Successful delivery of information technology in the NHSBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d6663 (Published 24 October 2011) Cite this as: BMJ 2011;343:d6663
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As clinical anaesthetists we welcome wholeheartedly this latest initiative to better integrate information systems into direct clinical care; and are delighted to see it endorsed by our own Royal College (RCoA).
Delivering information to, and handling information from anaesthetists is probably one of the most challenging (& unfortunately neglected) areas for information technology within the NHS, but is absolutely fundamental to both patient safety and quality of care.
During the peri-operative period we require rapid, easy & often simultaneous access to multiple data sources, including laboratory investigations, images, reports, prescriptions, guidelines & protocols. Sequential database access, with time-consuming navigation of individual search & security pathways, is too slow and distracts from real-time care of the unconscious patient. 'Topsy-grown' information systems consisting of secure data silos, frustrate both anaesthetists & good patient care alike.
We suggest that newly-appointed chief clinical information officers focus on optimising information flows for anaesthetists. This novel approach would automatically better integrate and better interface key hospital data systems, and in doing so help finally realise the true potential of information technology in the delivery of better healthcare for all.
Mark Davies FRCA
Royal Liverpool & Broadgreen University Hospitals NHS Trust.
No external funding and no competing interests declared.
Competing interests: No competing interests
Formal Clinical Information Roles in the NHS
The editorial by Altmann and Michael sketches some current thinking on a new formal clinical contribution to ‘the delivery of information technology in the NHS’. The model is based on US developments where a clinician is employed typically as a ‘medical’ information officer, responsible to the management team and given status by the US jargon designation ‘Chief’. There is a web-based magazine for such staffs (www.cmiomagazine.com/). The adoption of this terminology in the UK seems less appropriate, excepting Dr Altmann’s recent status, and arguably serves to narrow the consideration of other creative possibilities. In particular, as the authors’s indicate from their own experience of (‘rudimentary’) IT systems, there has been a small but effective clinical contribution to IT in secondary care in the NHS for more than thirty years, for example in Nephrology.1 This was largely developed at departmental level with an emphasis on software, when whole hospital IT was focussed particularly on hardware. Experience in Nephrology, one source of Dr Altmann’s expertise, is that major facilitation of departmental clinical processes, and patient management, can be achieved through well-designed information systems.2 The clinical departmental IT literature is very small, despite some scoping of multidisciplinary functions.3 The basis of departmental experience in secondary care was the unacknowledged effort of local senior staff acting as departmental ‘CIOs’, for whom no category of formal NHS activity has been available.
The contemporary incentives for IT development remain greatest at whole hospital level. The delivery of generic Trust-wide IT solutions for laboratory, ward administration, personnel and business information purposes would no doubt be advanced by (C)CIOs as described. Those staff will probably come from clinical departments, where they are likely to have developed their IT background and made some informatics contribution already. Trust IT inevitably concentrates on generic requirements that do not necessarily fit to the remarkably diverse activities of specialist departments. Arguably, what is required is a formal acknowledgement in the NHS that a sessional commitment to IT/informatics can form an established part of job planning and contracts for all staff, not just whole trust CIOs. By mobilising such interest at departmental level the penetration of IT into clinical practice could be enhanced by reputation and the intimate familiarity with clinical requirements. The better informed melding of trust generic systems and departmental routines would be a special advantage.5 The multi-consultant departments of current practice are a very suitable base from which an interested colleague should be able to develop, formally, IT interests to the general benefit (although other staffs might well wish to participate). This more general model of CIO status allows for the development of clinical IT as a discipline with the knowledge, skill and experience that will be required. The growing awareness of the need for formal clinical IT roles in the NHS can be developed more generally than the US model, to create a clinical IT culture that will inform both generic and specialist system requirements for the future.
1 Will EJ. Computing in Nephrology. Int J Artif Org 1987;10(4):213-215
2 Simpson K, Gordon M.. The anatomy of a clinical information system. BMJ 1998;316:1655-8
3 Greenhalgh T. Role of routines in collaborative work in healthcare organisations. BMJ 2008;337:a2448.
4 Vedvik E, Tjora AH, Faxvaag A. Beyond the EPR: Complementary roles of the hospital-wide electronic health record and clinical departmental systems. BMC Medical Informatics and Decision Making. 2009,9:29
5 Lenz R, Reichert M. IT support for healthcare processes– premises, challenges, perspectives. Data and Knowledge Engineering 2007;61:39-58
Competing interests: No competing interests