Download The Go-Between Issue 108 October 2012 Information for Information Users

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The Go-Between
Information for Information Users
The Go-Between would like to hear from potential
contributors. Articles should be on health informatics
related matters and around 250-400 words in length. Copy
deadline for Issue 109 is 20 November 2012.
For contributions etc. please write to the Editor
(address on back page).
____________________________________________________
In This Issue
4th Generation
Diary
Improving Information
Governance
News in Brief
NHS Safety Thermometer
Patient Decision Aids
Patient On-line Access
______________________________________________
Issue 108 October 2012
However, little is known about whether people with mental
health conditions have access to the internet.
Miles Rinaldi, Head of Recovery & Social Inclusion, and
Daniel Barrett, Service User Group co-ordinator of South
West London & St George’s Mental Health Trust
(SWL&StG) recently undertook a survey of service users
using community mental health services with the aim of
gaining an understanding of: access to the internet;
searches for health related information; and, if made
available on-line, whether access to care plans, medical
records and the ability to request prescriptions and
appointments would be taken up.
A questionnaire of eight questions was completed by 184
service users over a period of a month. The survey was
anonymous.
The Results
Over half of the respondents (54%, n=99), had used the
internet or email within the past year whereas 46% (n=85)
had not. There were no significant differences for internet
use and gender, ethnicity or age. However, there was a
significant difference for people with a diagnosis of
Obsessive Compulsive Disorder who were less likely to
have used the internet in the last year in comparison with
other diagnostic groups.
For all service users who used the internet, 87% access
the internet on a regular basis at least once a week with
66% accessing it daily. Service users who used the
internet were asked to identify all the ways they accessed
it. The majority had access through their own personal
computers (88%) followed by access through their smart
phones (33%).
Of the respondents who access the internet 91% search
for health information related to either their mental or
physical health with a high proportion searching for
information on medications, treatment options and, selfmanagement tools and techniques to support coping with
and living with a mental health condition.
Taking the temperature: the NHS Safety Thermometer –
see page 2
_______________________________________________
Patient On-line Access
In 2011, the NHS Future Forum, which advises the
Government on its health reforms, recommended that
patients should be able to access their medical records and
request prescriptions and appointments through the
internet by 2015.
A randomised controlled evaluation in England found the
uptake of paper-held shared care records was low by
professionals and patients alike and, patients with a
diagnosis of psychosis were significantly less likely to use
their records (Warner et al, 2000). In Great Britain, 77% of
households now have internet access (ONS, 2011).
All service users were asked whether, if available, they
would access their care plan, medical records and request
prescriptions and appointments through the internet.
Overall, 71% of service users responded ‘yes’, 14%
responded ‘no’ and 15% were ‘not sure’.
For those who did not want to access their own records or
were ’not sure’, the main reasons cited were concerns
over privacy, security, confidentiality and not having
access to a computer. It is interesting to note that over
half of service users (51%) without internet access
responded ‘yes’.
The internet is of growing importance specifically as a
source of health information. This evaluation has shown
that 54% of service users have accessed the internet in
the past year with the majority (87%) accessing the
internet on a regular basis at least once a week.
Continued on page 2.
Continued from page 1.
Service users access the internet from their own personal
computers but also through using their smart phones,
through work and within libraries. The majority of service
users (91%) search for health information related to either
their mental or physical health.
Over the last 5 years a number of patient online services
have been developed, Applications are being developed for
smartphones to enable people to self-manage their health
and wellbeing and electronic decision aids to support
shared decision-making are emerging.
If information
technology and the Internet are at the heart of giving
people greater control of their health and care is it not time
for services to embrace the technology?
More information:
Miles Rinaldi [email protected]
Daniel Barrett [email protected]
_______________________________________________
NHS Safety
Thermometer
Various research has indicated that approximately 10% of
patients are harmed during their healthcare experience.
Overall, this suggests that some 900,000 patients per year
experience some harm while receiving healthcare with an
estimated impact on healthcare spend of approximately £1
billion per year. An NHS Safety Thermometer has been
developed to survey all relevant patients in all relevant
NHS providers in England one day each month, by
collecting data on patient harm.
The NHS Safety Thermometer contains clinically valid and
pragmatic operational definitions for each complication
which means it can be used across a range of settings. It
gives a timely summary of results which can be used for
teams in their improvement work. The data collected can
be viewed at the ward, organisation or national level at the
push of a button.
The NHS Safety Thermometer is designed to be used by
frontline healthcare professionals to measure complications
in the place where the patient is being treated (point of
care). The NHS Safety Thermometer has two unique
features; first it is able to measure the proportion of
patients ‘harm free’ from pressure ulcers, falls, urinary
infection (in patients with a catheter) and new
Venousthromboembolism (VTE) i.e. patients who have
none of these complications.
It also provides clinical teams with automated graph and
merge functions at the press of a button. However, the
NHS Safety Thermometer needs to be used with caution.
Data must be used appropriately and some important
lessons have learned:

