The Information Centre & end user support€¦ · Web view3.5 The call centre an extension to the help desk 10. 3.6 User forums 10. 4. Functions that are not the responsibility

The Information Centre (IC) and user supportWritten by: Robin Beaumont e-mail: [email protected]

Date last updated: 14 January 2008

Version: 2Contents

1. Learning outcomes check list for the session........................................................................................................2

2. Introduction........................................................................................................................................................3

2.1 The 'modern data processing dilemma' - Perry 1987.....................................................................................3

2.2 From hierarchy to matrix management........................................................................................................4

2.3 Information and competitive advantage.......................................................................................................4

2.4 Possible solutions to the modern data processing dilemma..........................................................................5

3. Functions of an Information Centre....................................................................................................................6

3.1 Consultancy................................................................................................................................................. 63.1.1 The new user who has a problem to solve but is not sure how to go about it ........................................................63.1.2 The established user who wants to embark on a new project................................................................................7

3.2 Access to corporate information................................................................................................................... 7

3.3 Application development in personal computing..........................................................................................7

3.4 The Help desk............................................................................................................................................... 8

3.5 The call centre an extension to the help desk..............................................................................................10

3.6 User forums............................................................................................................................................... 10

4. Functions that are not the responsibility of the Information Centre................................................................11

4.1 Outsourcing............................................................................................................................................... 11

5. The Information Centre and the organisation...................................................................................................12

5.1 Position in organisation.............................................................................................................................. 12

5.2 Line of responsibility.................................................................................................................................. 13

5.3 Inappropriately rigid division into IT and Information management............................................................14

6. Structure of Information Centres......................................................................................................................14

6.1 Educational issues...................................................................................................................................... 17

6.2 Staffing levels............................................................................................................................................. 17

6.3 Information Centres in other HealthCare organisations...............................................................................19

6.4 Training the Trainers.................................................................................................................................. 20

6.5 Good practice............................................................................................................................................. 20

7. The NHS information Centre.............................................................................................................................21

8. Information / Clinical Goverence......................................................................................................................22

9. Summary...........................................................................................................................................................22

10. References....................................................................................................................................................22

11. Optional additional exercise.........................................................................................................................24

12. MCQs............................................................................................................................................................. 24

Introduction to Health Informatics

Information Centres

1. Learning outcomes check list for the sessionThis document aims to provide you with both skills (the 'be able to's' below) and useful information (the 'know what's' below). These are listed below. After you have completed this document you should come back to these points ticking off those you feel happy with.

Learning outcome Tick box

Describe what is meant by the modern data processing dilemma

Be aware of the changes in organisational management structures that has encouraged the development of personal computing

Describe the technological changes that have contributed to the modern data processing dilemma

Discuss the relationship between Information systems and competitive advantage

List the three main approaches taken to the modern data processing dilemma

Describe the main aims of an Information Centre

Describe the difference between a Information Centre and a traditional Data processing department

List the main functions of a Information Centre

Describe the 'consultancy' function of Information Centres

Describe the 6 factors thought to be important by Devargas when assessing someone's suitability for involvement in system development

Discuss the activities that the Information Centre should undertake regarding access to corporate information for end users

Describe how a Help Desk functions

Be aware of the call centre concept

Discuss the concept of user forums

Discuss the appropriate size of those projects deemed suitable for personal end user development.

Discuss the relationship between a Information Centre and the main IM&T department

Be aware of the concepts of facilities management and outsourcing

Be able to draw organisational charts showing suitable and unsuitable positions of the Information Centre in the overall organisational structure

Discuss the various lines of responsibility encountered for Information Centres.

Discuss the division of IT and Information management functions

Discuss the structure and main functions for each role in the Information Centre

List the characteristics of good training

Discuss the factors that need to be considered when considering staffing requirements for Information Centres

Be able to calculate roughly the staffing requirements for an Information Centre

Be aware of the "Training the trainers" concept

Robin Beaumont [email protected] Source: /tt/file_convert/605ada70873dfe5e8b1aebb8/document.doc Page 2 of 28

mailto:[email protected]


Information Centres

2. IntroductionThis section describes the information centre (IC) concept and compares it to the traditional information / IT department found in most UK hospitals up until a few years ago and still present in a large number.

Devargas 1989 in the preface to his short book provides a succinct definition of a information centre:

"The main mission of the information centre is to help and guide Business Professionals (whether in management circles or not) in utilising Information Technology in their work. The computer must be seen, by these professionals, as a tool which enables them to perform their work more effectively, efficiently and in the long run more economically".

The key point is to provide User empowerment teaching users rather than doing things for them as much as possible. The Information Centre must be pro-active and should be seen as a major organisational change agent (Thierauf 1988 p93). In contrast to the traditional DPD (Data Processing Department) which was reactive, inflexible and centralised. The Difference between the traditional DPD and the IC will become clearer as you work through this section.

For the Information Centre to be effective it must also possess a very effective communications function.

The following two sections discuss the reasons why the Information Centre was developed.

Exercise 1Using the titles given below create three lists of activities that a IC could undertake in your organisation. Do not worry if the same thing appears in more than one list:

User empowerment

Pro-activity

Communicating

2.1 The 'modern data processing dilemma' - Perry 1987Perry, 1987, has amongst others, described a 'modern data processing dilemma' that existed in many organisations in the late 1980's. These included:

1. Rapid uptake of desk top computers (in 1989 these where simple VDU, terminals attached to a mainframe). Resulting in users with the IT power but not the skills.

2. Rarity of programmers/ data analysts to support requests for data analysis and general IT training.

3. Conceptual shift in the organisations view of data from that of it being a relatively passive administrative thing to something that was a corporate resource. Producing problems with data management.

4. Increasing backlog of data processing work (i.e. requests for reports). Perry, 1987 stated that IBM had a 3 year backlog and was growing at a rate of 10% per year.

5. Data sabotage by end users in an attempt to control 'big brother' along with lack of ownership of data (i.e. only collected for the DoH - no use to us only used to plan budget! Therefore lets give then the data which will produce the largest budget).

Alongside the above problems the last two decades have seen a revolution in the capabilities and availability of IT:

1. User friendly software packages to allow data storage, reporting and interrogation (SQL, QBE, graphical point and drag techniques etc.).




Information Centres

2. Availability of training.

3. The workstation, laptop and palmtop computer.

4. Networking capabilities (development of international standards, WWW, corporate intranets, LANS, email and home teleworking, etc.)

Many of these changes where mirrored by a change in both organisational structure and the perception of data both of which are discussed below.

2.2 From hierarchy to matrix management

During the last decade many organisations have undergone a radical change in structure from monolithic hierarchical structures to more 'matrix' style structures with devolved budgets and workers that are multi-skilled. The organisation can then be thought of as a network where projects make use of various people in the relevant departments.

