CHIRAD Centre for Health Informatics Research and Development Graham Wright MPhil, MBA, MBCS, DN, Cert Ed, RNT, RCNT, SRN, RMN.

CHIRAD

Centre for Health Informatics Research and Development

Graham Wright

MPhil, MBA, MBCS, DN,

Cert Ed, RNT, RCNT, SRN, RMN

Frimley

Guildford

Chertsey

Redhill

Crawley

BasingstokeSalisbury

Bournemouth

Portsmouth

Southampton Winchester

EIHMS Programmes

Diploma

NVQ

Degree

Postgraduate

BScPublic and

Environmental Health

EIHMS Education Pathways

MSc 1AdvancedPractice

MSc 4Management /

Leadership

MSc 3Science

MSc 2“PublicHealth”

MScResearch

BScManagement

BScScience

M Nurse

BScSpecialist

Practitioner

BScClinical

Practitioner

DSc

CLIN DOC or PhD

P2000Diploma

ResearchIT Modules

Basic ScienceModel of Care

Language CompetenceCommunication Skills

IT

Level 6

Level 5Doctorate

Level 4(M)Masters

Level 4BPG Diploma

Level 4APG Certificate

Level 3Degree

Level 2UG Diploma

Level 1UG Certificate

5

Common Core

Modules

School Nursing

(SN)

Public Health Nursing / Health

Visiting (HV)

Community Learning

Disability Nursing

(CLDN)

Community Mental Health Nursing

(CMHN)Practice Nursing

(PN)

District Nursing

(DN)

Community Childrens Nursing

(CCN)

Theory

Practice

Progression towards Autonomous Practice

Formative Assessment Summative

ExitEntry

Ready for patient/client care

responsibility with supervision

AutonomousPractitioner

DependentLearner

Nursing milestones?

• Individual care • Nursing Process (1970’s)

– Nursing Diagnosis - requires nursing codes

• Nursing workload (1980’s) – Activities not tasks - requires nursing codes– management not care

• Health record rather than Nursing record– requires care codes (nursing codes)

Data > Information

Does information make a difference to patient care?

Traditionally the focus has been on the

Management of resources:-

Workload

Skill Mix

Finance

Important Information?

• What care the nurse think the patient requires.

• What care the doctors think the patient requires.

• What care the patient thinks he requires.

• What care the patient actually receives.

ICN (1991) common language• Improve communications

• Describe nursing care

• Enable comparison of nursing data

• Project trends in the provision of nursing data and allocation of resources to patients according to their needs.

• Stimulate nursing research

• Provide data about nursing practice to influence health policy

Nursing care

• Planned direct nursing care

• Planned indirect nursing care

• Unplanned direct nursing care

• Unplanned indirect nursing care

• In some studies only 20% is planned direct care - that is a care plan

Making the change on a National basis

• Business case - plans

• Identify and agree funds

• Strategic plan– Training plan

• Implement

• Few undertake evaluation - unlike nurses who use the nursing process!!!

The Information Management and Technology (IM&T) Strategy 1992

“ensure that the NHS and its patients get the maximum benefit from information technology, and will have a significant impact on patient care…. and on NHS efficiency”

The five key principles

Information will be person-based

Systems may be integrated

Information will be derived from operational systems

Information will be secure and confidential

Information will be shared across the NHS

On page five of the new NHS IM&T strategy published in January 1999 you will find exactly the same five key principles.

Five Initiatives

• Nationally linked population registers, based on existing registers of family health services authorities, containing people’s administrative details.

• A new NHS number for everyone by 1995, designed for use with computers and intended to be the link for a person’s records.

• A comprehensive dictionary of clinical terms, based on the Read codes.

• A training strategy for technical, clinical, and administrative staff to enable them to implement effective information systems and to use them effectively.

• To ensure that existing standards of confidentiality and security are not put at risk by information systems.