It is important to understand the effect of
demographics and case mix on the results

Not all harm is avoidable

User training and understanding is key

Focus should be on the burden of harm to patients, not
which organisation harm is detected in.
Extreme caution should be taken when interpreting initial
data points (i.e. at the beginning of data collection)
because organisations are still setting up systems and
training staff on the operational definitions. Once 6-8
months worth of data points have been collected, these
can be used to establish a baseline within an organisation
and set local improvement goals if appropriate.
The tool was designed to measure local improvement over
time and should not be used to compare organisations.
There are differences in data collection methods and
patient mix, which can invalidate comparison across
organisations. For example, trusts that have a high
percentage of older patients or specialist services are
likely to present with more harms.
Each organisation needs to understand the demographics
and case mix of the patients surveyed. For example, on
elderly care wards the overall harm rates will be high
because these patients are biologically susceptible to the
harms.
When interpreting data from the NHS Safety
Thermometer it should be remembered that some harm
will be avoidable but some of it won’t be.
Further guidance on data collection methods, data
analysis and interpretation will be published shortly.
More information:
Department of Health guidance
http://tinyurl.com/cgkqjuu
Health and Social Care Information Centre
http://tinyurl.com/79zr7r5
______________________________________________
Improving Information
Governance
BCS ASSIST held a series of well attended workshops
over the summer on Information Governance (IG). The
workshops considered the issues facing IG and made a
number of recommendations in a comprehensive report.
This article summarises some of those recommendations.
Culture

An investigation of ‘return on investment’ (RoI)
should be undertaken to make the ‘business case’ for
operating IG appropriately in order that senior
management can understand the need for
investment in staff and processes to protect and
utilise data.

Data and Information Management should be a
mandatory part of risk reporting at Boards of all NHS
organisations.

Everyone working in the NHS and providing NHS
commissioned services should have a basic
understanding of IG issues as part of their training or
induction and their professional accreditation to
enable information to be managed properly and
patient privacy to be protected.

Develop a simpler and smarter all encompassing
definition of IG to enable better understanding of
purpose and to aid senior management and wider
cultural engagement, to simplify the language of IG.

Shift the emphasis of IG to being about enabling use
of sensitive personal data whilst properly respecting
the privacy of the individual.

There is a need for a respected authoritative source
of IG guidance.

Improvements in sharing best practice are needed to
promote the ‘single version of the truth’.

Introduce a formal professional standard of practice,
possibly based on existing ISEB qualifications,
structured specifically to meet health and social care
needs.
Organisational Change

Clarity and leadership on change and associated IG
facets is needed from the ‘top’


Involvement of operational IG staff in resolving issues,
so that learning and knowledge transfer takes place
Workshops should take place with the updating of
relevant websites to disseminate good practice as
developments occur.
IG expertise and staff

The language of IG should be simplified in terms of
definitions and couched in simpler terms concerning
privacy

Clear short statements of policy concerning access to
identifiable data should be developed for use in all
NHS organisations and those commissioned by the
NHS to provide services.

Improve the education, training and development
facilities available for IG experts

Improve access to pooled expertise and IG networks,
such as enabling the continuation of the existing SHA
IG Groups and encourage wider membership

Develop professional leadership and professional
development of IG specialists, a task in which BCS
ASSIST could provide help and support.