A similar approach can be seen, to a limited extent, in some hospitals where clinical directorates are accountable for their own budgets. With this change in structure the power has also been devolved down to these team leaders and along with it the perceived need for information. This probably also accounts for the dramatic rise in requests for information experienced in the late 1980's. I believe this management revolution is just now beginning to hit the UK Hospital sector.

Obviously the Internet since 1990 has also made a dramatic impact which is only just beginning to hit the NHS since 2000.

2.3 Information and competitive advantage

A lot has been written about the dependency that should be placed upon information systems to ensure that a company becomes successful (see Boisot 1994). This is often described as gaining competitive edge over others, however, there is little in the way of any empirical evidence for such general claims. Indeed most claims are based upon case studies or one off surveys which have no real scientific weight. Such inflated claims have now been modified to become more realistic 'sustainable competitive advantage' (King, Grover and Hufnagel, 1989; Symons 1984 p7). It probably depends upon the characteristics of the company as much as anything. For example some department stores use real time monitoring of sales to guide stock replacements and future product line development. Clearly those stores that use such technologies have competitive advantage to some extent. Within the health service most pharmaceutical companies have a similar system, Next time you go into Boots in the UK look at the technology used in the medicines dispensing section.

It is important to realise that the slogan 'information is power' implies that information is a commodity and therefore should be treated as such. This is different in many respects to accepting that information is a integral component to a business process, such as providing care to a patient.

The idea that ' information is power' in a modified form can possibly be linked to several developments within clinical medicine including:

1. Decision support

2. Medical audit

3. Epidemiology (epidemic monitoring and modelling)

4. Commissioning

The topic of decision support will not be considered here.




Information Centres

Medical audit was the buzz word a few years ago but now appears, to have been replaced by Evidence Based Medicine (EBM). This is in contrast to the GP arena where audit has a ongoing role. Reasons for this may well include the fact that most people would simply rather be told what to do rather than work it out for themselves. It must also be noted that medical audit within the hospital environment is much more difficult because of the relative lack of relevant information systems and skills compared to the GP environment. For example in the UK it often revolves around individual case reports.

Epidemiology has always been very closely linked to the collection of data to make valid inferences and is increasingly becoming more dependent upon Information Technology for advanced techniques such as simulations and Geographical Information Systems. Much of the driving force behind many GPs initially using computers in the UK was the offer of a free system in return for anonymised drug data sets from themselves. Clearly the system supplier and drug companies saw this data in a very different light from that of the GP!

Commissioning between purchasers and providers in the UK is theoretically based upon data analysis techniques, however, in reality most of this is hot air in the authors experience. Contracts were often based upon last years figures and the data at all levels was manipulated to take into account its flawed nature. In the UK the 'contracting' process is now being replaced by that of commissioning.

Exercise 2Create a table similar to the one below (a trivial example is given). Fill it with two or three instances where you think the information collected by an individual is of limited value to themselves but to someone else might be considered to be a powerful resource.

2.4 Possible solutions to the modern data processing dilemmaPerry, 1987 suggests that organisations have three possible approaches to the above information dilemma:

1. 'Hands off' In other words let the users just get on with it, it's bound to end in tears! Perry compares this approach to that of the manager years ago in the automobile industry who did not perceive foreign automobiles as a threat to domestic production.

2. 'Maintain central dominance' over users by managerial control. In other words deciding that the users will just have to wait and suffer along with curtailing any 'illegal' activities such as attempts to manage their own data (i.e. building database or producing reports etc.).

3. 'Create an Information Centre' designed to support and encourage users to gain the relevant skills. In medicine the term 'Compliance enabling strategy' has come to be used for those methods doctors use to encourage compliance. Similarly the Information Centre aims at encouraging compliance. This is similar to the situation In medicine where doctors are said to use 'compliance enabling strategies' providing patients with the appropriate information which will motivate them to do what the doctor wants!

Exercise 3Looking back at the information on the last few pages, do you believe there is a 'modern data processing dilemma' within your hospital or organisation? List the reasons for you answer on one side of A4

If you do, which of the three above methods do you feel your hospital or organisation presently adopts to tackle this problem?


Data collector

Data description

Person who values it

Comments

e.g Nurse HIV status Local newspaper reporter



Information Centres

3. Functions of an Information Centre Various writers list the main functions of an Information Centre slightly differently but most of them are remarkably similar. Devargas, 1994 provides a typical list:

1. Consultancy2. Training3. Help-desk4. Access to corporate information5. Decision support services6. Executive support services7. Marketing of personal computing8. Co-ordination and planning of future information needs9. Product support in hardware and software10. Trial and evaluation support11. Application development in personal computing12. Library and newsletter services

While some of the above items are self explanatory others are discussed further below.

However, before doing so it is pertinent to realise that in a healthcare context in addition to those activities listed above for a generic organisation information centre such centres within the hospital sector need to address the additional issue of coding (Read, Smomed codes, HRGs and ICD10). Most hospitals have a coding department consisting of a number of coding clerks. All those who wish to collect additional data by way of user applications should, if it can be suitably coded, be offered the support to do this wherever possible. Applications should be designed with pick boxes of relevant codes to prevent excessive searching.

3.1 ConsultancyThe term 'consultancy' in this context relates to the development or enhancement of information, software or IT. Devargas divides 'consultancy' into two main categories (p46 -48):

1. The new user who has a problem to solve but is not sure how to go about it

2. The established user who wants to embark on a new project

3.1.1 The new user who has a problem to solve but is not sure how to go about itThis is the new user who has a problem to solve but is not sure how to go about it - Most new users are technophobes, too frightened to ask for help and unaware of where to get it, however there are some who want nothing to do with it. Devargas suggests that those insufficiently committed be 'flushed out' and protected from the demands of personal computing. They should not be forced, as any amount of training will be a waste of resources.

Concerning the development of software he suggests the following criteria are useful when assessing someone's suitability (adapted and extended from Devargas p49):

1. Will the user help develop and maintain the application?

2. How far can the user actually help develop the application themselves (analysis and / or programming skills)?

3. Is the user willing to undergo the appropriate training?

4. Does the user understand the effort involved?

5. Does the user or the users' department possess the necessary resources (human + material) and skills?

6. Does the user understand the security and coding issues associated with the development?




Information Centres

3.1.2 The established user who wants to embark on a new projectWhere an established user wants to embark on a new project the Information Centre should provide guidance and support. Specifically the Information Centre should evaluate any such proposal in terms of:

its impact on the organisation as a whole

whether it will be maintainable

human resourcing implications

possible benefits to the organisation

The project should also be evaluated in terms of suitability for local versus mainframe development with the criteria listed in Devergas p47 - 49.