Main Findings

All of the respondents considered the 1992 NHS IM&T strategy to be only partially fulfilled, with 25% expressing the belief that it was half-way or more to fulfilment in terms of benefits achieved.

75% thought that the strategy had gone only a small way to achieving the benefits it stated in 1992.

Main Findings

Respondents were also clear about their beliefs that the implementation was too technology driven and that there was a serious lack of education and training to prepare clinicians and healthcare professionals.

Main Findings

One of the National Initiatives was the production of a training strategy and 60% of respondents thought it was complete as a project.

A training strategy was developed by the IMG.

Not one respondent thought the IM&T training strategy had completely fulfilled its expectations, indeed 57% thought it unsuccessful.

Education and training, or rather the lack of it, was commented on more than any other subject within the survey.

87% of the respondents used the Internet for learning

and teaching

Problem Study NHSE

Lack of political support Yes No

Lack of Education and Training Yes No

Issues of security and confidentiality Yes No

IMG was remote from the service Yes Yes

National strategy aims were not relevant to localoperational realities

Yes Yes

Resentment about local charging for access to the nationalIM&T infrastructure

No Yes

Reluctance to mandate local compliance with nationalstrategic objectives

Yes Yes

The poor quality of recorded clinical data Yes Yes

Well publicised ‘failures’ which have created a mythologyof disaster around IM&T in the NHS

Yes Yes

The complexities of IT procurement processes Yes Yes

An insufficiently understood and committed informaticsculture in the NHS

Yes Yes

An absence at local level of a mechanism to coordinate thedevelopment of information strategies

No Yes

A lack of understanding amongst many NHS managersthat information and IT is a critical Chief Executive issue

Yes Yes

A failure to appreciate the full potential of radical changesin working practices made possible by IT

Yes Yes

Information Technology in Nursing

A Paperless Paper!

Are HEIs ready for Are HEIs ready for Health Informatics?Health Informatics?

Review of IM&T in Curriculum 1999 repeat of 1994 survey

Betts, Olsson and Wright

A follow-up study that examines what changes, if any, have taken place over the last five years.

To develop guidance on how IM&T can be included in pre-registration curricula

To develop guidance on how IM&T can be included in post-registration curricula

To develop guidance for the education of nurse teachers

To develop guidance on the sources of advice

Existing products, materials and services should be mapped against curriculum guidelines together with the effective use of those materials in particular environments

Examples of “good practice” should be identified, developed and disseminated

That a feasibility project be instituted to explore the need for education at a specialist IM&T strategic level and the need for the development of Research and Development Centre(s)

Original Recommendations

Method

• Sample– The Council of Deans and Heads for Nursing,

Midwifery and Health Visiting for UK Universities

• Response– 15 from 62 i.e. 25% response– Appear to be from HEIs active in subject

Fundamental Question

Are good IM&T educational products effectively used to underpin the training of nursing and midwifery students for managing clinical information?

Informatics teaching in HEIs

There appears to be a fair amount of Health Informatics in the curricula of nursing programmes.

We asked the two questions about content

Do you include these skills/topics under the heading of:-

HEALTH INFORMATICS

INFORMATION TECHNOLOGY

(%)Computer Skills 85Information Management 80Privacy and Confidentiality 75Record Keeping 75Care Planning (Computerised) 62Others 60NHS Information Strategy 59Research Methods 52Quality Issues 52NHSnet 50Collaborative Care Planning 48Resource Management 44Clinical Governance 43Electronic Health Record 43NHS Information Flows 41Telecare/Telemedicine/ 39Electronic Library of Health 38NHS Direct 31Clinical Coding 28Case Mix 27Contracting for Health 25Anticipated Recovery Pathways 21Epidemiology 21Primary Care Groups 19Health Resource Groups 13

Where is the second stage?