Whilst employment of IG staff will obviously be the
subject of the same financial regime as other staff,
there needs to be sufficient expertise available to NHS
and NHS commissioned organisations to enable their
legal obligations to be met. Guidance should be
provided by the Department of Health in the form of a
minimum level of skills and knowledge required by
organisations, whether employed directly or not, to
meet their IG obligations.
The full report is available on the BCS ASSIST website.
More information:
http://www.bcs.org/upload/pdf/info-governance-report2012.pdf
______________________________________________
4th Generation
4G is promised to be the super-fast internet connection for
mobile devices. It refers to the fourth generation of cellular
(or mobile) communications and is set to supplant the
current 3G network that many of us use on our mobile
devices when away from Wi-Fi coverage.
The most obvious difference will be speed. Browsing the
web, streaming music and videos and downloading apps
on phones or tablets will be considerably faster on a 4G
network than on the current 3G network. “True 4G” is
defined by the International Telecommunications Union
(ITU) as providing a "sustained data rate of 100Mbps for
mobile connections and 1Gbps for fixed connections".
That's a mobile speed vastly exceeds the performance of
most people's current home broadband connections. 3G
mobile connections have a maximum speed of 7.2Mbps,
but generally offer around 1-2Mbps - so 4G is set to be up
to 100 times.
To confuse matters there are other technologies that are
“4G-like”. The commercially available 4G Long Term
Evolution (LTE) and Mobile WiMax and "advanced 3G"
HSDPA+ networks in the States and elsewhere might be
described as “4G”, but don't meet the technical
requirements to provide the sustained connection speeds
of “true 4G”. Even so, the ITU has allowed networks to
market these technologies as 4G, in an attempt to try to
keep things as clear as possible for the average consumer.
When is the UK getting 4G?
4G LTE trials have been running in Slough (near O2's
headquarters) and there is already a very limited 4G LTE
network in Cornwall. Britain's major cities should have a
decent 4G LTE network at some point later in 2012, once
Ofcom auctions off the 2.6GHz band and the 800MHz
band of the mobile spectrum to allow operators to offer
faster mobile connections.
The cost of 4G is expected to be only marginally more
expensive than 3G. O2, Vodafone, 3 and Everything
Everywhere etc have yet to announce exactly how much
they plan to charge for their customers for 4G.
The new third-generation iPad is 4G-enabled and, by all
accounts, works well on 4G LTE networks in the US.
However, rather annoyingly, it won't work on the 4G LTE
networks that are set to be rolled-out across some of the
UK's cities later this year, due to a frequency mismatch.
However, many city-dwelling Brits will be able to use 4G
mobiles and tablets later this year.
When will the UK get True4G?
The bad news is that the UK is unlikely to get a national
4G network any time soon. It is a complex area, involving
a large number of technical and competition issues that
need to be resolved before proposals are finalised. For
example, a very high proportion of households in the UK
rely on Digital Terrestrial TV – Freeview – which needs to
be relocated before 4G can be rolled out. Some are
predicting that a national 4G network will not be in place
until 2015.
More information: http://www.4gbritain.org
______________________________________________
Patient Decision Aids
In September five new Patient Decision Aids were
launched by the Shared Decision Making Programme.
The aim of the Shared Decision Making Programme is to
promote shared decision-making in NHS care, promote
patient centred care, and increase patient choice,
autonomy and involvement in clinical decision making; to
make “no decision about me, without me” a reality. The
Shared Decision Making programme is part of the
Department of Health’s Quality Improvement Productivity
and Prevention (QIPP) programme.
Patients are not always aware that they have a choice, but
when they are involved in decisions about their treatment,
their experience, satisfaction and outcomes improve. The
Patient Decision Aids present the information they need so
they can weigh up the pros and cons and be fully involved
in choosing the treatment which best suits their needs,
values and preferences. Patients can work through the
online Patient Decision Aids in their own time, alone or
supported by family and friends, or by a team of specially
trained telephone health coaches.
These five Patient Decision Aids are the first in a series of
36 being rolled out over the coming six months. The
condition areas covered include abdominal aortic
aneurysm repair, cataracts, and established kidney failure,
(kidney dialysis and transplant). Forthcoming Patient
Decision Aids will extend to osteoarthritis of the hip,
osteoarthritis of the knee, Multiple Sclerosis, pregnancy