3.2 Access to corporate informationAll UK hospitals have a basic PAS (Patient Administration System) of some sort. Other hospitals are more fully developed with individual clinical systems (e.g. such as theatres or ITU). Also some specialties in the UK have information systems as a result of organised development. One such specialty is the UK renal dialysis service where most units have a purpose build system often of some complexity.

The Information Centre should actively promote( e.g. via newsletters and user groups):

1. Awareness of what data is available

2. Possible format of the data (e.g. excel spread sheet, Access or suitability for SPSS etc.)

3. Provide training, along with facilities, so that end users can carry out basic analysis

4. Provide support for more complex analyses

All UK hospitals are required to produce returns to the DoH among which are the HES (Hospital Episode Statistics). Although these are very basic much information can be gleamed from them particularly if the Information Centre can also provide some of the additional data that is not sent to the Doh such as consultants name and test results.

Key point:

All clinicians interested in analysing patients data should make it their business to find out:

What data can be provided from the relevant information systems (i.e. a list of fields).

What format it is available in (Excel, Access, SPSS etc.)

What relevant facilities( hardware + software) and training are available

What support is available for more complex analyses.

3.3 Application development in personal computingThis rather strange title indicates the type of software development that is small scale and designed for 'personal' use.

Here we are not discussing large database development. Often all that is required are several additional screens with a dozen or so fields to collect additional data for research / audit purposes, this may be for a few weeks, months or even years. Another common situation is the displaying of information in a particular software package such as Excel.




Information Centres

It is important that end users are trained in suitable methods of specifying their requirements. The level of such training is dependent upon both how complex the development is and how fully they wish to become involved in the process. For a 'personal computing' development that would be carried out by the Information Department relatively easy to learn techniques, such as defining data dictionaries along with screen layout design methods such as story-boarding are adequate. However, if they wish to become involved in a large system development, such as a departmental system, they should understand various data / object modelling techniques.

It is important that the application development team in the Information Centre are not overloaded with such requests. According to Devargas p51 if a first prototype of the proposed application can not be turned around within 10 working days it should usually be rejected as a unsuitable personal computing application development. It should then be considered as a project in its own right by the corporate information systems development department.

3.4 The Help deskThe help desk is of critical importance for the success of any large information system. Karen Schoemehl (Schoemehl K 2000) provides an excellent case study of the development of a large help desk facility over a period of more than ten years starting in 1987. The case study was of the help desk facility for FHP Healthcare in Costa Mesa, California who employs more than 10,000 people and supports approximately 750,000 members.

During the period the help desk facility was transformed several times, the main changes involving:

Specialisation versus generalisation

Centralisation versus de-centralisation

Automation / Monitoring

Communication / feedback

Professionalisation

Specialisation versus generalisation - At the beginning telephone support was a ad hoc unstructured activity which was low key and un-clearly defined. Gradually a generalist role developed which eventually transformed into several specialist roles. The generalist roles were of two types; that of telephone 'analysts' and face to face 'analysts' who visited the departments ('customer support representatives'). The specialists had expert knowledge of a portfolio of software packages. At the last reorganisation the specialists were relocated to the various product departments each of which now has a customer support department.

Centralisation versus de-centralisation - The help desk moved several times within the organisation. At the last reorganisation the aim was to de-centralise with the creation of several informal regional help desks. These in turn are supported by a centralised help desk.

Automation / Monitoring - One of the most important functions of a help desk is to monitor problems. Initially this was carried out manually by a separate 'Help desk quality assurance department' the function is now carried out on line by those who receive the calls although a separate department carry out the analysis.

Recently more pertinent information is being made available to the help desk operators to facilitate problem resolution, in essence a basic decision support system.

Communication / feedback - Two feedback mechanisms were put in place: an annual customer survey and a daily customer feedback program.




Information Centres

The survey was formal and contacted all key customers on all of the systems / software packages used. The results were tabulated and published for both internal personnel and clients. The customer callback program was much more informal, but just as important. By contacting five random customers who had closed calls with the help desk on the previous day, five pertinent questions were asked:

Was the help desk reached in a timely manner?

Was the help analyst courteous and understanding in handling problems or concerns?

Did the help desk analyst provide timely status on the problem as it was resolved?

Was the problem or concern addressed in a timely manner?

Was the level of service received from the help desk satisfactory?

Additionally any ad hoc criticism of the service was reported to the help desk supervisor or customer support services manager who personally followed up the customer.

Schoemehl, 2000 states that the above level of feedback "is essential in determining whether a help desk . . . is successful".

Professionalisation - Round about 1990 the organisation became an active member of the Help Desk Institute "A leading professional organisation for technical customer support professionals" (p354).

The present helpdesk set-up is shown below.

The removal of the specialist knowledge from the help desk facility has meant that two issues need to be addressed:

Help desk location - The main help desk has been relocated in proximity to the computer and network operations departments. This has also been done to facilitate cross training and a potential backup support structure.

Knowledge management - An ongoing analysis and development process of the knowledge requirements and availability to the help desk operators aims to increase the problem resolution rate within the help desk. This is necessary because the resolution rate within the help desk fell from 80% before the removal of the 'specialists' to 50% currently with the increase reliance on external resolving departments.




Information Centres

3.5 The call centre an extension to the help deskDuring the past few years the 'call centre' concept has emerged. This is usually a centralised facility that provides a number of services. To the caller it would appear that they are communicating with a particular company or personal secretary when in reality the operator is providing a number of services and is aware of the callers expectations by a number of clues, usually provided on a computer screen.

In the UK the 'NHS Direct' initiative exists provides health guidance to the general public (http://www.nhsdirect.nhs.uk/ ). Additionally out of hours calls to GPs and dentists are automatically transferred to the service. Other countries have similar services while in the United states a further development, called the 'Integrated Healthcare Call centre' involving doctors, nurses, healthcare and voluntary organisations, along with the Internet to provide a wide range of services for both patients and health care professionals (see Gilman R, 2000 for details).

In many ways this is similar to the arrangement of the present support help desk described by Schoemehl above.

3.6 User forums

Devergas provides a clear description of what user forums are and why they are necessary for the IC. Much of the information below is taken from his book.

User forums should be organised by the Information Centre where its main objective is to bring together users in an environment where they can share their Information Centre products and experiences. Someone may, or example give a presentation or demonstration on the use of various charts produced by a spreadsheet for analysing data they were particularly interested in. Each meeting should have at least one presentation from a user and one from a

member of the Information Centre.

