A vision for the UCL School of Life and Medical Sciences

By Anthony J Peacock, on 4 February 2010

Professor Sir John Tooke, talks about his vision for the UCL School of Life and Medical Sciences.

[youtube=http://www.youtube.com/watch?v=si1_O6sL_N4]

Professor Sir John Tooke, Vice-Provost (Health), Head
of UCL School of Life & Medical Sciences and Head of UCL Medical School

CHIME in UCL Eprints chart (December 2009)

By Henry W W Potts, on 15 January 2010

The December 2009 top downloads from UCL Eprints is now available: the review on electronic patient records co-written by Henry Potts and Pippa Bark with Trish Greenhalgh et al. in Milbank Quarterly is at #13 with 108 downloads, while Bate & Robert (2002, in Public Administration) is at #19 with 76.

For the fourth quarter of 2009, Bate & Robert (2002) is at #14, while Kalra (2006, in IMIA Yearbook of Medical Informatics) is at #26. And for the year 2009 in total, it’s Kalra (2006) at #16, Bate & Robert (2002) at #18 and Potts (2005) at #31.

Papers accepted: how staff turnover affects patients and more

By Henry W W Potts, on 5 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.

Henry

Electronic patient records are not a panacea

By Henry W W Potts, on 22 December 2009

Large-scale electronic patient record (EPR) programmes promise much but sometimes deliver little, according to a new study by UCL researchers including CHIME’s Dr Henry Potts and Pippa Bark. The study reviewed findings from hundreds of previous studies from all over the world.

The major literature review, published in the US journal Milbank Quarterly, identifies fundamental and often overlooked tensions in the design and implementation of EPR programmes. The findings have implications for President Obama’s election promise of “a computerized medical record for every American within five years”, and for other large-scale EPR programmes around the world.

First author Professor Trish Greenhalgh of UCL’s Department of Open Learning said: “EPRs are often depicted as the cornerstone of a modern health service. According to many policy documents and political speeches, they will make healthcare better, safer, cheaper and more integrated. Implementing them will make lost records, duplication of effort, mistaken identity and drug administration errors a thing of the past.

“Yet clinicians and managers the world over struggle to implement EPR systems. Depressingly, outside the world of the carefully-controlled trial, between 50 and 80 per cent of EPR projects fail – and the larger the project, the more likely it is to fail. This comprehensive review suggests that the EPR is a complex technology introduced into a complex system – and that only a small proportion of the research to date has been capable of addressing these complexities.

“Our results provide no simple solutions to the problem of failed EPR projects, nor do they support an anti-technology policy of returning to paper. Rather, they suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world.”

Key findings of the new review include:

• While secondary work like audit and billing may be made more efficient by EPRs, primary clinical work can be made less efficient;

• Paper, far from being technologically obsolete, can offer greater flexibility for many aspects of clinical work than the types of electronic record currently available;

• Smaller, more local EPR systems appear to be more efficient and effective than larger ones in many situations and settings;

• Seamless integration between different EPR systems is unlikely ever to happen, as human input will probably always be required to re-contextualise information for different uses.

Co-author Henry Potts added: “There has been considerable prior debate in the media and among academics about the benefits and hazards of EPR systems. We believe the next generation of research should focus on how human imagination, flexibility and collaboration can work with electronic systems and help overcome their inherent limitations, thereby allowing us to realise the full potential of EPR systems.

“In the US, the debate over these issues is just beginning and it’s important that policymakers worldwide pay attention to the problems and issues we raise in order to avoid costly mistakes.”

The research was sponsored by the Medical Research Council, the UK Department of Health and the UK NIHR Service Delivery and Organisation programme. The full text of the paper is freely available at Milbank.org or through UCL Eprints.

The paper was the basis for an interview with Henry Potts by UCL News, and has also been covered by Pulse, Computer Weekly, eHealthInsider and others. This Health Care Renewal blog entry is particularly interesting.

“If you want things to change, things will have to stay as they are”.

