mid-Yorkshire Hospitals NHS Trust and Dr Sue Clamp from the Yorkshire Centre for Health Informatics at the University of Leeds.

Day 2 Stream 1 – The IHRIM conference


Professor Iain Carpenter: ‘That’s not my problem’: What might we have forgotten while introducing electronic health records?

Clinical practice developed around the use of verbal communication and paper records.  Electronic records are introduced across health and social care and patient access and control of their health records will become the norm.  We need to step ‘out of the box’ and look back at all that goes on around accessing, using and communicating health records – otherwise we could sleep walk into problems that may be expensive and difficult to resolve.


Andy Hyde: ‘Impact of an EPR on Patient Care, the Norwegian Experience’

Diakonhjemmet Hospital in Norway is paperless, well nearly. The hospital implemented an EPJ solution in 1994 and went paperless in 2005 when we started scanning historical journal content and the paper that is generated during treatment. The benefits of a fully paperless EPJ are taken for granted. Information in the EPJ is available for those who need it, where they need it when they need it and it is legible! An EPJ with in-built quality control can alert the treatment provider in case of possible errors such as incorrect medicine dosages, dangerous drug interactions and a patient’s critical information. This increases patient safety. However, after 18 years use of the EPJ there is an enormous amount of information available and this in itself can be a problem. The transition to paperless EPJ can affect personnel in two ways. Maybe head count reduction is the goal but there is also an opportunity to reskill and redeploy to gain other benefits from the changes.

A “hidden” benefit of implementing an EPJ which not too many hospitals realise is the use of the data in the systems for better hospital management. Thousands of registrations each day can be aggregated into information and knowledge. Business intelligence as it is known as in modern jargon. Management reporting before took large numbers of man days and was relative unresponsive to change whereas with IT based solutions management information can be generated several times a day if necessary and at least daily and weekly with almost no resource. This for me as Director of Quality Management is the greatest benefit of the implementation of the EPJ at Diakonhjemmet Hospital and we can identify concrete improvements in quality, safety and patient satisfaction from this approach


Tony Cobain: ‘Practical Information Governance Issues’

Is there a IG role for Records Managers in the new world of electronic records?

As we not only deploy more data rich PAS and EPR systems, and as many organisations are rolling out scanning solutions for paper records many Records Managers will be wondering what the future has in store for them. Once the guardian of the case note, they are seeing responsibilities for monitoring completeness and availability potentially diminish.

So is there an IG role for them in the brave new world? Tony certainly thinks so and he’ll explain why.


Heather Walker: ‘Epidemiology & benefit to patients from accurate coding’

The NHS invests a lot of time and money in training clinical coders and in collecting coded data in both primary and secondary care. What is often overlooked is how this information can be used to benefit patients and to improve patient care. The greater the quality and accuracy of this coded data the more use can be made of it for benchmarking and information governance.


Dawn Monaghan: ‘Managing Risks of Data Loss’

Dawn will be considering the impact to information governance and the application of the Data Protection Act rules in a time of changing systems, structures, processes and practice.   She will also consider why IG needs to be seen as a front line process, rather than a back office one as is presently the case in many organisations.   Dawn will also cover sharing of data with new partners, requests for information held now by someone else or new information held by you and how to avoid being a newspaper headline!

Day 2 Stream 2 – NICE Conference Stream


Morten Skjørshammer & Andy Hyde: ‘Quality Management in a Norwegian Hospital’

Diakonhjemmet Hospital in Oslo, Norway has been a pioneer in the use of information technology in Norway for over 15 years. We were the second hospital in Norway to implement an electronic patient record and patient administration system as early as 1994. We still use the same system now and the hospital is virtually paperless. All the main clinical and support areas have come on board through the years including medical biology, radiology, operating theatres etc. There are still some areas where we are not completely digital but there are plans for these areas to be realised in the short to medium term.

But clinical technology by itself does not produce or improve quality of care. That is a management task. The current CEO, Morten Skjørshammer, has been a staunch supporter of the use of IT not only in patient care but has also been especially keen on the use of IT for hospital management. We have defined quality in a very broad sense. Patient safety and quality is no longer only a product of the decisions doctors and nurses make but a product of the total management of the hospital. Finances, buildings, personnel, IT itself, and the systems for managing quality such as the adverse event system, contribute as much, if not more to the patient’s quality of treatment and certainly their experience of being in the hospital.

