AGM and Bringing Healthcare Information to the Public

Date
Thursday 23 January 2003

Venue:
The Board Room, Moorfields Eye Hospital, City Road, London, EC1V 2CD

All the best AGMs are short and to the point. We did reasonably well against this standard.

Andrew Capey provided the Chairman’s Report which mainly confirmed the events reported in Newsletter 44.

Barrie Winnard provided the Treasurer’s Report where activity has been low, and reserves maintained. It was noted that members had not been asked for subscriptions this year (ending 30th April).

Barrie is also now the organiser of our host location, and participants appreciated the available facilities and refreshments.

The Group agreed to change its name, for the reasons given above in this Newsletter.

Keith Clough chaired the meeting, and spent some time twisting arms to maximise volunteering for the new Committee.

It was announced that the next meeting of the group would be in March at Harrogate as part of HC2003. Thereafter, the new Committee would re-establish regular meetings of the group.

Following the AGM there was a presentation and discussion on:

Bringing healthcare information to the public

The meeting was open to members of ASSIST and IHM, as well as those in the BCS and its Health Informatics Specialist Groups.

The speakers were:

Alasdair Liddell, who is now an independent consultant, who will talk about the Living Health project, which was piloted in the West Midlands by Flextech Telewest and for which tenders for a national service are being invited.

and

Lesley McCourt, General Manager of North East London NHS Direct, who have had rather longer experience of providing healthcare information direct to the public.

So much of the discussion within health informatics is about how healthcare professionals can do their jobs safely and effectively. Turn that around, and there is far less discussion about the benefits for those other important participants in healthcare - the public and where individuals need to act the role of patient.

A start was made on this alternative perspective by our two speakers.

Alasdair Liddell described the Living Health Project and the pilot work in the West Midlands area involving TeleWest.

Living Health was a DH funded pilot to make use of digital interactive home television. £3.8M was provided in November 2000; the pilot ran from May to November 2001; after a short extension, the pilot closed in May 2002.

UK has quite a lead in the coverage of digital television, with up to 8M households capable of receiving such a service. The timescale of takeup has been even faster than internet connection.

The main resource for the users was upwards of 22,000 pages of healthcare information. Provided by television, the content of a page has to be limited to about 50 words, but navigation between pages can be standardised and made simple for the user of a remote control. Navigation by menus, or by Prev/Next buttons, or by A-Z indexes is easier than using a browser and mouse.

With the main information resource, the pilot set out to evaluate the feasibility of consumer use. The target population in the Living Health pilot was 54,000 customers of TeleWest Birmingham.

By the end of the pilot, nearly half the target population had used the service; the service was receiving about 9K page hits per day; and the average visit was 12 minutes with 30 pages.

Besides the main resource, there were two subprojects.

Users could logon using a PIN and make appointments in primary care. The full possibilities of such a service were not explored as only a few practices and users took part.

In-Vision provided a telephone call-back service with a one-way video link from NHS Direct to supplement the usual telephone-only consultation. The video link could just show the NHS Direct nurse, or could show diagrams or video clips.

Television is very inclusive with high user familiarity. Compared to internet use, the Living Health television pilot showed access skewed to higher age and lower socio-economic groups. Television was not merely duplicating other services.

Besides the achievements of the pilot, there are some clear future expansion possibilities.

More could be done with a return circuit from the user eg, by cable.

There is more scope to carry transactions, such as bookings and reminders, on such a service: a television alternative to e-mail. Once information can be person specific, it become possible to replace appointments whose only purpose is to hand over information.

And, more telecare could be enabled as bandwidth increases.

Lesley McCourt is general manager of NHS Direct for NE London, and she described the wider role of the NHS Direct service.

NHS Direct is a 24-hour available service for home or anywhere access. It is provided from 22 sites, with load sharing of calls if the most local centre is overloaded.

Calls are handled by nurses using a triage with standard algorithms but including their professional knowledge as well. The algorithms are subject to ongoing review and updates under change control.

Besides the telephone service, there is also the internet NHS-OnLine, which can be accessed from a personal PC or from public access points. OnLine has a health encyclopaedia and takes 250K visits per month. A visit averages 10-15 minutes and 30-40 pages. OnLine is delivered from two mirrored data centres.

NHS Direct has developed rapidly, and continues to change. Fairly immediate requirements are for NHS Direct to relate more closely to other NHS services, and to become more integrated with the NHS IT family of applications. The initial takeon of clinical content relied heavily on US sources, and this needs to be revised for UK practice and UK clinical databases.

There is considerable potential for a much better service through much closer integration.

All NHS Direct sites need to be running a single version of their software. This is part of being really consistent across the service.

There would be financial benefit, if nothing else, in sharing many operational databases eg, with A&E departments.

With standardised triage, it should be possible for everyone to get the same response whether that is from NHS Direct, or a practice nurse or GP, or an A&E department. At present, these sources play against each other in the public’s perception.

More intelligent telephony and call routing would for example allow scarcer resources such as interpreters to be deployed as required.

When there has been a contact with NHS Direct, there should be better information flows to other carers. At present, the default route to primary care is using fax, with limited takeup of EDI messages.

Ultimately, it really should be possible to make one call to access all services. NHS Direct could become the standard route to emergency ambulances.

NHS Direct, Primary Care, and A&E are not set up to compete, and NHS Direct was not set up merely to save money elsewhere. The objective is to change the relation between the public and the health service, and to assist the public to access the most appropriate part of the service as may be required.