By rmhipmt, on 15 December 2009

I’ve been meaning to post about the Tory plans for NHS IT for a while. They published an independent review of NPfIT, way back in August. Since then various things have happened to make the picture seem even more complicated, even harder to sum up in a single post. One is that the state of the public finances has forced the government to comment on whether it wants to continue with the Programme. Or at least it has forced the chancellor to say rather threatening things about the future of the Programme (“not essential for frontline services”), which in turn has forced the health minister to speak out in its defence (“the NHS couldn’t function without it”). Of course, they could both be right, the Programme is a large and complex beast and it probably doesn’t help to talk about ‘it’ as if it was a single unitary thing. The government, presumably, will cut elements to save money where it can, but other elements will be recognised as worth completing.

In fact this pragmatic approach possibly isn’t a million miles from Tory thinking on the topic. Except that, for obvious reasons, their public pronouncements are rather more critical than that. Large government IT projects are exactly the kind of thing that the Tories hate. These projects are created to enable the kind of centralising, meddling over-powerful government that the Tories are philosophically opposed to, and their all-too-predictable failures, mired in bureaucracy and political interference, illustrate exactly what the Tories believe is bad about big government in practice. So Tory pledges to dismantle the National Programme should come as no surprise. The new Tories, however, add an intriguing ideological twist to the debate. Because as much as they hate information technology, they quite like information. To quote David Cameron:
“We’ll measure those things that people really care about: how long will my Dad survive if he gets cancer, what happens after my initial treatment, how does a hospital do on issues like infections? We will collect patients’ views on all aspects of their care via a simple questionnaire. And we will allow patients to give immediate feedback to hospitals about any bad care they have endured. We’ll compile all this information in a meaningful and accessible way that can be easily understood and let every patient compare and contrast different care providers. And we’ll then let patients, with their GPs, pick precisely where they want to be treated.”

Given that the Tories are committed to: (a) dismantling the IT infrastructure, (b) releasing clinicians from paperwork and (c) getting rid of bureaucrats, there could well be some difficulty collecting all this additional data. However, here’s another quote, from a paper the Party produced in April, ‘An NHS Information Revolution to Save Lives’:
“As well as allowing different providers to compete to manage NHS information, we will drive greater innovation by allowing them to develop new ways of using information to provide better services to patients. For example, we want to see a system where people could download an NHS application with real time updates on their i-phone and where online internet forums like ‘facebook’ provide a powerful way for patients to group together and share their views.”

Apart from the eye-catchingly stupid idea of the ‘i-phone’ app with ‘real time updates’, the other big problem with this is that the promise of more and better information sounds hollow without an enhanced commitment to patient choice. Otherwise what’s all this information for? But it isn’t clear that patients want more choice. It, actually, isn’t clear that they want the amount of choice that they have already. Of course, it was the Labour government’s decision to insert choice into the NHS direct booking system that made ‘Choose and Book’ such a complicated and unpopular endeavour with GPs and hospital doctors. So will the Tories scrap that element of the National Programme for IT?

Earlier this year, David Cameron spoke about NPfIT:
“Now I want you to imagine how we’d have gone about updating NHS computers, if we’d had the chance. We would have said: today, you don’t need a massive central computer to do this. People can store their health records securely online, they can show them to whichever doctor they want. They’re in control, not the state. And when they’re in control of their own health records, they’re more interested in their health, so they might start living more healthily, saving the NHS money. But best of all, in this age of austerity, a web-based version of the government’s bureaucratic scheme services like Google Health or Microsoft Health Vault cost virtually nothing to run.”

I find many things about David Cameron irritating, but few them are more irritating than his way of characterising NPfIT as an attempt to purchase one really, really, really, big computer. The rhetoric is saying:
• Labour = information technology = old-fashioned, bureaucractic, centralising, failed
• Tories = information = contemporary, streamlined, democratic, empowering

The problem is that although a passage like this might look like good copy to someone writing a political speech, it doesn’t really fly as policy. Google Health and Microsoft Health Vault are products aimed squarely at the US market. When the Tories commissioned Glyn Hayes to write an independent review of NHS IT, Google declined to provide information and the Hayes’s final report makes it absolutely clear that, valuable as patient-held records might be for some people, they can’t replace the NHS’s need to keep its own records.

Glyn Hayes’s team, very wisely, said that NPfIT should not be abandoned, but should be restructured. For example there should be more scope for local decision-making about purchasing. Very sensible, but slightly problematic politically because that’s kind of happening already.