The “system” is developed from a corporate governance perspective and the model underlying the implementation is quality based using the PDCA circle from Deming’s quality management domain. It is built up of four main components; process mapping including an Enterprise Architecture Model (EAM), a performance management system, adverse event management and document management. The EAM is at the hub of the system and the other components are integrated tightly with this.

Morten has spearheaded the purchase and implementation of the components, QlikView (performance management), QualiWare (Process modelling and EAM), Synergi (adverse events) and EK (document management). For the CEO of a modern hospital it is important that he gets timely and correct information when and where he needs it: nothing new but a fact not lost on our CEO.

The management information system, DIA-LIS, that automatically monitors over 100 process indicators daily allowing a quick response to any unexpected change in activity or quality.

The process mapping and EAM system maps the key clinical pathways but also includes compliance, competency mapping and organisational structure. This allows us to produce a compliance matrix showing that we manage the hospital in accordance with the relevant legal regulations and that all the activities are performed by qualified personnel, a prerequisite for quality management and corporate governance. The process mapping of critical care pathways enables standardisation of generic processes such as receipt and processing of referrals, admitting and discharging patients, radiology and lab services, processes for infection control and adverse event management. Through standardisation we can measure process quality and thus improve it.

The adverse event system does not just record adverse events but it is used to categorise them, evaluate risk and manage corrective and preventative actions. The results of these are discussed at departmental quality meetings and are the focus of one of the three full ISO based management reviews each year.

Supporting all the systems are the hospitals documented procedures stored in the document management system. There are also a number of online reference systems both for doctors and nurses as well as standards documentation from the national heath body similar to documentation from NICE although NICE has documented standards and measurement of care to a much more detailed level than us in Norway.

In summary, two things are often held true in the use of IT to support process and process improvement. First is the primary success factor often used as a reason for failure, management support – Diakonhjemmet CEO, Morten, does not only support but actively contributes to the use of IT in the hospital both in the clinics and in administration. Second it is often said that a process should be improved before applying new technology. We believe that these go hand in hand not sequentially. New technology implementation has opened up new opportunities not possible before.

Our presentation would cover a general overview of the use of IT at the hospital, the use of the four key systems for corporate governance and quality management and then a closer look at quality improvement which we believe is a result of this holistic approach.

In conclusion, use of outcome measurement in Norway is not widespread therefore the results are based on process improvement measurement in the belief that better standardised processes and better hospital management will result in better quality of care.

Day 2 Stream 3 – UKTI Conference Stream

‘The challenges and Opportunities of Growing a Business Internationally’

This session will be run by UK Trade & Investment, the Government organisation that helps UK based companies succeed in international markets. It will offer valuable insights into international business opportunities in very different global markets, each seeking to increase online delivery of healthcare services.

Representatives from China, Australia, New Zealand and France will discuss healthcare reform and development of national policies on delivery of online healthcare, telemedicine and telehealth. They will also consider the implications of the changing paradigm for healthcare delivery and where opportunities exist for international partnerships and collaborations.

Large global brands will discuss the importance of business networks and strategic relationships and how their experiences of strategic relationships have made the difference in developing their global business brand from technology collaboration through to M&A strategies.

The session will feature presentations covering:

China

Healthcare policy reform in China is throwing open new opportunities to international suppliers. This session will explain the reforms and show what these mean for potential international business and partners. Companies will learn from the experience of a major international player in China about ways to access global value chains, whether a technology SME or large corporation.

Australia

The National Broadband Network (NBN) will connect every Australian home and business to the internet providing 100 Mb speed – transforming access to information, services and digital media. Healthcare is a key application area and this session will outline the development of the NBN thus far and the opportunities it represents.

New Zealand

New Zealand’s National Health IT Strategy supports improvements in the quality and delivery of healthcare services, underpins new models of care, and seeks to deliver better value for money. This presentation will explore the developing role of the Health IT Strategy and the NZ Health IT sector.  It also explores how New Zealand is learning from the NHS model and the opportunities this represents to UK companies within a small, but well funded public health system with an innovative approach to technology.

France

France offers a growing ehealth market; featuring significant government investment into e-health projects (€750 million into the “Digital Hospital” programme, €2.4 billion dedicated to modernising the healthcare sector as part of the “Grand Emprunt” initiative). Key officials from ASIP-santé (the government agency responsible for e-health) and Appui santé & medico-social (the National Agency for supporting the performance of health facilities) will explain the ‘Whole system demonstrator’ pilot ehealth implementation projects in France; illustrating opportunities in the development of ‘connected health’ in France.