These meetings should not be for programmers or gurus who want to show how to do wonderful things but for ordinary people with a clinical need. A typical agenda is shown opposite:

The user forum should also have representatives on the Information Centre committee. One function of such members is to channel those projects which are considered too big, or


Typical Agenda for a User Forum

Topic Presenter Time

Introduction Anybody 5 mins

Demonstration of Excel to show various admission changes in orthopaedics in the last 3 years (e.g. for fractured femur in the over 80s).

User 1 hour

New features to be aware of in the mail facility

Information Centre member 30 mins

General discussion 30 mins


http://www.nhsdirect.nhs.uk/


Information Centres

inappropriate, for the Information Centre to the corporate information systems development department for assessment. This process is shown here.




Information Centres

4. Functions that are not the responsibility of the Information Centre It is important to realise that the Information Centre is not the only source of IM&T support for the organisation. As mentioned above projects that are unsuitable for the Information Centre are passed to the corporate systems development section. This is just one of several departments that may exist. Each organisation tends to organise their IM&T activities differently. The most traditional approach for a non health organisation is to have a corporate Data Processing Department (DPD) which not only deals with data requests from managers but is often divided into several sections such as accounts, payroll etc. There is often a separate Hardware section (the 'IT' department) dealing with cabling, printers, software and audit (checking machines for illegal software etc.). For simplicity I will refer to these other possible departments within the organisation that deal with Information Management (IM) or information Technology (IT) as the 'main IM&T department'.

The term 'IM&T' stands for "Information Management and Technology". A term used much in the NHS, basically it is the fusion of the data processing (e.g. coding, records management etc) and IT (hardware and software) services. The basic premise being that the two services should be integrated as tightly as possible.

The various writers on Information Centres provide a range of suggestions for exactly what a Information Centre should not be involved in. Devargas lists the following:

1. Developments that are complex

2. Hardware fixes

3. Non-standard 'pirate' software

4. Voluminous data transfers from central machines to PCs

5. Support for non-standard hardware or software

Authors differ as to the degree of involvement the Information Centre should have concerning hardware and / or software issues. Another activity that the Information Centre should not become involved in is that of Outsourcing. This is described below.

4.1 OutsourcingThe trend in modern organisations is to transfer selective services to other companies. The process is known as Outsourcing or Facilities Management (FM).

Deciding which functions to outsource along with selecting the company as well as the necessarily complex contract negotiations requires experts within the 'outsourcing' field to be involved. Furthermore performance monitoring and ongoing contract negotiation presents ongoing resourcing issues.

Laureto-Ward, 2000 provides a good description of the process of Healthcare information services outsourcing. There are numerous outsourcing consultancies such as the outsourcing Institute (http://www.outsourcing.com/ - charge for their materials) and Unisys (http://www.unisys.com/services/outsourcing/insights/white__papers/ do provide free information). At present there seems to be very little empirical / quantitative research investigating the widely alleged benefits of such a strategy.

See also section 6 of "Information Systems Development Methods" at: http://www.robin-beaumont.co.uk/virtualclassroom/chap12/s3/des1.pdf



http://www.robin-beaumont.co.uk/virtualclassroom/chap12/s3/des1.pdf

http://www.unisys.com/services/outsourcing/insights/white__papers/

http://www.outsourcing.com/


Information Centres

5. The Information Centre and the organisationThe information centre can be in one of several positions in the organisation as well as relating differently to other departments. Clearly the position in the organisation is a reflection of, as well as reflected in, the degree of muscle it has or can muster. These issues are discussed below.

Exercise 4Draw a rough diagram showing where you think the Information Centre should sit within a hospital of approximately 500 beds

5.1 Position in organisationThere are numerous possibilities as to where the IC might site in the organisation. Often the actual position is related to how the Information Centre came into being in the particular organisation. Three possibilities are given below.

Within the NHS the most common situation is that represented by '1', that is in the rare instance where a hospital has a Information Centre. In the 1991 NRHA (Northern Regional Health Authority - part of the NHS) survey only two of the hospitals in the Northern region where found to have representatives on the management board that had sole responsibility for IM&T. This situation is in stark contrast to the recommendation of most writers (such as James Martin in his books on Information engineering) on information management who specify that it is essential to have board level representation.

IC within the main IM&T department

In this situation the information centre is controlled by the main IM&T department.

IC separate and member of the management board

The dashed lines represent the possibility that the actual department might be 'virtual' in the sense that the personnel may reside in each of the departments or alternatively people with the required knowledge might belong to a separate IC department.




Information Centres

IC separate, member of the management board with separate sub-departments

Clearly the last situation above is designed for a large organisation where specialist information is required in a number of areas. A very important consideration in the above situation would be maintaining adequate cover for all areas continually. Given the health area it may also be necessary to provide some form of 24hr cover.

5.2 Line of responsibilityWithin most UK hospitals the IM&T interests are represented far down the line of responsibility. They are only represented on the management board very indirectly as a tag on to some other managerial function. Frequently, and inappropriately, directors of finance (DoF) or medical records take on the responsibility. When this happens the IM&T developments, if they exist at all, are frequently 'coloured' inappropriately by the backgrounds of the people concerned. For example directors of medical records often feel a great desire for central control as this is perceived inappropriately as a method of maintaining coding standards. Similarly DoF frequently have little experience of clinical systems and the pivotal role these play in developing an information infrastructure in a hospital.

Within England such a state was encouraged by the national IM&T Strategy which supported the development of a manager rather than clinician led Health service. This was in sharp contrast to the IM&T strategy for the Scottish Health Service which stated in no uncertain terms the pivotal importance of real time clinical systems as the basis for developing hospital information systems (Knox 1997). The audit commissions 1996 report on hospital IM&T also stressed the unsuitability of DoF being in charge of IM&T:

"It is vital to ensure that such a department [IM&T departments] has equally strong links and accountability to clinical as to financial and administrative departments.(p44)…..Evaluation of the service given by departments and their 'help desks' should be undertaken regularly through user surveys. (p45)….. In practice few of the staff of these specialist departments have any direct experience of clinical care. Indeed, the IM&T departments are very frequently found to be tired to finance and administration rather than clinical services: this was true of 45% of the main study sites. Such a situation usually occurs because computers were originally applied to financial management of the hospital. This often makes then difficult to make rapport with clinical staff and to provide them with operational advice and support. Needs for financial information tends to be given priority over clinical needs, if only because the technical staff can better understand the issues and solutions and can therefore be positively supportive of proposals." [audit commission 1995]

In 1998 a new Information strategy for the NHS was developed (NHS E 1998) being basically a U-turn and adopting much from the Scottish strategy.

In the In the mid 1990's NHS TD (which was part of the then NHS Information Authority) assessed the need for, and functions of, what they called 'Resource centres'. These were basically functionally cut down Information Centres. For further information showing how such a centre run at Whipp's Cross Hospital's medical centre in the UK see Sotheran & Millen 1997. It would be very interesting to know what has happened to this in 2008?




