A New Era

Nurse working at deskThe BCS Health Northern Specialist Group was given an insight into how the use of clinical informatics is being encouraged across the North West by the new Health Informatics Clinical Advisory Team (HICAT) at NHS North West.

Dr Andrew Coley, Chief Clinical Officer (CCO) for Health Informatics in NHS North West, and three of the five members of his team - Dr Asad Sadiq, Mr Bibhas Roy and Dr Amir Hannan - presented their new approach at a meeting in Manchester in July of this year. Phil Paterson reports.

Dr Andrew Coley, a Senior Clinical Adviser to NHS North West and a practising GP, reminded the audience that between 2003 and 2006 there were various national health informatics initiatives, but there was always a mismatch between IT products/developments and the style in which they were offered to clinicians and what clinicians really wanted.

Historically, IT project failures are usually more of a behavioural change problem than an IT problem. In health informatics the big problem is that clinical change management has always been missing. The introduction of health informatics to clinicians needs behavioural management for transformational change.

The aim of the HICAT is to provide ‘world class health informatics with clinical leadership’ and ‘delivering improvement through clinical engagement’. The team’s approach is based on seven key beliefs:

  1. Genuine engagement occurs most effectively following debate at a local level.
  2. One must place the patient at the centre of a cultural move towards a new care pathway.
  3. Changes must be evidence-based.
  4. Local clinical leaders are essential - they are likely to be respected and seen as honest brokers by colleagues.
  5. Local evidence is often more compelling than ‘remote’ national evidence.
  6. Success means aligning roles and responsibilities between clinical leaders and managers.
  7. Requesting a clinician to change working processes will produce dissonance, leading to disengagement, or, if the product is good, engagement - the latter being the aim.

In order to achieve impact with clinicians across the North West Dr Coley appointed a multi-disciplinary team of five clinical leads to work with him, one each for diagnostics, acute care, mental health, primary/ community care, and Lorenzo.

The Clinical Health Informatics Leads (CHILs) are clinical champions, appointed to lead and work with other clinicians to bring about the changes required for clinical engagement and service implementation, leading to business as usual after the implementation of information systems. Providing evidence of quality and benefits realisation is seen as the key to escalating clinical engagement.

Health informatics - getting it right

Bibhas Roy, an orthopaedic surgeon from Trafford and Secondary Care IT Lead, presented the HICAT Mission Statement and the aspirations of the current team.

‘The Health Informatics Clinical Advisory Team works across the complete healthcare spectrum,’ he says, ‘ensuring that the people of the North West enjoy better care, better health and a better life through the innovative and efficient use of information technology.’

He outlined a history of health informatics to show that it is not new. It started back in the 1950’s. IMIA (the International Medical Informatics Association) had its grassroots in an IFIP Technical Committee formed back in 1967, resulting in it being officially recognised in 1989; and Medline has been around since 1965.

Mr Roy illustrated how the domains of clinical work, information communications technology and the organisation of medicine and healthcare all overlap.

Industry statistics show that disastrous, runaway IT projects are characterised by being well over target delivery time and estimated budget, whilst delivering much less than the intended functionality. Many large IT projects are likely to fail.

The most frequent reason for failed and unwanted computer projects is poor requirements. If the stakeholders are not happy with the IT, there is usually something wrong with it and the organisation ends up paying a substantial premium on every project.

It must be remembered that organisations and requirements are dynamic, not static. Auditing projects for requirements or defects could cut the failure rate of projects by up to 80 per cent.

There have been some NHS successes. NHS Mail started off as being unpopular, but it got better; it was approved as secure, offered mobile access and provided an SMS gateway. Why did it work for the NHS? The requirements were ‘simple and accurate - email requirements’.

PACS is now available in all hospitals, it is interlinked in the North West and it has expanded to other media. PACS has been a great success in the North West and is a good example of the acceptance of changing requirements and clinician involvement where needed.

The key to success in both cases was the simplicity of the requirements, accurately specified. Alas the requirements specifications are not all there to the same extent for all other large IT systems.

Digital dictation for clinicians - a success story

Dr Asad Sadiq, a consultant psychiatrist from Bury and Mental Health IT Lead, is a full time clinician who is an enthusiast for IT in his spare time. He does not operate on patients, but talks to them and listens to them during his consultation process, which could last for an hour or more per patient.

It is important that he listens and it can be inappropriate to write notes at the same time. However, he needs to document the important points of each consultation.

After seeing a demonstration of digital dictation at the HC2009 Conference at Harrogate, Dr Sadiq organised a meeting at Bury involving consultants, the IT manager, secretaries and the admin manager and a digital dictation pilot project was initiated.

The pilot went very well and everybody, even the older clinicians, engaged and liked it. The key success factor was the interaction between the lead clinician and the IT director.

Problems with the old analogue dictation system included cassettes being lost, so consultants had to re-do letters, urgent letters were hard to find on the cassettes and the poor quality of old cassettes meant that medical secretaries had difficulties hearing the dictation. Dictaphones also had problems. The administration manager of the typing pool of medical secretaries could not tell who was doing what.

With digital dictation the dictation goes straight to the secretary. The clinician dictates and is then freed to focus his mind on the next patient. The admin manager can check the workload and see who is doing what. The voice quality is much better than before. It is safe, quick and efficient.

Dr Sadiq concluded by emphasising that full-time clinicians who just use IT have higher credibility with colleagues than clinicians who work full-time or part-time in IT. It is imperative to engage the front-line clinicians in order to achieve a successful IT implementation. It needs clinicians to pull rather than managers to push.

Patient empowerment through health informatics

Dr Amir Hannan, a GP from Hyde and Primary Care IT Lead, focused on patient eMPOWERment. The ‘MPOWER’ stands for ‘Medical patient and the Public cOmmunication, World wide web, Electronic Record’.

Dr Hannan’s aim is to put patients at the heart of health informatics by empowering, educating and enabling them to make informed decisions about their own health through accessing personal and clinical information.

Dr Hannan is encouraging the involvement of his patients with their own records and giving them access, via the practice website, to information to help them manage their own conditions better.

Thankyou letters from patients confirmed their appreciation of this approach.

The NHS Choices website and Map of Medicine are good examples of the provision of information for patients.

Medical records can be shared with patients through electronic access functionality that is already available, or soon will be, in most versions of the commercial GP computer systems used in the North West.

The challenge is about changing the culture of healthcare and re-balancing relationships between people who use services and those who provide them.

Dr Hannan and two GP colleagues have recently produced documentation on clinical engagement for ‘Enabling Patients to Access Electronic Health Records: Guidance for Health Professionals’ which will be released to GPs by the Royal College of General Practitioners (RCGP).

Dr Hannan’s Haughton Thornley Medical Centre’s website www.htmc.co.uk contains lots of useful information for his patients and is ‘open 24 hours’.

The future

Patient access to more information will impact beneficially on the work-life balance of GPs. Some patients are very appreciative of it and take greater responsibility for their own healthcare as a result.

Further, 24 hour access to information means that patients are not left waiting helplessly for access to their GP and pressure on GPs is thereby relieved, counterbalancing the increasing demand for GPs’ time caused by increasing numbers of elderly and chronic disease patients.

Currently, 12 GPs in the North West are giving patients access to their own records. The target is 100s.

In today’s world of immediate communications, if the population likes something new and takes it up, it can make an impact immediately.

HICAT can be contacted at: http://www.northwest.nhs.uk/whatwedo/hicat/

Autumn 2010