CHIRAD

1. CHIRAD Centre for Health Informatics Research and Development Graham Wright MPhil, MBA, MBCS, DN, Cert Ed, RNT, RCNT, SRN, RMN

2. Frimley Chertsey Redhill Guildford Basingstoke Salisbury Crawley Winchester Southampton Portsmouth Bournemouth

3. Postgraduate Degree Diploma EIHMS Programmes NVQ

4. MSc 2 “Public Health” MSc 4 Management / Leadership MSc 1 Advanced Practice MSc Research MSc 3 Science BSc Clinical Practitioner BSc Specialist Practitioner BSc Public and Environmental Health BSc Science EIHMS Education Pathways Level 6 DSc Level 5 Doctorate CLIN DOC or PhD Level 4(M) Masters Level 4B PG Diploma Research IT Modules Level 4A PG Certificate M Nurse Level 3 Degree BSc Management Level 2 UG Diploma Basic Science Model of Care Language Competence Communication Skills IT P2000 Diploma Level 1 UG Certificate

5. School Nursing (SN) Community Childrens Nursing (CCN) Public Health Nursing / Health Visiting (HV) 5 Common Core Modules Community Learning Disability Nursing (CLDN) District Nursing (DN) Theory Community Mental Health Nursing (CMHN) Practice Practice Nursing (PN) SPECIALIST PRACTICE MODULES SPECIALIST PRACTICE MODULES

6. Formative Assessment Summative Ready for patient/client care responsibility with supervision Progression towards Autonomous Practice Entry Exit Dependent Learner Autonomous Practitioner

7. Nursing milestones? • Individual care • Nursing Process (1970’s) • Nursing Diagnosis - requires nursing codes • Nursing workload (1980’s) • Activities not tasks - requires nursing codes • management not care • Health record rather than Nursing record • requires care codes (nursing codes)

8. Data > Information Does information make a difference to patient care? Traditionally the focus has been on the Management of resources:- Workload Skill Mix Finance

9. Important Information? • What care the nurse think the patient requires. • What care the doctors think the patient requires. • What care the patient thinks he requires. • What care the patient actually receives.

10. ICN (1991) common language • Improve communications • Describe nursing care • Enable comparison of nursing data • Project trends in the provision of nursing data and allocation of resources to patients according to their needs. • Stimulate nursing research • Provide data about nursing practice to influence health policy

11. Nursing care • Planned direct nursing care • Planned indirect nursing care • Unplanned direct nursing care • Unplanned indirect nursing care • In some studies only 20% is planned direct care - that is a care plan

12. Making the change on a National basis • Business case - plans • Identify and agree funds • Strategic plan • Training plan • Implement • Few undertake evaluation - unlike nurses who use the nursing process!!!

13. The Information Management and Technology (IM&T) Strategy 1992 • “ensure that the NHS and its patients get the maximum benefit from information technology, and will have a significant impact on patient care…. and on NHS efficiency”

14. The five key principles • Information will be person-based • Systems may be integrated • Information will be derived from operational systems • Information will be secure and confidential • Information will be shared across the NHS On page five of the new NHS IM&T strategy published in January 1999 you will find exactly the same five key principles.

15. Five Initiatives • Nationally linked population registers, based on existing registers of family health services authorities, containing people’s administrative details. • A new NHS number for everyone by 1995, designed for use with computers and intended to be the link for a person’s records. • A comprehensive dictionary of clinical terms, based on the Read codes. • A training strategy for technical, clinical, and administrative staff to enable them to implement effective information systems and to use them effectively. • To ensure that existing standards of confidentiality and security are not put at risk by information systems.

16. Main Findings All of the respondents considered the 1992 NHS IM&T strategy to be only partially fulfilled, with 25% expressing the belief that it was half-way or more to fulfilment in terms of benefits achieved. 75% thought that the strategy had gone only a small way to achieving the benefits it stated in 1992.

17. Main Findings Respondents were also clear about their beliefs that the implementation was too technology driven and that there was a serious lack of education and training to prepare clinicians and healthcare professionals.

