bioneural.net » nhs

Clinical knowledge architect for hire

Bruce — Wed, 19 Mar 2008 08:34:04 +0000

Dr Bruce McKenzie is now available for freelance consultancy as a clinical knowledge architect, addressing the unmet need for usable knowledge resources at the point-of-care in UK general practice. General practitioners (GPs) make more decisions in a day than a typical business executive, and these decisions cost not just money but potentially lives. It's challenging work, and you can but hope your decisions are based on good information. The problem is information overload and access to what you need when you need it: there's just too much and it's too hard to find in the context of a 10 minute consultation. As a GP for 10 years I can relate to this. I also have informatics knowledge and experience, and this puts me in a position to offer you solutions that are built the way a doctor would design them. The fact is information doesn't become knowledge by itself. After careful needs assessment raw information must be broken down and reconstructed into a usable form as part of a design process that draws upon both the art and science of information architecture. In other words it's a creative process, but it also necessitates solid technical insight into the context in which a knowledge resource will be used. With my primary care background, grasp of medical informatics, passion for writing, and practical experience in delivering concise clinical guidance for use at the point-of-care, I am now available for freelance consultancy as a clinical knowledge architect. Experience in primary care Ten years experience in several general ...

Hanging up the stethoscope

Bruce — Sat, 15 Dec 2007 11:56:35 +0000

From http://www.bioneural.net :

The week just gone marked 15 years in medicine. Two of those years were spent in New Zealand, the rest in England, and the last 10 in general (family) practice. It also marked the end of my clinical career—I'm hanging up the stethoscope and starting down a new path. I don't yet know where that path begins, let alone where it leads. But it's something I have to do. Leaving clinical practice is not a rash decision; it was in fact made during Project Koru. I had wanted to re-train in public health, but my application to do so in New Zealand was rejected. For a variety of reasons re-training within the UK National Health Service holds little appeal. So I thought I could return to general practice for a time while I considered my options. Thus I returned to the despair, hopelessness, poverty, psychosomatic illness, the reek of stale sweat and urine in nursing homes, and of cigarette smoke that lingers in your clothes and hair. And I found that I just can't do it any more. Herewith I present an Ode to general practice: I don't want to stick my finger up any more bums; I've had my fill of free-range brats and control-less mums. A look at your tonsils and throat I ask; You cough in my face as I perform this task. Stop smoking and loose weight I hear myself say, But taking some responsibility is not your way. Your job/ lover/ mother is making you ill; Nothing I can fix with patience or pill. The poverty ...

999 advice on your iPod

Bruce — Fri, 21 Apr 2006 03:14:51 +0000

From http://www.bioneural.net :

As reported by the BBC, the Sussex Ambulance Service NHS Trust are providing MP3-based first aid advice on how to deal with common and potentially serious situations (such as fits, collapses and resuscitation). This joins first aid advice available as a podcast on the iTunes Music Store by St. John's Ambulance. The Trust's website provides further details: Did you know you can now download first aid advice in mp3 format to store on your iPod (or any mp3) player? They are copyright free and have been professionally recorded so they will always be crystal clear when ever you need them. They cover all the situations where giving the correct first aid may mean the difference between life and death. All the advice provided is up to date and complies with Resuscitation Council guidelines. Of course, we realise that everyone hopes that they are never confronted with these situations. But unfortunately, the facts are otherwise. What is more, the chances are the victim will be somebody close to you. At first the whole idea seems a bit bizarre. Imagine the scene: there's been a road traffic accident, and several people are injured. In the midst of the chaos stands the wo(man) in charge, identified by the tell-tale white earbuds that scream "I know first aid!". Gesticulating in one direction then the other, shouting instructions to passers-by with eyes and thumbs on the iPod controls to review that last instruction, our luckless hero is unable to hear the approaching ambulance and becomes the incidents only fatality... Worst aid ...

QOF checklist and Read Codes

Bruce — Fri, 25 Feb 2005 08:11:20 +0000

From http://www.bioneural.net :

The New General Medical Services Contract (nGMS) for NHS general practitioners changes the way GPs are remunerated. Under the contract GPs are paid performance-related income according to a Quality and Outcomes Framework (QOF)—essentially a list of clinical and other standards associated with points (income) for achieving certain target thresholds. One of the informatics challenges of nGMS is therefore the recording of activity in a consistent and efficient manner. Clinical system templates If a patient has a condition that is singled out by nGMS (e.g. asthma, diabetes, etc.) then the easiest way to record data would be to have the system prompt the GP for anything that is missing (as EMIS does, the system I use at work). There are a few of problems with this approach: The template serves the dual purpose of maximizing QOF points and of managing the patient clinically. You might think there is no conflict here, and although there is some overlap, there is more to managing patients than gathering points. Consequently, the templates can be bloated with requests for data input not required for QOF and it is difficult to see what is "essential" from a points perspective. When time is limited—as it often is—sometimes you might choose to ask the questions or perform the tasks that really "count"; The templates may contain a confusing selection of Read Codes (or Clinical Terms if you prefer). Even before you get into the template you have to code the condition correctly. Because the Read Codes are often not intuitive, consistent, ...