Information Centres

5.3 Inappropriately rigid division into IT and Information managementTraditionally in NHS hospitals, there has been a firm division between the information and 'technology' departments. Historically this was due to information being considered to be synonymous with medical records along with the PAS (Patient Administration System) and 'technology' being the computer system to support the PAS. Such a rigid division has been shown to result in problems once the organisational structure changes to that of a more matrix style. Consider a situation where a person provides both functions at a local level (i.e. within one clinical specialty). The LAN manager manages the local network and also provides local user application support. Such applications are developed within the constraints of the hardware on the LAN. The LAN manager also has in depth knowledge of the local data dictionary preventing possible duplication.

Clearly at the corporate level there is a need for individual hardware and information management experts but these people must work very closely having daily contact with each other. In addition it is essential to have a person who is overall in charge of both the IT and information departments.

The actual structure of the Information Centre will now be discussed.

6. Structure of Information CentresThe structure of the information centre is obviously dependent upon a number of factors, the size of the organisation the number of staff, staff turn over rates and the level of computer use to mention a few. Thierauf 1988 provides three possible scenarios for small, medium and large information centres.

Small IC - Thierauf

He recommends that the small Information Centre should consist of four members of staff; a Information Centre manager, secretary, and two analysts end user application developers.

Medium IC - Thierauf

It should be noted that the structure in the first diagram was developed before LANs (Local area networks) became common place, with the associated need for local network managers. Therefore I have updated the original somewhat. The second diagram is based on Devargas 1989 (p113) who suggests a simpler structure with details of specific tasks for each of the team. I have adapted the original to take into account health service needs.

Large IC - Thierauf

In addition to the personnel indicated in the diagram there would probably be a communications department with responsibility for developing Newsletters, scheduling training sessions and developing teaching material in various formats




Information Centres

Based centrally or within specialties acting as first pointof contact along with individual network managers?

IC manager

Analysts X 2

Possible structure of an Information Centre (IC)

1. Medium sized Information Centre

Applicationdevelopers X 2

Hardwarespecialist

Software specialist + trainer

2. Large sized information centre

Consultants

Consultingmanager

Hardwarespecialist

IC manager

Secretary

Secretaries

Analystsmanager

Applicationdevelopersmanager

Trainingmanager

Softwarespecialist

Analysts Applicationdevelopers Trainers

Staffing level. Possiblyone of the four for each

50 users?

IIC manager

Activities: Management of personnel Planning and budgeting IC activities Investing & proposing in future IC activities Interface between main IM&T department and user management Monitoring performance of IC & its products Making periodic reports to the management board Meeting regularly with DP management to co-ordinate interface Hiring and supervising training of IC staff Maintaining security procedures

IIC Secretary / Administrator

Activities: Secretarial & administrative tasks Maintaining documentation Maintaining accounting procedures (for costing to departments) Handling User administrative requests (requisitions, passwords etc.) Issuing schedules of training, seminars and user groups Maintaining a library of training material

IIC analyst / consultant(s)

Activities: Product support (each consultant must specialise in one) Specialty support (each consultant must specialise in one) Assist in the selection and promotion of new IC services/products Evaluate new products Develop detailed implementation plans for new products Surveying user areas to identify potential needs Working with users to develop IC - user plans Obtaining and distributing corporate data definitions to users Develop methods for downloading / uploading data Instructing user on how to solve there business problems Assist user on hardware, software & information planning Act as a interface between the main IM&T department and the users Develop IC training materials, self study materials etc. Prepare user and technical manuals Help users identify potential areas where personal computing would be

productive Developing IC newsletters Help the help desk when required Creating and maintaining back-up and recovery procedures Keeping the users informed of what corporate information is available to

them and in what form

Help desk

Activities:Assisting user on hardware & software problemsMust be:

Good communicator diplomatic Patient

Must have: knowledge of business, products and

information management including coding ability to do multiple jobs ability to organise

Activities of those in a IC. Based on Devargas 1989 p.113




Information Centres

Devargas 1989 – IC Activites

Devargas 1989 (p113) suggests a simpler structure for the IC with details of specific tasks for each of the team which I have adapted to take into account health service needs

In this instance the IC consists of the following:

Manager Secretary / administrator Analysts / consultants Help Desk

Details of the activites of each of the above:

Manager Activities:

1. · Management of personnel 2. · Planning and budgeting IC activities 3. · Investing & proposing in future IC activities 4. · Interface between main IM&T department and user management 5. · Monitoring performance of IC & its products 6. · Making periodic reports to the management board 7. · Meeting regularly with DP management to co-ordinate interface 8. · Hiring and supervising training of IC staff 9. · Maintaining security procedures

Secretary / administrator Activities:

1. · Secretarial & administrative tasks 2. · Maintaining documentation 3. · Maintaining accounting procedures (for costing to departments) 4. · Handling User administrative requests (requisitions, passwords etc.) 5. · Issuing schedules of training, seminars and user groups 6. · Maintaining a library of training material

Analysts / consultants· Activities:1. · Product support (each consultant must specialise in one) 2. · Specialty support (each consultant must specialise in one) 3. · Assist in the selection and promotion of new IC services/products 4. · Evaluate new products 5. · Develop detailed implementation plans for new products 6. · Surveying user areas to identify potential needs 7. · Working with users to develop IC - user plans 8. · Obtaining and distributing corporate data definitions to users 9. · Develop methods for downloading / uploading data 10. · Instructing user on how to solve there business problems 11. · Assist user on hardware, software & information planning 12. · Act as a interface between the main IM&T department and the users 13. · Develop IC training materials, self study materials etc. 14. · Prepare user and technical manuals 15. · Help users identify potential areas where personal computing would be productive 16. · Developing IC newsletters 17. · Help the help desk when required 18. · Creating and maintaining back-up and recovery procedures 19. · Keeping the users informed of what corporate information is available to them and in what form

Help Desk ActivitiesAssisting user on hardware & software problems. Must be:

o · Good communicator o · diplomatic o · Patient

Must have:

o · knowledge of business, products and information management including coding o · ability to do multiple jobs o · ability to organise




Information Centres

Many concerned with hospital IM&T departments would react with disbelief to the resource implications suggested in the above diagrams. Such people would say it was either not desirable or financially possible. To assess the truth of this statement it is necessary to consider the observed and required staffing levels which is the subject of the next section.

