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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