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Archive for the 'Health Care' Category

Symposium on Using Information in Management Decision-Making

rmhipmt16 August 2011

On the 15th September UCL is hosting a symposium to explore how healthcare managers can make better use of information. We have confirmed presentations from Professor Sir Brian Jarman, Professor Terry Young, Dr James Mountford and other high profile thinkers and leaders from industry and the NHS as well as leading academics in informatics and related fields.

The audience will contain managers, including clinical leaders, from across the NHS. The day will provide an opportunity to explore techniques and approaches to understanding and analysing information, to understand where specialist skills and training are required and to discuss what managers need to know in order to really understand what information means.

The day will be entertaining and instructive and is part of an on-going project at UCL to connect the work of Health Informatics specialists with the needs of NHS leaders and decision-makers.

To register for the event go to http://informationinhealthcare.eventbrite.com.  Places are limited and will be made available at £50 each on a first come, first served basis.

Draft Programme

9:00 am     Registration and Welcome

9:30 am     Healthcare Information – the Management Challenge Prof. Terry Young, Brunel University

10:00 am   Cancer Decision Making: Turning Data into Intelligence Claire Housden, Strategic Funding Manager, Roche Products Ltd

10:30 am   Demand Forecasting and Capacity Planning Prof. Martin Utley, UCL

11:00 am   Coffee

11:30 am   tbc Dr Henry Potts, UCL

12:00 pm   A hospital is a collection of people not buildings’ – a Marketing Response to the new Commissioning Landscape Dr Marc Farr, East Kent Hospitals University NHS Trust

12:30 pm   Lunch

1:30 pm     Management Information – Health Informatics Last Opportunity Simon Mortimore, UCLH NHS Trust

2:00 pm     Using Information to Drive Outcomes for Patients and Populations Dr James Mountford and Tony Lezard, UCL Partners

2:30 pm     Tea

3:00 pm     Hospital mortality outcome measures and aspects of their implementation Prof. Sir Brian Jarman, Imperial College

4:00 pm     Closing Remarks Dr Paul Taylor, UCL

4:30 pm     Close






CHIME in the news

Henry W W Potts10 March 2011

Carl and Jeremy’s paper on open source approaches in health was covered by TechEye and some other blogs.

Our BMJ paper on the ethnic attainment gap in academic performance in medicine attracted a certain amount of coverage, with the story being covered by the Press Association and GP.

And a talk of mine on the adoption of m-health at Health Innovation Expo 2011 resulted in this GP article. Based on some research using the North Central London Anticaogulation and Stroke Prevention Service as a case study, we had concluded that PCTs lacked the necessary skills to make the best judgments when it came to technology adoption. In questions after the talk, I was developing an argument that smaller GP consortia will be even more poorly placed in this regard.

Papers accepted: how staff turnover affects patients and more

Henry W W Potts5 January 2010

I had two papers accepted at the end of last year. Williams & Potts, “Group membership and staff turnover affect outcomes in group CBT for persistent pain” has been accepted by Pain. This is a retrospective analysis of service data with the intriguing finding that higher rates of staff turnover were associated with poorer patient outcomes. The first author is Dr Amanda Williams in the Dept. of Clinical, Educational and Health Psychology at UCL.

Colligan, Anderson, Potts & Berman, “Does the process map influence the outcome of quality improvement work? A comparison of a sequential flow diagrams and a hierarchical task analysis diagram” has been accepted by BMC Health Services Research and is now available online in provisional form. This study found that the style of process map used to describe a clinical task had a significant effect on what risks in the task individuals identified. First author Dr Lacey Colligan is now at the University of Virginia, but previously did her MSc with us at CHIME.


Why patient access to EHR is a must.

rmjlsea5 August 2009

We spend a fair amount of time talking about the things we can do if we had proper EHR. I just found out that sometimes you discover use cases not only by imagining what would be better, but also experiencing what has gone bad. It is bitter, but it is still useful.

I have arrived Turkey less than a week ago, and I am here for family related things. When I was here two months ago, my mother was trying to get better after her meniscus surgery for her left knee. That was a surgery he failed to  mention to me, just like my father failed to mention his eye surgery. My parents, being classical parents, still try to keep me away from anything that may worry me. Since I’m in London, they assume that I’ll worry too much for their problems, since I can’t help them from abroad. Well, it is true that I’ll worry, but it is not true that I can’t help. I could have helped if I had access to their medical data as their son, since one can do a lot today, armed with Internet access. Even knowing their exact problems recorded by their doctors would help, instead of trying to pull out the words from my parents’ mouth who barely say more than “it is no big deal actually”.

I could have avoided the situation I’ve faced a couple of days ago also. Here is what happens when you don’t have access to your medical data as a patient.