Day 2 Stream: 4 – Moving Strategy to Delivery: Practicalities


Jane Stewart: ‘Electronic Patient Journey System (ePJS): underpinning Service Delivery’

In 1999 the South London and Maudsley NHS Foundation Trust was formed and the need was quickly indentified to rationalise the multiplicity of clinical and admin systems and supporting processes. In 2000 the Trust implemented the CCS system to support CPA; this was followed by the SLAM Patient Journey Process. SLAM collaborated with a technical partner STRAND technology to develop a full mental health electronic clinical patient record system and introduced ePJS in 2006.

The electronic Patient Journey System (ePJS) is a browser-based electronic information repository, enabling the documentation and exchange of clinical data between clinicians, researchers and administrators. The system functionality is driven by business and user requirement, with an emphasis on concise operation affording the end user a clear process of information submission and retrieval. The ePJS has been developed to enable a flexible and functional application, able to quickly adapt to changes to the clinical and business environment and underpin the key elements of specialist mental health research.

The development of ePJS and its subsequent implementation across clinical services within SLaM provides an integrated solution to a user base of almost 5,250 staff.


Ian Gaywood: ‘The Orchid Project’

Routinely collected clinical information has many potential research uses but these cannot be realised because the data are fragmented, inconsistent, poorly organised and unsearchable. ORCHID is a clinician-led project developing an information model to overcome these shortcomings. At its heart lies a series of complex hierarchies which map the relationships among pieces of clinical information. These hierarchies are supplemented by core data sets which create detailed patient phenotypes. All types of clinical and laboratory information can be organised in this way across all specialties. Datasets can be integrated with data held in biobanks to produce a complete patient profile which be used to create complex patient cohorts for research and audit purposes. Cross-mapping to ICD–10 and SNOMED CT allows automated production of secondary uses data such as outpatient HES coding. ORCHID is implemented using the open source cityEHR developed at City University, London and is consistent with all relevant health records standards. It will be deployed using bespoke web-based interfaces for data collection, searching and analysis.


Keith Simpson: ‘Renal Patient View (RPV): Real time internet access to medical records for patients’

Renal PatientView is a UK wide system run by the Renal Information Exchange Group (RIXG). It provides renal patients with secure web based access to their latest test results, clinic letters and medicines. A link to NHS Blood and Transplant displays their current status on the transplant list. They can add some of measurements they make themselves and can provide anonymous feedback to their renal units. There are also links to high quality websites with information about their diagnosis and treatment. Patients can share this information with anyone they want, and view it from home or indeed anywhere in the world. It can also be used by both patients and their consultants during tele-consultations.

In a formal case controlled evaluation RPV patients reported that RPV was highly regarded and very useful. Security is tight but RPV is easy to use and about 1000 patients log in every day. More that 19 000 patients have registered and it is available in almost all UK adult and paediatric renal units


Neil Stutchbury: ‘Knowledge Management Strategy at Monitor: Culture, Benefits and Implications for the new Sector Regulator’

Monitor is currently the independent regulator of NHS foundation trusts. Its role is changing significantly with the recent Health and Social Care Act into a healthcare sector regulator with broad responsibilities across the whole sector. The talk will briefly describe Monitor’s new role and the knowledge management (KM) strategy we developed and implemented in 2010–11 to support the FT regulator. The talk will identify some of the “soft” issues around achieving a KM culture and the benefits achieved. Finally the implications for Monitor’s new role will be discussed, with particular emphasis on the role of information and collaborative working that will be required to deliver the benefits of the Act.

Day 2 Stream 5 – Productivity & Efficiency Demonstrators


Stephen Appleton: IT Delivers Return on Investment

Stephen will be giving an overview of how the North Mersey HIS are putting IM&T at the centre of Clinical Pathway Transformation, and how ICT Innovations are being deployed across the Local Health Community to release clinical productivity and increase the quality of care.


Phil Trickey: ‘Developing Commissioning Support Services – an informatics perspective’

The NHS is in the midst of one of the most significant changes in its history with uncertainty, risk and challenges at every step of the way. Commissioning Support Organisations are by no means immune to these uncertainties and challenges.

This short presentation sets out some of the current challenges that CSOs are facing and, while it probably raises more questions than it answers, it gives a flavour of what it feels like to be involved in the creation of a CSO and our direction of travel from an informatics perspective.


  1. In Westminster, Kensington & Chelsea and Hammersmith & Fulham  ↩