Identify skills

and

competencies

Identify courses

and programme

curricula

Identify learning

material and

products

Figure 1: Logical progression in developing educational products

Not heard Seen would Seen would Usednot use use if available

(%) (%) (%) (%)IT Eductra 80 7 7 7A Patient’s View 73 0 13 13What seems to be the problem? 73 7 7 13EPR CDRom 67 7 13 13CALCOM for Windows 67 7 27 0Terms, Records and Information 67 13 7 13Med Works 60 0 33 7What is Data Protection 60 13 7 20Personal Health Record (CBT) 57 0 36 7The Nine Month Miracle 57 7 36 0Security for the Nursing Professions 57 14 14 14ADAPT for Teaching and Learning 57 14 21 7Rainbow 1 53 13 0 33GHIFT Database 53 13 20 13Rainbow 4 53 20 0 27Spreadsheets for NHS Managers 47 27 20 7Drug Calculations 40 20 20 20AGNIS 40 20 27 13A.D.A.M. 20 0 33 47Body Works 20 7 33 40

Table 1 : The educational products surveyed

Supporting information users Supporting the teachersA.D.A.M3 GHIFT1

The Nine Month Miracle3 IT Eductra2

Med Works3 ADAPT1

Rainbow 11

Rainbow 41

BodyWorks3

Security for Nursing Professions1

Drug Calculations3

EPR CD-ROM1

AGNIS4

CALCOM for Windows1

A Patient's View1

Personal Health Records (CBT)1

Spreadsheets for NHS Managers1

What is Data Protection1

What seems to be the problem?1

Terms, Records and Information1

using products to teach ‘managing clinical information’

• 67% had not heard of the EPR CD-ROM or the Terms, Records and Information open learning package

• 73% had not heard of the videos A Patient’s View and What Seems to be the Problem?

• 80% of student nurses were reported to be taught how to use a computerised system during their clinical placements.

materials developed to support the teacher

• 80% had not heard of IT Eductra,

• 57% ADAPT for Teaching and Learning

• 53% the GHIFT Database.

It would appear that the informatics community, whilst extremely good at communicating with each other, needs to recognise that some of the key users do not access the same communication networks.

Why the gap?

• Is it because IM&T materials produced by the NHS are owned by the NHS– Are they ‘sold’ to trusts and training departments?– Are they seen as part of the IM&T trainers kit?– Are there vested interests which keep NHS materials

within the NHS training arenas?

• Is it because the NHS contracts with HEIs to provide the teaching and feel it is not the NHS’s role to provide them with materials?

Why the Gap?

• Do staff in HEIs have any idea what is being produced by the NHS?

• Do they know the emerging NHS agendas?

• Do staff in HEIs know about other sources?– Do they use the internet?– Is web based material hard to find?– Is it a case of it not being produced by MY

TEAM in my University?

What about other materials

• Does the Informatics Community have to tell Schools of Nursing what is available?

• If so who in the Community should be responsible?

• Why are multi-million Ecu project outcomes so invisible to the Higher Education sector?

Broader Issues

• Are the these products predominately designed to provide facts rather than concepts?

• Are they training rather than education?

• Are some produced solely to tick the boxes to show that a strategy / project has been addressed?

• Is the production more important than the implementation?

A core curriculum?

The original study found that a total of 65% of respondents wanted a Core Curriculum for IM&T.

In 1999, 93% wanted a core curriculum for Health Informatics.

Core curricula were written for pre and post registration but appear not to have been widely disseminated.

HEIs want Guidance

Institute of Health & Care Development (IHCD) and ENB however produced a product in November 1997 entitled “Information for Caring” and subtitled “A framework for including health informatics in programmes of learning for nurses, midwives and health visitors and other clinical professions” .

The purpose of the document was “to raise the profile of health informatics within curriculum design and development…”

Aim

To evaluate the use of ‘Information for Caring’ and how it performs as a tool in order to determine its effectiveness at supporting the integration of health informatics through HE core processes for curriculum development and validation/review.

Council of DeansICT project