Guidelines: a solution for guideline overload

Bruce — Mon, 21 Jun 2004 11:20:01 +0000

From http://www.bioneural.net :

As previously raised, there are many competing guidelines (NICE, NSF, PCT, etc.) and formularies (Clinical Terms, prescribing) that clinicians must take account of at the point-of-care. Most clinical systems used in British general practice offer templates to prompt data entry and pick-list formularies for prescribing and coding, but these only go so far. How can a practice take account of this competing management advice to streamline and standardize patient care? The answer, somewhat paradoxically, may be to produce another guideline... Why produce an in-house guideline? It promotes a shared standard of care, based on evidence; It can illustrate a role for in-house staff groups (e.g. doctors, nurses, admin) with defined responsibilities; It can converge multiple "competing" guidelines into one ("the best of the best"); It can condense overly complex guidelines for practical use at the point-of-care; It encourages continuity of care (we all follow the same plan); It enables audit against set criteria/ common Clinical Terms; It may improve cost effectiveness (e.g. linkage to a preferred drug formulary, rational lab tests); It should improve clinical outcomes ("best practice"); It could provide documentary evidence for the RCGP QPA; It can help maximise quality point payments under the New GMS Contract; As a guideline cf. protocol, it allows for clinical judgement/ patient preference; It can be useful tool for discussing treatment options with patients. Why use an intranet to publish in-house guidelines? They can be readily updated as the master copy is electronic; This ensures everybody is looking at the same (current) version; The guideline is easily located; It can be cross-linked to other relevant guidelines and documents (e.g. patient ...

NHS IT: the story continues

Bruce — Sun, 02 May 2004 16:00:25 +0000

From http://www.bioneural.net :

From a primary care viewpoint, a summary of NHS IT strategy from Jan 2001 to April 2004, outlining the National Programme for IT (NPfIT) and the implications of the New GMS Contract... What came before? In case you missed it, here is a potted history of IT strategy in the NHS up to December 2000. Building the Information Core (Jan 2001) Building the Information Core: Implementing the NHS Plan was essentially an update to Information for Health (1998) in the light of The NHS Plan (2000), which had some effect on priorities and their delivery dates. It also had to take account of the e-Government Interoperability Framework (e-GIF), all about standards for information interchange in the public sector. The "clarified" targets were: By March 2001: 95% of GP practices and 25% of Trust clinical staff with NHSnet connections and using NHS information services such as the National electronic Library for Health; By March 2002: desktop connections for NHS clinical staff to basic e-mail, browsing and directory services, and roll out of NHS cryptography support services begins By March 2003: migration to national standards for e-mail, browsing and office systems completed and all NHS staff with desktop access, and clinical information systems start to use the SNOMED Clinical Terms; By March 2004: major national payroll/HR systems implemented; By 2005: a vibrant networked NHS, with booking systems in place, electronic transfer of records within primary care, all acute Trusts with level 3 Electronic Patient Records and first generation Electronic Health Records. Delivering 21st Century IT Support for the NHS (Jun 2002) If Building the ...

A history of NHS IT to the Millennium

Bruce — Thu, 29 Apr 2004 16:18:29 +0000

From http://www.bioneural.net :

A potted history of NHS IT strategy up to December 2000, prior to the New GMS contract and the National Programme for IT (NPfIT)... IM&T strategy (1992) The first NHS IT strategy of any significance. The Information Management and Technology (IM&T) Strategy (1992) cited the "lack of integration and commonality" between existing IT systems as a barrier to efficiency and progress. It was to be nationally led but implemented via a Local Action Plan. Key principles of the strategy were: person-based information (linking to an NHS number); systems integration (esp. to reduce duplication of data entry); deriving management information from operational (day-to-day) systems; ensuring security and confidentiality of patient information; information sharing via an NHS-wide network. The strategy also importantly specified the need for: a national thesaurus of coded clinical terms (expansion of the Read Codes); national standards for computer?computer communication e.g. EDIFACT, EDI, X.400, GP system accreditation (RFA). Implementation guidance in the form of a Handbook was produced in 1994. In 1996 the Handbook was updated to take account of other national developments: Developing a Primary Care-led NHS (esp. GP fundholding); Care in the Community; implementing The Health of the Nation; implementing the Patient?s Charter; and the move towards a knowledge-based NHS. Information for health (1998) A product of The new NHS White Paper (see below), a 7-year plan (1998-2005) broadly aiming to "provide the right information wherever it is needed in the NHS, from the doctor?s surgery to any hospital accident and emergency unit. The strategy will also ensure proper information to tackle the causes of ill-health, to plan and monitor ...

Digital divide between professionals & patients

Bruce — Thu, 29 Jan 2004 16:46:45 +0000

From http://www.bioneural.net :

Since the early 1990's the Internet has enjoyed unprecedented use as a library of health-related information and resources. The freedoms it provides have seen access to it positioned high on professional, political, and cultural agendas. As with much of healthcare, however, who has access is in part determined by the so-called "digital divide" between various groups, such as those in differing socio-economic classes. A new divide has notionally been created between UK National Health Service professionals and their patients, as the former now have almost universal Internet access via the health service's wide-area network, NHSnet... Viewpoint Bruce McKenzie MB ChB, DMI RCSEd, MRCGP Volume Editor of Medicine and the Internet (OUP 2002) and General Practitioner, Chesterfield, United Kingdom Patient use of the Internet Two principal benefits of the Internet for health-care consumers are health information (databases, Web sites, etc.) and support facilities offering self-help advice or pointing to additional resources (forums, mailing lists, etc). Numerous annotated Internet site guides are available to assist patients in locating these resources. Improving access to this online health-care information has the potential to enable patients to participate more actively in the decision-making process with their doctors [1]. A "free market in information" [2], however, provides equal access to both evidence-based and unsubstantiated health information, resulting in concerns over information quality (reviewed elsewhere [3]). It also raises other issues. For example, Coiera [2] asks whether ready access to knowledge of what is considered "best practice" will see resource-strapped health services struggle to cope with heightened societal expectations of optimal care ...