6.1 Educational issuesWhen an Information Centre is initially set up possibly the most important activity undertaken by it is that of assessing the needs of potential users and designing suitable training. The 1995 audit commission report on IM&T in NHS hospitals has some interesting things to say about training:

"Budgets for information and systems generally make insufficient allowance for training. Hospitals should plan to invest a significant amount (some have advocated 30%) of the costs of any development in education and training of staff. Training should be:

Job-related - in order to motivate staff the use of the systems must be seen to result in immediate benefits to there work;

flexible - where necessary, individual tutoring may be required; individuals will learn at different rates and some may wish to learn the system in their own time;

progressive - to allow staff to develop their use of the system;

ongoing - to permit new staff to acquire the necessary knowledge, understanding and skills;

pro-active - searching out those with problems to offer guidance;

non-threatening - showing sensitivity about mixing different staff, in case some feel vulnerable when being trained alongside colleagues;

effective - carried out in an appropriate place, preferably away from the work environment to avoid distractions and interruptions; and

evaluated - to determine the effectiveness and acceptability and to change the emphasis and approach as necessary." (p.46 -47)

6.2 Staffing levelsThe Findings

The 1995 audit commission report provides details for the number of IT and Information management personnel in a selection of hospitals. The results are given below. It is interesting to note the number of sites that stated they had no IT staff against the five that had 25 or more. It would have been interesting to have the raw data to find if there was any correlation between IT and IM staff. Eyeballing the data the average number of IT staff would appear to be around 8 (excluding the outliers on either side?) and possibly 5 for the number of information staff.

It should be noted that the vast majority of so called IM staff will be medical records, Coding or contract monitoring personnel rather than those dealing directly with clinical information in a real time environment.




Information Centres

IT and Information management staff in hospital IM&T departments (Audit commission 1995)

25 20 15 10 5 0 5 10 15 20 25

0

5

10

15

20

25 or more

IM staffIT staff

n=151n=160

The question as to how do the above figures reflect actual user support? requires one to look again at the audit commissions report

"…the ratio of specialist staff to users ranged from 1 to 80 up to 1 to 300 in sites visited in this study. In any case, staff often prefer to turn to those who work with them as their first point of contact for help, rather than to a computer help desk.

Support is customarily separated into first (general knowledge, such as how to switch on etc.) and second level. …… First level support operations .. should be delegated to staff who are experiences and have been provided with additional education and training to be able to deal with most routine problems. These 'computer first aid' staff should be distributed throughout the hospital, in easy reach to all users, with job descriptions that recognise this activity and with rates of pay that recognise the added skills involved." (p48).

From the above figures it appears that no hospital manages to attain the 1:50 ratio suggested by Perry as an adequate level of support.

Requirements of a District General Hospital (DGH)

Perry, 1987 suggests that core staffing should consist of one per fifty end users supported. The person should be graded as a senior systems analyst. In addition there should be clerical and data processing (query and report generation) support. This is the requirement for a small Information Centre. The question is "is this suitable for a typical DGH (District General Hospital) with approximately 500 beds?"

A typical DGH most likely consists of:

1. General Medicine2. General Surgery3. Day surgery unit4. ITU5. Theatres and anaesthesia6. Maternity7. SCABU8. Two minor specialties9. Outpatients




Information Centres

10. Pathology11. Biochemistry12. Admissions13. Mortuary

We therefore have 13 operational areas with very different tasks. And unfortunately every one of these and their sub departments may wish to develop user applications. Luckily several of these may possess some type of LAN with a manager, biochemistry and theatres almost certainly will have such an arrangement. The LAN managers can then hopefully be press ganged into serving a Information Centre function part of their time. We will assume that there are three such people and consider then equivalent to 1.5 full time Information Centre consultancy staff

We will also assume that we have particularly competent Information Centre consultancy staff all who have expertise in two of the above areas. Therefore we would need at least 7 Information Centre consultancy staff in addition to possibly another 8 others identified from the diagrams above. It is important to realise that Information Centre staff will also require regular training to perform adequately. It is important to note that these staff will need more time than most given that software packages are upgraded, on average, twice a year and each person may have a portfolio of up to half a dozen packages, constant updating of NHS IM&T issues such as coding will also require regular training.

It would therefore appear that most hospitals have a long way to go before offering the support the staff need.

Besides the lack of an adequate Information Centre infrastructure another important deficit at present is the problem of convincing some clinical managers to release staff to attend training sessions and getting them to acknowledge the fact that staff time needs to be set aside for ongoing computer skills training and information management tasks.

6.3 Information Centres in other HealthCare organisationsWhile the focus has been on the typical hospital setup in this section it is important to consider the requirements of other healthcare organisations.

GPs - These tend to designate a individual who is particularly interested in IT. They gain help also from the systems supplier by way of Help desk - telephone support, Web sites, e-mail and ongoing training. Occasionally a person may be employed across several practices to provide support. Some suppliers actively encourage 'user groups' to support best practice.

Community based Nurses - This is less organised. The main source of support being through the systems supplier help desk.




Information Centres

6.4 Training the TrainersVarious commentators have suggested that the only possible way to solve the massive IM&T training requirements of the NHS which are currently not being met is to set up a system whereby the main effort is aimed at producing a group of trainers (I prefer the work educators) who will subsequently go out and inform the masses. While this technique sounds very sensible, in reality it does present problems.

The main problem with this suggestion are that some people who undergo an educational programme in IM&T soon realise how little they know and often in post course evaluations state that they have anxieties about unrealistic expectations being placed upon them afterwards (Beaumont R 1997).

6.5 Good practice To end this section on a happier note an example is given where efforts are being made to meet the training need. The audit commission report describes a situation in Burton on Trent NHS trust:

"When the hospital was introducing a hospital-wide system it made a commitment to extensive investment in training, backed by resources. This entailed not only initial training but also follow-up training and pro-active support for users from a variety of sources.

Core trainers within each ward and department were nominated for each of the system modules. These were trained on each of the modules and then returned to the workplace to train their colleagues.

They provided support on the wards and in departments, helping, advising and reassuring there colleagues.

Time was taken to understand and sort out individual problems.

Staff were taken away from there work environment to train.

Training manuals and guidance for specific tasks were developed.

(p.48)"




Information Centres

7. The NHS information CentreThe NHS Information Centre for Health and Social Care (http://www.ic.nhs.uk ) Is not a 'information centre' as the concept has been discussed in this document what is does is provide basic audits of various aspects of the NHS but is really far less useful than the NHS HES site for clinical information.

Two areas which they are developing are Casemix and the Quality and Outcomes Framework.


Quality and Outcomes FrameworkWhat is QOF?