(after a Caesarean), localised prostate cancer and
rheumatoid arthritis.
Totally Health is responsible for the development of the
Patient Decision Aids, along with designing and powering
the technology behind them. The editorial content has
been compiled by the BMJ Group, supported by a series
of Medical Advisory Groups, consisting of condition
specialists and patient representatives.
More information: http://sdm.rightcare.nhs.uk
______________________________________________
News in Brief
Fund to Boost Digital Innovation
The Department of Health has set a fund from which local
NHS organisations could now be awarded funding to
develop new digital services that improve patient care
including information sharing more easily across the NHS.
See:
http://www.dh.gov.uk/health/2012/08/informationsharing-challenge/
N4
Change in the Public Sector
A joint meeting of three BCS specialist groups: Business
Change, ASSIST (The Association for Informatics
Professionals in Health and Social Care), and Health
London & South East is taking place on 14 November
2012 (18:00-21:00 hours). Two speakers are: Lynne
Maher is Director for Design and Innovation at the NHS
Institute for Innovation and Improvement; and Kathleen
Hall, correspondent for Computer Weekly. The event is
being held at the London BCS headquarters in 5
Southampton Street, Covent Garden. Further details and
to book a place: https://events.bcs.org/book/421/.
The contract for N3 – the NHS national network – is due to
come to an end in the next couple of years. An “N4”
project has been initiated to develop options for what
happens next. These options will be driven by the
requirements of health and care organisations in
consultation with potential suppliers. More information:
http://www.connectingforhealth.nhs.uk/systemsandservices
/n3/n4.
NHS Sickness Rate Falls
Digital First
___________________________________________________
Digital First, formerly known as Digital by Default is a
Department of Health initiative which aims to reduce
unnecessary face-to-face contact between patients and
healthcare professionals by incorporating technology into
these interactions. A report on Digital First has been
published on the NHS Institute's high impact innovation
site. The report identifies ten simple uses of technology
worth implementing, which could reduce inappropriate
face-to-face contacts, by using existing technologies. See:
http://digital.innovation.nhs.uk/pg/dashboard#
NHS staff had a sickness absence rate of 4.12 per cent in
2011/12 – slightly lower than in the previous two years.
This equates to about 15.56 million days lost to sickness
according to new analysis published by the Health and
Social Care Information Centre. For the full report see:
http://www.ic.nhs.uk/news-and-events/news/sicknessabsence-rate-among-nhs-workers-falls-to-412-per-cent.
Diary
06 - 07
Nov 12
(http://www.ehi.co.uk/events/ehi-live-2012/)
14 Nov 12
Information Centre
It is understood that the Health & Social Care Information
Centre is to be replaced with a new Health & Social Care
Information Centre. The new organisation will operate as
an “arm’s length” body (similar to NICE) and will have a
wider remit taking on the remaining functions of NHS
Connecting for Health.
Replacement of NHSmail
The NHSmail 2 project has been established to look at
options for when the current NHSmail (national e-mail
system) contract ceases. Despite the name of the project,
no assumptions have yet been made about the solution.
Information will be published as it becomes available at:
http://www.connectingforhealth.nhs.uk/systemsandservices
/nhsmail/nhsmail2.
New MH Discharge Summary
A new Mental Health Discharge Summary has been
developed to help standardise the data items and
information that GPs receive when a patient is discharged
from in-patient mental health care. For details see:
http://www.connectingforhealth.nhs.uk/systemsandservices
/clinrecords/mhds/intromhds.pdf
Bowel Cancer
About a quarter of bowel cancer patients in England are
only diagnosed with the disease after an emergency
admission to hospital, new advanced research from a
national audit has found. See: http://www.ic.nhs.uk/newsand-events/news/quarter-of-bowel-cancer-patientsdiagnosed-after-emergency-admission-to-hospital.
EHI Live 2012 (E-Health Insider), NEC,
Birmingham
BCS: “On-going Change in the Public
Sector”, London WC2E
(https://events.bcs.org/book/421/)
29 Nov 12
BCS W London: ”Follow Facebook and
Protect Your Website!”, University of
Westminster, London W1W
(https://events.bcs.org/book/423/)
01 - 02
Dec 12
“The Digital Doctor” Conference,
London WC2E
(http://thedigitaldoctor-estw.eventbrite.co.uk/)
12 Feb 13
BCS Kingston & Croydon: “Cloud
Migration Experiences”, London WC2E
(https://events.bcs.org/book/381/)
__________________________________________________________
Address for correspondence:
The Go-Between,
c/o David Green, Director of IM&T,
SW London & St George’s MH NHS Trust,
Springfield University Hospital, Tooting,
LONDON SW17 7DJ.
[email protected]
London & South East