When I arrived here last week I did not find my mother in a better position. Her knee was not that better than the last time, in fact she was almost the same she was just after the surgery, and that was actually worse than she was before the surgery.  In two months she was supposed to get better, she was not supposed to have knee pain, and yet she was in front of me with her right knee making her limp. I asked her why she has not gotten better, and what I heard made me frustrated and angry. Later when I calmed down and asked the details, I came to realize that what happened to my mother is a perfect example of information being handled improperly, which in my opinion has led to malpractice. (Please drop me a line if you don’t agree, after reading the rest of it). So what happened to my mother?

She visited a surgeon a couple times for her problem. He was highly recommended, and he approached my mother’s case with care. He told my mother that most doctors would recommend that she had an implant placed in her knee. Her knee had multiple problems, meniscus being one of them. There were cysts in her knee, and some cartilage and fractured pieces that needed cleaning. He told my mother that he would perform a surgery that would give her maybe another four or five years before an implant, and my mother preferred this option, which was percieved as an offer from an experienced surgeon, who was regarded by many others as a man who could do what he said. My mother paid him for her multiple appointments before the surgery, and for two others after the surgery. The only minor problem that was discovered later was that, he never performed the surgery!

He says that he is suffering from thalassemia, also known as mediterranean anemia, and he got high fever at the night just before the surgery. So he made a phone call to a colleguage of his from the same hospital, telling him to do the surgery. Instead of telling this to his patient, he notified a relative of my mother, who is also working in the same hospital as a doctor, two days after the surgery. Being shocked, my mother’s relative was trying to come up with the right words to explain the situation to my mother, who were paying for new appointments to her doctor after the surgery. Finally when the situation was explained to her, she checked the papers given to her after her discharge, and things got even better at that point. The colleguage who was called at the last minute also lied to his friend, my mother’s doctor, and he did not perform the surgery even. Two names were on the paper, saying those two doctors performed the surgery. My mother had an ultrasound, since she did not have the slightest trust for no one in this anymore, and it was understood that some of the things written down as performed, were not performed.

The least I can call this situation is mess.  Having this situation at hand, I could not help thinking about what would happen if I had access to my mother’s medical data. I could have seen her doctor for the surgery being changed from a to b, for from b to c1, c2. These doctors who simply referred my mother to other doctors in just a couple of hours would at least have access to her data from her previous appointments. (Still this does not mean they would care, looking at what they have done). I could stop this from happening. I could check out a web based system all the time to follow her treatment. That would make me feel much better as opposed to what my mother believes. Assuming people in the hospital kept records right, I could simply ring my brother and ask why the name for the scheduled surgery was changed.  This did not require a huge technological infrastructure, just a capable EHR sytem in a hospital linked to a patient portal would be enough. No connectivity, no semantic interoperability, just an EHR system which would have made this type of applications easy to develop.

All these woulds or coulds do not mean anything now of course. My mother is waiting for my wedding to be over, to have a second operation for an implant, and who knows what kind of other similar situations are out there just as I write this.  I am really sorry for having a real life example about the importance of patient access to EHR, based on my own family, but there is a lesson we need to learn here. Patients should have access to simple, but critical information about themselves all the time. If something about their care fails, they should be given the option to catch it. I really would not like other people to see the importance of this in the way I did,  but until we fix these problems, these situations won’t go away easily.

On having a therapeutic relationship with your PC

rmhipmt1 July 2009

My kids can expend a fair amount of energy waving Wii handsets around. I have a colleague whose hi-spec laptop could be used for weight training. But, by and large, computers don’t help you exercise. Interesting, then, to learn about this project in which school children were given pedometers and encouraged to record the amount they walked on a website. Different classes in the school then competed to see which would first complete a virtual journey. At the same time the website allowed them to monitor their eating and advised them on healthy living.

These kinds of applications are sometimes called ehealth interventions. We used to talk about something called telemedicine, in which some form of telecommunications technology connected patients with doctors. The problem with that was that the difficulty in healthcare isn’t, for most of us in the West, that the doctor is too far away, it’s that he or she is too busy. Giving patients another way to get at the doctor doesn’t help with that problem. So people started to think about telemedicine as a way of connecting patients with some kind of service that might replace a doctor. NHS Direct is a scheme of this kind. But the assumption was that the transaction would be little more than an exchange of information. Patient sends data up the way, service provider sends advice down the way.

What is interesting about the way ehealth is developing, is that we are seeing applications where the ‘magic ingredient’ in the intervention isn’t advice. In one application patients use mobile phones to send blood glucose measurements to a company. The company then supplies them with feedback based on their measurements. This helps them in their self-management. There are also applications on computers that deal with depression, drinking problems and such conditions. A recent meta-analysis found the web or computer-based tools were effective in smoking cessation.

The interesting idea here is that we can consider ehealth applications where patients aren’t consulting a physician or looking up information, or necessarily receiving any kind of conventional healthcare advice. These applications work because they engage the user in a process which helps them learn to change their behaviour. It’s a kind of therapeutic relationship. But with a PC.