The Quality and Outcomes Framework (QOF) is a voluntary annual reward and incentive programme for all GP surgeries in England, detailing practice achievement results. It is not about performance management but resourcing and then rewarding good practice. The QOF contains four main components, known as domains. Each domain consists of a set of measures of achievement, known as indicators, against which practices score points according to their level of achievement:

1. clinical domain: this domain consists of 80 indicators across 19 clinical areas (e.g. coronary heart disease, heart failure, hypertension)

2. organisational domain: this domain consists of 43 indicators across five organisational areas - records and information; information for patients; education and training; practice management and medicines management

3. patient care experience domain: this domain consists of four indicators that relate to length of consultations and to patient surveys

4. additional services domain: this domain consists of eight indicators across four service areas which include cervical screening, child health surveillance, maternity services and contraceptive services.

Why do we have QOF?

QOF was introduced as part of the new General Medical Services (GMS) contract on 1 April 2004. Participation rates are very high, with most Personal Medical Services (PMS) practices also taking part. Practices score points on the basis of achievement against each indicator, up to a maximum of 1,000 points. How is QOF 2006/07 measured?

QOF is measured by QMAS, a national IT system developed by NHS Connecting for Health (CfH). QMAS ensures consistency in the calculation of quality achievement and disease prevalence, and is linked to payment systems. It is not a comprehensive source of data on quality of care in general practice, but it is potentially a rich and valuable source of such information, providing the limitations of the data are acknowledged. The Prescribing Support Unit (PSU), part of The Information Centre, works on behalf of the Department of Health and in collaboration with CfH to obtain extracts from QMAS to support the publication of QOF information. Further details on how QOF is measured (e.g. QMAS system; practice list size, patient exceptions etc) can be found in the QOF 2006/07 bulletin. Where do I view the QOF 2006/07 results?

QOF 2006/07 online database Browse the online database to find the results for your local surgery. QOF 2006/07 bulletin Read the summary report which includes explanations and key findings. QOF 2006/07 data tables From: http://www.qof.ic.nhs.uk/ accessed 14/01/2008


http://www.qof.ic.nhs.uk/

http://www.ic.nhs.uk/default.asp?sID=1189009323642

http://www.ic.nhs.uk/default.asp?sID=1188384143642

http://www.qof.ic.nhs.uk/

http://www.ic.nhs.uk/


Information Centres

8. Information / Clinical GoverenceIn recent years the development of additional roles such as that of Information Goverence and Clinical Goverence has changed the structure of the traditional IT / information divide in the UK healthcare system, we now have something approaching the following:

Whether this is an improvement or yet another layer of bureaucracy is still to be evaluated. One compromise is to subsume the Goverence role within either, or both, of the traditional roles. In fact there is now possibilities that IT professionals, as part of their undergraduate education, will be exposed to Goverence issues.

An alternative:

9. SummaryThis section has described the basic ideas behind the Information Centre concept including its history suggesting reasons why it came into existence. The structure and functions of a typical Information Centre where described along with how this might be transferred into the NHS hospital environment. Particular emphasis was placed on user support and training, along with the importance of 'training the trainers' and ended with a brief description of a hospital where something is actually happening. Finally a brief introduction to the NHS 'Information Centre' was provided and the concept of Information/clinical goverence.

10.ReferencesAudit Commission 1995 For your information: A study of information management and systems in the acute hospital. HMSO London. ISBN 0 11 886416 5

Beaumont R 1997 Introduction to Health Informatics for Specialist Registrars: Newcastle Site Evaluation report & Recommendations available online at: www.robinbt2.free-online.co.uk\virtualclassroom\chap21\s2\sprfrep.pdf

Boisot Max 1994 Information and Organisations: The manager as anthropologist. Collins Harper London.


IT InformationGoverenc

e

IT Information

Goverence

Goverence



Information Centres

Christoff A Kurt 1990 Managing the Information Center. Scott, Foreman/Little Brown higher education London.

Devargas Mario 1989 Introducing the information centre. NCC Blackwell Manchester.

Gilman 2000 The anatomy of a call centre. in Davidson P L (ed.) 2000 Healthcare Information Systems. Auerbach Publications Florida. pp. 337-348

King W R Grover V Hufnagel E H 1989 Using Information and Information technology for sustainable competitive advantage: Some Empirical Evidence. Information and Managament 17 (2) 87 - 93

Knox Charlie 1997 IM&T strategy in the Scottish Health Service. British journal of health care computing & information management [February] 14 (1) 27 - 29

Laureto-Ward R A 2000 Healthcare Information Services Outsourcing. in Davidson P L (ed.) 2000 Healthcare Information Systems. Auerbach Publications Florida. pp. 413-438

Morton Scott (ed.) 1991 The corporation of the 1990s: information technology and organisational transformation. Oxford University Press ISBN 0 19 506358 9

NHS E 1998 Information for Health: An information Strategy for the Modern NHS 1998 - 2005 http://www.doh.gov.uk/nhsexipu/strategy/

Perry E William 1987 The Information Centre. Prentice Hall.

Schoemehl Karen A 2000 Developing and redeveloping the help desk: A case study. in Davidson P L (ed.) 2000 Healthcare Information Systems. Auerbach Publications Florida. pp. 349-357

Sotheran Martin, Millen Di 1996 Resource centres for IM&T learning: enabling people flexibly. British journal of health care computing & information management [December] 13 (10) 16 - 18

Symons Veronica Jean 1990 Evaluation of information systems: Multiple perspectives. Phd Thesis St. Edmonds College University of Cambridge UK

Thierauf J Robert 1988 Effective Information Centres: Guidelines for MIS and IC managers. Quorum books London.



http://www.doh.gov.uk/nhsexipu/strategy/


Information Centres

11. Optional additional exercise1. Set up a discussion board/ forum thread about "Information management & IT support at work" to discover:

What type of support is offered to other students at work What they may have found useful or not so! What people found difficult to understand in this section What was missing

If anyone has been involved in setting up an information centre

2. Ask a member of your IT or information support centre to look through the material presented here, if possible copy this document electronically place it on a local intranet or link to it at: http://www.robin-beaumont.co.uk/virtualclassroom/chap4/soc4/ic1.pdf .

12. MCQsThe following Multiple Choice Questions (MCQs) have been designed to see if you have read through the material carefully. Unless otherwise stated there is one correct response for each question.

