RSS feedsDevelopments in health information are running at a feverish pace. All the signs and symptoms point to a fast-changing sector and the prognosis is good for health information professionals willing to work in a changing world.
Information professionals in the health sector, perhaps more than any other, face issues and opportunities from a wide variety of sources. New products and services from content providers can drive improved and adapted service levels from information professionals. At the same time content providers are increasingly aggregating content into meaningful information, and integrating information delivery into workflow products for the practitioner, bypassing the health information professional.
Developments in hardware technologies such as tablet PCs and PDAs are also putting information into the hands of practitioners while the trend towards direct access of health information by practitioners and researchers is driven by the development of Web 2.0, fostering peer-to-peer information handling.
Once the much delayed NHS electronic patient record (EPR) system is fully introduced, health information will centre on it. The development of the NHS National Programme for IT (NPfIT) is much debated and there are many issues of critical interest to the health information professional, ranging from privacy and security to data concerns such as consistent data input and secondary data use and analysis.
Health information professionals who have recognised their interest in the debate have struggled to make their voices heard. Information professional body CILIP’s special interest group spends time issuing responses to various consultations on health information to raise awareness of the interest of the health information professional.
Less prompting
Alan Fricker, past chair of CILIP’s health libraries group, who has been
involved in policy responses, and also the group’s public health work, says:
“The point of making these responses is to improve the engagement of health li
braries with these issues and raise the profile, so that less prompting is
needed in future reports.”
However, many health information professionals are too busy firefighting the daily challenges they face, mostly focused on funding, to identify and address the core issues facing them.
Dan Penny, analyst at Outsell, identifies a number of issues that will affect the role of the health information professional. “The emphasis of the role will change from being purely a curator to sitting on cross-disciplinary teams working with IT and medical practitioners to establish what is the best value-added product,” he says. “They are now advising more on selection. There will be a shift in the nature of the procurement process and procurement metrics. Rather than assembling the components of a car, they will be looking at how the car overall runs.”
The supplier landscape is set to change, according to Penny. “There will
definitely be both a convergence of different types of technology and of content
and technology suppliers.”
There has been talk of a tie-up between Google and health website WebMD in the
past.
Penny says: “There has been speculation for a number of years about tie-ups, though, and we have yet to see one. The challenge is the different business models. For high-growth businesses it is a challenge to tie up with traditional content providers as the numbers don’t stack up from a purely investor perspective.”
As we went to press, Google announced another collaboration with US academic
medical institution the Cleveland Clinic to pilot an
e-records system.
A further concern is the future of vertical search, according to Penny, where
specific search engines find information quicker. “Information professionals
need to be aware of information-seeking behaviours and to keep a handle on
developments in vertical search.”
The key question, Penny believes, is whether the change in the way information
develops will be led by the development of tools or aggregation around
electronic patient records.
Electronic patient records have been a long time in coming but as the development has been tweaked towards greater localisation, progress is being made.
Jon Orrell, a GP, says: “An analogy to the original NPfIT programme would be a decision to award monopoly contracts to Trabant and Lada to provide cars for the nation, the buyers presuming that people had no cars. People who had bought BMWs and Land Rovers with their own money would not be happy to adopt this, especially when after four years the Trabants did not work.
“All the national team need do is provide the highways, MOT inspectors, police and highway code, then let the market work. People can drive different cars on the same road network. It is the same with IT for the NHS.”
Orrell is involved in just such a scheme for the Care Records Service, which has accepted that diverse GP systems can be used to feed into a summary for A &E departments, without them all having to use cluster-provided offerings. He says that serious consideration is now being given to integration between diverse mental health, GP and hospital systems. He praises the approach as letting best of breed prosper for individual niche markets with integration for sharing patient details to make patient care better.
Bandwagon
Content providers are ready to leap on the bandwagon. Martin Delahunty,
publishing director for Elsevier’s healthcare magazines and medicine publishing
group, says: “This is a huge opportunity for Elsevier and every other publisher
with a lot of content.”
He explains: “The NHS is progressing at a huge pace and there will be a tipping point when the patient records are up and running and accessed by all, and that is when we will be presenting ourselves to provide information around the EPR. Under the government’s chief medical officer the patient is very much at the centre of things.”
Publishers like Reed Elsevier are preparing for that and the development of technology. The role of the GP and hospital-based technician is changing as there is a big push to more primary and secondary care devolving from hospitals.
Delahunty adds: “The other opportunity will be meeting the information needs of patients and the need for increased transparency and accountability which puts pressure on the GP and consultant but provides us with an opportunity to provide more detailed and sophisticated information.”
Process links
Analyst Gartner’s NHS specialist VP Jonathan Edwards says: “The computer-based
patient record is a very important topic. And that has a link with decision
support, workflow and knowledge management.”
He points out that the changes in the UK market have held back computerised patient record systems. The expectations of clinicians are for systems using decision support, knowledge management and electronic reporting. This is the vision of the NHS but it is delivery of these systems that it has struggled with the most.
Gartner’s Hype Cycle reports highlight where it believes technologies are in the cycle of use and acceptance worldwide. Edwards points out that because of the NHS the UK market is a special case and the UK is often at a different stage to other countries in its information systems development.
