Archive for the 'the public & eHealth' Category

Today’s wild-eyed idea

Perhaps (surely?) there are very good tools and applications available for the support of distributed data collection, but something about the widgets being deployed (very useful synopsis here, many thanks Simon Dickson) in DIUS’ recent consultation on ‘Science & Society’ struck me.

As far as I can understand it, the widgets allow interested parties to select from a menu of (in this context) the topics being consulted upon. Very sensible – it’s unlikely that everyone will be interested in every consultation question, so why not enable interested lobbies to focus their attention.

The next handy thing that’s enabled is the easy embedding of a panel, presenting the selected topics as some form of poll, within the interested party’s publication medium of choice. Again as I understand it, this is rather like embedding a Youtube video, or a tag cloud, into the sidebar of your blog, for instance. The interested party’s constituency can then respond to the poll in (that distributed) context.

And then (hey presto!) that data is piped back to the original consultation database. Not quite sure how this element works, but the idea is brill.

Even in its own terms, this is simply wizard. It’s disruptive technology of the best sort, being a game-changer for how consultation can be done. Congratulations to Steph Gray and colleagues. His own summary of their approach is well-worth inward disgestion alone.

But I was thinking of a slightly different context. I’m just working up ideas for a wee review project, in a domain characterised by fierce (and to a certain extent divergent – they’re pilot projects, which should explain a certain amount) enthusiasm for a series of clinical data-sets. Nationally, there’s a fair amount of consistency, but it’s difficult to gain consensus over the items that aren’t part of this. And politically this is not the moment to attempt to be Stalinist.

So, would this distributed approach support this ‘agreement to differ’? And would it do this better than currently mainstream approaches to clinical data sets? Could some differentiation be usefully applied by making more of the social (web 2.0) potential, rather than thinking purely within the frame of data collection?

Certainly the ease of embedding the tailorable poll (or data-collection form) in a variety of contexts would surely be a handy wee niche thingy?

Must see if a dog-walk would either help develop this, or delete the train of thought…

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eHealth and the culture of the NHS IT community

A quiet (spear-carrier’s, merely, possibly) welcome for the appointment of Alasdair Bishop’s appointment as Head of Change & Benefits in the SGHD eHealth team. I hadn’t seen him for quite a while until just recently, when we met at a workshop considering the potential scope of the eHealth Improvement Programme – on the basis of what he was forcefully and effectively arguing for there, I think I may have an idea of his views on things like focus, and the setting of priorities…!

However, perhaps some interesting cultural challenges are available? I thought I’d replay an email I drafted following the event.

I began by thinking of the eHIP in terms of a ‘business opportunity’ but came to realise that this needs more nuance.  

There’s a risk as well as an opportunity (as in SWOT, somewhere): if the eHIP is really well integrated with the other health improvement and change initiatives around, e.g. the Improvement Service Team – as it should be – ICT has had a history of being rather cloth-eared about things like culture, the dynamics & demands of change tools like PDSA etc etc….then over the piece, it may drive a wedge through the existing eH community.

I perceive this being broadly comprised of three (stereotype-warning!) groups:

  •  Those who work in NHS IT as a branch of the IM&T industry (procurement, machine-running & contract management with ATOS or whoever, keeping the infrastructure going etc etc.) – quite a bloc of staff, and plenty in senior Health Board IM&T mgt;
  • Those whose home discipline. is Project/Programme Mgt – could next month be at home helping put in a retail system, say – smaller numbers;
  • Those who enjoy working in public service, who aren’t clinicians, and who are too restless or otherwise don’t fancy ‘status quo managementt’, and have found a space in IT project management & learnt about it as they go along – a reasonable number of these, mostly locally

For the Change & Benefits team, maybe some utility in a little quiet sociological analysis (a.k.a. skills audit, or something?) to underpin resource/org’l planning?

When the going gets tough, or arduous over time, then I wonder whether inhabitants of any of these three groups are likely to gravitate to their own home territory (comfort zone)…? At the scoping workshop, quite a few of us tended to default to talking about IT rather then service change, for example.

If we are going to be ruthless and focus down on just a few real priorities (e.g. single sign on) then the going will get tough – apart from anything else, there are fewer places to hide if it’s not going well. Most of us are subject to, but also indulge in, what might be called ‘chronic agenda shuffling’ (I call mine ‘occupational hobbies’ – things I can turn to when the main priorities are delayed, not going well, or when I just fancy a bit of displacement activity). Keeping all these plates spinning is a full-time and absorbing activity, and who can blame us for not making progress with all those Good Ideas listed at the beginning of the Electronic Clinical Communications Initiative, it’s all we can do to keep the plates in the air. There’s also an element of it being more congenial to grumble about something than actually fix it – you know how it is.

All this stuff is normal organisational survival tactics/behaviour. Signing up at a workshop to being radical/focused won’t make normal life go away back at base the day after.