1 Which of the following represents the overriding aims of the Information centre (IC): User empowerment, Cost effectiveness, Standards setting

a. User empowerment, communicator, problem solverb. User empowerment, pro-activity, problem solverc. User empowerment, pro-activity, communicatord. User empowerment, Cost effectiveness, problem solver

2. Who first described the 'modern data processing dilemma': Proust

a. Proutb. Perryc. Perried. Percy Whitlock

3. Which five problems from the following list produced the 'modern data processing dilemma':

a. Development of the main frame computerb. Data sabotagec. The size of the Internetd. Reduction in data qualitye. Development of desk top computersf. Development of Psion organisersg. Rarity of programmers / data analystsh. Development of complex statistical softwarei. Conceptual shift in the perceived value of dataj. Uptake of total quality managementk. Backlog of data processingl. Development of electronic monitoring devices

4. Which of the following definitions, do you think, best describes the term 'matrix organisational structure'?

a. A network of departments that share resources.b. A network of departments with a common aim.c. A hierarchy with specific functionsd. A network of departments with no clear aime. A network of departments that share core information



http://www.robin-beaumont.co.uk/virtualclassroom/chap4/soc4/ic1.pdf


Information Centres

5. The concept that 'information is power' could be said to be (more than one may be correct):

a. A dangerous policy to adoptb. A organisationally dependent conceptc. An over enthusiastic management claim of the 1980'sd. A concept that has been modified in the last few yearse. A necessary principal to adopt in modern clinical practicef. A principal that is becoming increasingly important in health care management in the UK

6. Perry suggests that three approaches have been taken to attempt to solve the modern data processing dilemma. They are:

a. Train users, Maintain central dominance, Develop a ICb. Hands off, Maintain central dominance, Develop a ICc. Hands off, Maintain central dominance, Develop a DPDd. Hands off, Develop a IC, Produce a Information strategye. Hands off, Develop a IC, Develop links with other organisations

7. According to Devargas which of the following are functions of an IC (more than one is correct):

a. Large systems developmentb. Drive Corporate Information / IT Strategy developmentc. Facilitate access to corporate information d. Manage small scale 'individual' /personal systems developmente. Assist Corporate Information / IT Strategy developmentf. Maintain a help deskg. Communicate with end -usersh. via newsletter etc. Provide Training

8. When assessing the suitability of a prospective new user to be involved in a system development you should access, amongst other things, their (more than one is correct):

a. Position in the organisationb. Willingness to undergo trainingc. Length of time in postd. Computer anxiety scoree. Awareness of amount of effort involvedf. Knowledge of Unixg. Availability of resourcesh. Age of personi. Sex of personj. Understanding of coding issuesk. Understanding of security issues

9. Access to corporate information should be facilitated by the IC by promoting: a. Awareness raising of data available and possible formats, along with training and support for complex analyses.b. Publishing a data dictionary, along with training and support for complex analyses.c. Awareness raising of data available and possible formats, along with request pro-formas and support for complex

analyses.d. Training would not be provided. Publishing a data dictionary, along with request pro formas and support for complex

analyses.e. Publication of previous analyses, along with training and support for complex analyses.

10. For a small scale 'personal' system development what are the appropriate level of skill requirements for someone who wishes to become involved:

a. Creating data dictionaries and drawing a possible screen layoutb. Object modelling and Entity Relationship modellingc. Creating data dictionaries and story-boards d. Creating data dictionaries and being able to use Accesse. Being able to use Access and story-boards




Information Centres

11. Assuming that the department mentioned below has a poor level of IT and Information management knowledge, which one of the following projects is suitable for the IC to take on board with them?:

a. The development of a clinical information system for a Rheumatology outpatient departmentb. The enhancement of a Rheumatology outpatient department information system to create a couple of audit reportsc. The enhancement of a Rheumatology outpatient department information system to capture data from a new

measuring deviced. The enhancement of a Rheumatology outpatient department information system to allow real time integration with

the Biochemistry and Histology departments along with transfer of appropriate data to the local Electronic Patient Record

e. The enhancement of a Rheumatology outpatient department information system to create a interactive ad hoc report generator

12. Which of the following does Schoemehl, 2000 think is essential in determining whether a help desk is successful? a. Adequate resourcingb. Occasional customer feedbackc. Possession of a mission statementd. Regular and ad hoc 'critical incident feed backe. The use of focus groups

13. A call centre tends to be . . .

a. A centralised service operating for one organisationb. A organisation that provides a number of services via telephonistsc. A number of people working from home providing ad hoc servicesd. A centralised service that directs people to a number of specialist services e. A number of people working from a centralised resource each offering a number of services each of which the caller

believes to be dedicated to them

14. The main objective of the user forum is to: a. Disseminate IC policyb. Market the ICc. Evaluate past projectsd. Get users to share their Information Centre experiencese. Get users to present their requirements

15. Which of the following is not a function of a IC according to Devargas: a. Developments that can be prototyped within 1 weekb. Mending a Printerc. Basic training on a word processord. Setting up a newslettere. Running User forums

16. Which of the following definitions best describes Outsourcing?

a. The distribution of functions across several departmentsb. The transferral of one or more functions to an outside companyc. The buying in of a specialist function that the company's unable to provided. The selling off of one or more functions to an outside companye. The transferral of one or more employees to an outside company to gain experience

17. Concerning IC (and / or IM&T) representation in a typical Hospital, where is this best placed in the organisation?a. Responsible to the Director of Financeb. Responsible to the Chief Executivec. Responsible to the management boardd. Responsible to no onee. Responsible to the Director of Clinical Services




Information Centres

18. Within a IC Devargas defines several roles, what are they? a. Financial Manager, Administrator, Analyst, Help deskb. Manager, Secretary, Analyst, Help deskc. Manager, Secretary, IT expert, Help deskd. Manager, Administrator, Database expert, Help deske. Manager, Secretary, Analyst, Coding expert, Help desk

19. What percentage of a system development cost do the Audit Commission suggest might be sensible to allocate for education and training of staff:

a. >30%b. <30%c. 20%d. <5%e. 5%

20. The Audit Commission provides a list of what they consider the necessary characteristics of good training. Which of the following list gives them?

a. efficient, pro-active, job-related, evaluated, flexible, progressive, ongoing, non-threateningb. effective, pro-active, job-related, evaluated, flexible, progressive, ongoing, non-threateningc. affortable, pro-active, job-related, evaluated, flexible, progressive, ongoing, non-threateningd. effective, pro-active, job-related, evaluated, flexible, progressive, ongoing, monitorede. effective, pro-active, job-related, evaluated, generic, progressive, ongoing, non-threatening

21. Which of the following is considered to be true in the section?a. A significant proportion of hospitals in the UK have adequate IM&T support staffb. A significant proportion of hospitals in the UK have adequate IT support staffc. A significant proportion of hospitals in the UK do not have adequate IM&T support staffd. A significant proportion of hospitals in the UK do not have adequate IT support staffe. A significant proportion of hospitals in the UK have inadequately qualified IM&T support staff

22. The section made use extensively of various writers on IC's. Who were they? a. Devargasb. Devargas, Perry, Thieraufc. Devargas, The audit commissiond. Devargos, Boisote. Devargas, King & Grover et al ………………………………

………End of questions.

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The Information Centre & end user support€¦ · Web view3.5 The call centre an extension to the help desk 10. 3.6 User forums 10. 4. Functions that are not the responsibility