Edwards highlights the UK-specific trends in health information: “Semantic interoperability is at a peak in the NHS. Everyone wants it to happen, whereas version 3 of the HL7 XML-based application integration messaging standard for healthcare is at the bottom of the trough.”
He says that interest in standard medical vocabularies is high for ensuring the quality of data and communications integration: “Ideally, you would want every clinician to use Snomed but they are developing mapping technologies to normalise all local terminology into Snomed.” Snomed stands for Systematised Nomenclature of Medicine, a standard computerised language.
According to Edwards, the UK is further behind other countries in its development of information lifecycle management (ILM) systems for health data despite the fact that digital imaging is being installed. “We are well ahead with implementing imaging but behind the US and countries in Europe in terms of the need for an ILM strategy. The penny hasn’t dropped in the UK,” he says.
“Technologies such as speech recognition and tablet PCs are also further back in acceptance than in other countries,” Edwards adds. “Whereas England is quite far ahead in its use of telemedicine and local authority projects have become standard services.”
As health information technologies develop, there looks set to be competition between information providers along the chain from content providers to librarians to provide information at the point of need. Workflow is a hot topic.
BMJ Group, the publisher of British Medical Journal, has already starting rolling out EPR-based versions of its Clinical Evidence product, although David Tovey, editorial director of BMJ Knowledge, says a fully functioning version is in the pipeline. According to Tovey, BMJ Group has spent the past 15 months restructuring its content into bite-size chunks so it can be delivered at the point of care.
Elsevier is taking a similar tack in the development of its information delivery. Delahunty says:“We are looking at integrating information into the physicians’ workflow. To integrate it into the workflow you have to understand the practitioners’ day-to-day working life and recognise their needs. Primary care GPs and hospital-based practitioners have different information needs.
“For example, GPs spend very little time with each patient, perhaps three minutes, and have a very short time to access information. They tend to access magazine-style clinical information in easy-to-digest chunks that lead on to research-based information.
“Hospital-based consultants tend to have better access to digital libraries and may be on the NHS network and have more desk-based time. So the way we provide information is also different. Hospital-based consultants are more likely to be interested in medical and political news and confident in accessing clinical information online.”
Map of medicine
Health information professionals have an opportunity to embed themselves in the
development of workflow-based health information provision. The NHS-developed
Map of Medicine contains clinical information visualised in 387 patient
pathways. It is a single healthcare knowledge source for the NHS in England and
Wales that shares evidence-based best practice.
As the Map of Medicine was being developed there was librarian input, and training is beginning to be provided for librarians to adapt it to local needs, but how much each trust might involve its local library staff will vary according to local circumstances.
Betsy Anagnostelis, joint academic support manager for biomedicine at UCL Library Services, will be working on localising the Map of Medicine, helping clinical teams to review pathways and processes to reflect best practice.
She believes this process will provide health librarians with an important new role: “A clinician colleague has called us the evidence team, providing an evidence check in the process of localising the Map of Medicine pathways. Though coined by a clinician, the term carries some resonance and we may employ it more widely.
“We are part of one of the first teams locally to be trained in how to edit the Map of Medicine pathways. However, we see our role as a wider one of supporting clinical teams through the process of localisation, especially as it relates to managing knowledge. The ability to link through to key relevant information at the point of patient care is an important aspect of this development.”
Sarah Lawson, senior information specialist at King’s College London and the
Medical Library at St Thomas’ Hospital, believes training will take on an
increasingly important role: “Health information/
library professionals are already taking on roles that extend more widely than
traditional database searching support.
“For instance, at King’s I provide critical appraisal skills modules as part of a series of research methodology training courses for King’s and NHS staff. The outreach trainer at King’s and I are also working together with NHS libraries across south-east London to provide critical appraisal training for NHS staff.”
Some prominent health information professionals have been gazing into their crystal balls. Sir Muir Gray, chief knowledge officer of the NHS, sees a future where digital document delivery is centralised, leaving the health librarian of 2001 free to “use their valuable skills in the boardroom and close to clinicians and patients”.
Helen Bingham, a health information professional active in a number of professional groups, sees the librarian of 2011 working differently in a number of ways, including becoming the local knowledge manager, employing evidence-based practice and specialising more.
It has been said that the best way to see the future is to create it now. It is clear that the old models of health information delivery are breaking down and it is up to the health information professionals to get in at the beginning to build new models if they are to secure their future.
UP AND COMING IN HEALTH INFORMATION
Health information professionals and analysts tip the following trends
•Involvement in cross-disciplinary work and more tailored training
•Standardising data input and semantic interoperability in health information
systems
•Librarians’ taking on knowledge management work
•Involvement in the NHS’s Map of Medicine
•Workflow is a concern of information professionals, not just content service
providers
•Library space usage changing to reflect new roles and priorities
•Convergence of technologies and content in ways is likely to be reflected by
supplier tie-ups
•Consortial purchasing of health information
Other trends have yet to have their day
•Electronic patient records: full roll-out will be catalyst for change
•Blogs and wikis: trust and provenance are at the heart of health information,
and blogs and wikis face trust issues
•PDAs: delivering information at the point of care through PDAs or tablet PCs
could see drive growth
•E-books: print libraries still needed till more e-books appear
•Digital imaging management: a challenge for info pros
All Medical
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