20.02.13
Patient power, clinician power and the power of information
The UK’s leading health informatics event, HC2013, will be held at a critical time in the transformation of the NHS in England, just after a key date when new organisations come into full operation, replacing the old structures. John Rayner, director of The Health Informatics Service, gives an overview of the issues covered in several of the conference streams.
What are the main themes of the streams?
There are three parts to this: patient power, clinician power and the power of information or IT. The first one, patient power, is about recognising that if you involve patients in their own healthcare they do better than those that are not involved. So it is predominantly about providing patients with not just information, but with the power to influence the care they receive.
In terms of information, it’s about giving patients access to high quality regulated information rather than spurious information of the internet – information that has been well-evidenced that will allow patients to interact with the professionals so they become a part of the care pathway and a co-producer. It’s about providing multichannel access to information and providing an environment in which patients can interact. So in the simplest form it could be providing patients with web-based information or by smart phones, hospital websites, etc.
If you look at the way local authorities provide a range of online and multichannel services through their council websites, you can do anything from applying for planning permission to getting bins emptied. So it's about bringing the NHS in line with the ‘egov’ agenda and making healthcare as accessible and the information related to healthcare as accessible as other public services.
Part of this stream is giving patients access to their own health record, predominantly primary care and also the challenge for the next two to three years, which is that patients will want access to their secondary care record. If we see integration between primary, secondary and social care records then we will see increasing demand for patients to not just access their records but to contribute to them.
The next stream covers clinician power. What aspects will be presented?
This stream talks about how patients with long-term conditions can manage their condition at a place and time convenient to them. So we will hear specifically from speakers who have worked with patients who reside in care homes and residential homes – 60% of whom have long-term conditions. They will describe how to engage with those patients and the GPs of those patients so that conditions can be managed in the community rather than in hospital.
This is a good example (based on evidence) that connecting nursing and residential homes and telemedicine can not only reduce short-term length of stay, but can also speed up discharge when patients can go back to an environment covered by telehealth devices.
This session to some extent recognises that hospitals cannot afford to carry on working the way they are now and are going to have to do things in a different way if they are going to survive into the future. The thesis here is that there is really no option for secondary care providers. They have got to work across the community rather than being in wards focused on hospital services, and treat more people in primary care and their own homes. There will be specific examples of how patients with COPD can measure and monitor their own oxygen saturation.
The next stream on ‘IT value proposition’ is presented by HIMSS Analytics. Will this include a UK focus?
HIMSS Analytics will be sharing some of their European and UK data. This is making the link between all things secondary care needs to do, such as reduce overall mortality rates and hospital acquired infection rates, and the ability to close wards because patients are being treated elsewhere. They can do all that when they have a higher level of EMR adoption. This is also linked to the levels of investment needed for high levels of EMR adoption. I think that HIMSS will be describing the EMRAM model and will be giving specific examples of UK hospitals that have gone through this process. Any acute trust that is looking past the national programme to develop its EPR strategy can use EMRAM as a benchmark of where it is now.
The suggestion is that you need a significant level of investment to get a return to almost EMRAM level six and level six is linked to an investment level of 3.6% of turnover, when we know most hospitals in the NHS invest between 1-1.7%. It suggests that there is a heck of a way to go in investment by acute trusts that really want to get some of the benefits from IT.
Does that mean that this session should target the senior executives, not just the IT people?
Absolutely. Any decision maker responsible for committing resources, traditionally chief executives and directors of finance etc. For this session in particular – you will have heard the adage that we need to move away from organisational leadership to whole-system leadership – anyone with responsibilities for preserving whole systems, and by that I mean whole health economies rather than IT systems, needs to hear this story. So there are two vital connections: the level of investment in IT needs to increase; and organisations who survive this sort of reform and organisational change are those that successfully innovate.
Do you think the awareness is lacking about how you need to invest up front and need to look at a planning horizon of three to four years ahead or more?
There are a couple of critical points here. There is an expectation that as soon as you spend any money on it you are going to get a return. That is unfounded. The evidence suggests you have to get a robust core platform in place, which you would need to do over several years before you can expect any return. So you have to be wary of business cases based on high levels of cash releasing efficiency. The starting point of many hospitals is so low that unless they invest several millions of pounds over two to three years they are not going to get the return that they expect.
In the final stream, adapting and thriving in the new world, what advice will be given to NHS organisations?
This stream is linking innovation with leadership. The first speaker [Trevor Wright, Head of Strategic Systems and Technology for the NHS-CB Regional Office (North of England)] has worked with a number of NHS organisations on achieving the nirvana of the shared care record. There is more focus on the whole-leadership thinking that has contributed to the success, rather than on how he has made technology work.
Another speaker will talk about ‘converting their know-how into the do-how’. The proposition is that while a lot of people know what to do, doing is something different. Competition is going to be part of his pitch. He recognises that competition is old style he also recognises that when collaboration is evident in individual organisations they are under enormous pressure to exhibit the type of behaviour that the new system demands.
HC2013, incorporating HEALTH+IN4MATICS, returns to the ICC Birmingham on 16-17 April. Click here to register.
(Interview courtesy HealthTech Wire, copyright so2say communications. All rights reserved. Image copyright Bob Hall.)