18. Main Findings One of the National Initiatives was the production of a training strategy and 60% of respondents thought it was complete as a project. A training strategy was developed by the IMG. Not one respondent thought the IM&T training strategy had completely fulfilled its expectations, indeed 57% thought it unsuccessful. Education and training, or rather the lack of it, was commented on more than any other subject within the survey.

19. 87% of the respondents used the Internet for learning and teaching

21. Information Technology in Nursing A Paperless Paper! Are HEIs ready for Health Informatics?

22. Review of IM&T in Curriculum 1999 repeat of 1994 survey Betts, Olsson and Wright A follow-up study that examines what changes, if any, have taken place over the last five years.

23. Original Recommendations • To develop guidance on how IM&T can be included in pre-registration curricula • To develop guidance on how IM&T can be included in post-registration curricula • To develop guidance for the education of nurse teachers • To develop guidance on the sources of advice • Existing products, materials and services should be mapped against curriculum guidelines together with the effective use of those materials in particular environments • Examples of “good practice” should be identified, developed and disseminated • That a feasibility project be instituted to explore the need for education at a specialist IM&T strategic level and the need for the development of Research and Development Centre(s)

24. Method • Sample • The Council of Deans and Heads for Nursing, Midwifery and Health Visiting for UK Universities • Response • 15 from 62 i.e. 25% response • Appear to be from HEIs active in subject

25. Fundamental Question Are good IM&T educational products effectively used to underpin the training of nursing and midwifery students for managing clinical information?

26. Informatics teaching in HEIs There appears to be a fair amount of Health Informatics in the curricula of nursing programmes. We asked the two questions about content Do you include these skills/topics under the heading of:- HEALTH INFORMATICS INFORMATION TECHNOLOGY

28. Where is the second stage?

31. using products to teach ‘managing clinical information’ • 67% had not heard of the EPR CD-ROM or the Terms, Records and Information open learning package • 73% had not heard of the videos A Patient’s View and What Seems to be the Problem? • 80% of student nurses were reported to be taught how to use a computerised system during their clinical placements.

32. materials developed to support the teacher • 80% had not heard of IT Eductra, • 57% ADAPT for Teaching and Learning • 53% the GHIFT Database. It would appear that the informatics community, whilst extremely good at communicating with each other, needs to recognise that some of the key users do not access the same communication networks.

33. Why the gap? • Is it because IM&T materials produced by the NHS are owned by the NHS • Are they ‘sold’ to trusts and training departments? • Are they seen as part of the IM&T trainers kit? • Are there vested interests which keep NHS materials within the NHS training arenas? • Is it because the NHS contracts with HEIs to provide the teaching and feel it is not the NHS’s role to provide them with materials?

34. Why the Gap? • Do staff in HEIs have any idea what is being produced by the NHS? • Do they know the emerging NHS agendas? • Do staff in HEIs know about other sources? • Do they use the internet? • Is web based material hard to find? • Is it a case of it not being produced by MY TEAM in my University?

35. What about other materials • Does the Informatics Community have to tell Schools of Nursing what is available? • If so who in the Community should be responsible? • Why are multi-million Ecu project outcomes so invisible to the Higher Education sector?

36. Broader Issues • Are the these products predominately designed to provide facts rather than concepts? • Are they training rather than education? • Are some produced solely to tick the boxes to show that a strategy / project has been addressed? • Is the production more important than the implementation?

37. A core curriculum? The original study found that a total of 65% of respondents wanted a Core Curriculum for IM&T. In 1999, 93% wanted a core curriculum for Health Informatics. Core curricula were written for pre and post registration but appear not to have been widely disseminated.

38. HEIs want Guidance Institute of Health & Care Development (IHCD) and ENB however produced a product in November 1997 entitled “Information for Caring” and subtitled “A framework for including health informatics in programmes of learning for nurses, midwives and health visitors and other clinical professions” . The purpose of the document was “to raise the profile of health informatics within curriculum design and development…”

39. Council of DeansICT project Aim To evaluate the use of ‘Information for Caring’ and how it performs as a tool in order to determine its effectiveness at supporting the integration of health informatics through HE core processes for curriculum development and validation/review.