But back to Alistair. He is the only person I know in this domain who has actually done this focusing, with it’s attendant No Place to Hide risks, with CHI. Maybe there are more lessons to learn from his personal experience. He’ll be in a good position to pass them on.

Good luck Alasdair!

The power of stories

Here’s a wee story:

at a recent consultation event shortly before the implementation of a major revamp of one of our call & recall (screening) systems, a GP pipes up with a question. He works in an area where a sizeable proportion of his patients – for a variety of reasons – don’t tend to interpret the arrival of an official brown envellope in the same way as ‘the rest of us’. So he’s arranged that, alongside sending the letter out, the practice calls the patient being invited for screening, to explain & coax them into coming along.

[The new system dispatches the letter from a central location, gaining a variety of technical and technological efficiencies as a result].

He asks “can his practice be sent their patient letters, so while they forward the notes,  they can contact the patients concerned?”. The presenters of the new arrangements have a wee huddle, and come back with “hmmmn, sorry that can’t be done”. Thinking on his feet, the GP asks “can you let me know that you’re sending the letter out, so that my practice can at least try to coincide our call with the arrival of the note at the patient?” The presenters have another wee huddle, and the answer’s the same…”sorry”.

This seems to have the implication that patients who maybe can’t read, or don’t speak English, or are maybe spooked by official-looking correspondence, end up dis-advantaged.

But the point of this is not to point a finger at those involved, rather to ask a little about what sort of learning can be done from stories like this. How to translate a story into a more general lesson? In the IM&T world, there’s also the burden of the tendency to take things literally. I don’t think that this so much about humans becoming infused with the machines’ literal-mindedness, as about working in a culture where everyone bangs on about ‘delivery’ all the time. When this is wrapped up in procedures and techniques, the last thing that it is sensible to do is to query and seek to re-interpret what’s to be ‘delivered’. Far better (as in ‘career-enhancing’) to take it literally. But this gets in the way of learning from experience – which surely involves re-interpretation, I wonder?

Anyone hearing this sort of story may have a number of reflections, including:

  • there but for the grace of god go the rest of us;

  • we should talk to people more about what new systems are intended to do;

But will general reflections like these help them (or, more likely, others) avoid making a similar (not the same) mistake next time?

Of course, this is scarcely new – one only has to think ‘the oral tradition’ to remember that people have been passing on knowledge via stories for hundreds and thousands of years. But how does it work, in the mind of the listener or nowadays reader and viewer – how does the story transfer into changed behaviour in different contexts? Surely this will have been researched – must have a hunt about.

One thing is sure: we need to provide ways of capturing these stories and sharing them – plenty of tools available for that.

Diversity, Equality, Impact Assessments & eHealth

Just off to a session tomorrow with folk on ‘what sort of Impact Assessment?’ should be applied to eHealth, re E&D. Hope to avoid begging too many questions – there’s always the risk of taking the question too literally and diving straight to forms design. There’s a good deal to clarify first, including:

what is eHealth? In the NHSScotland context this might include:

  • A strategy – which might or might not be equality-promoting, in terms of its assumptions, discussions, recommendations?

  • A varied set of IM&T programmes (which have lifecycles and are at various points or milestones on these)?

  • A set of teams (e.g. SEHD, Deloitte’s, NISG, ISD, Health Boards, others e.g. ATOS)?

  • A set of Governance arrangements (e.g. Committees, sub-committees, groups of various kinds, all of which are inhabited by people and which work in particular ways)?

where’s Equality & Diversity at? For example:

Only once we’ve got a little clarity on these points is it sensible to look at what ‘Impact’ is, how best to assess it, and when?

We have a starting point – (see attached file) the NSS Impact Assessment Checklist (IAC) as revised using the one from SAMH – thanks to Charlie McMillan of SAMH for sharing his draft checklist, with its equal treatment of positive and negative impacts. But there’ll be a fair bit to work on…

equality-diversity-impact-assessment-format-charlie-mcmillan-converted-to-nss-28-may-07.doc

Diversity & Equality & eHealth

Information Services here has an Equality & Diversity Information Programme (EDIP) going on. In NHSScotland we don’t really collect terribly much Diversity information just now, so we’ve not enough way of knowing whether or not our health services are structured and delivered in a culturally-aware fashion. The EDIP is intended to make a start on remedying this, by doing things like talking with members of diverse ‘Diversity’ groupings about their experiences of healthcare, & also designing E&D (or D&E) data-sets, etc etc – read the EDIP material for a much better summary, anyway.

Of course there remain the (small, sure) tasks of actually embedding theses data sets within the major NHS patient systems, persuading healthcare practitioners to collect the relevant data, and thereafter to use it sensitively in their dealings with patients. To name but three – there are bound to be more.

Perhaps eHealth might have a part to play here? One could imagine, within an endeavour that may seek to actualise the vision of a joinedy-up health record that’s managed jointly by the NHS and the patient concerned, that patients themselves could create this E&D data? There’s also the question of the presentation and handling of the data within day-to-day healthcare. It’s not really as simple as an On/Off thing, after all. I might want my ethnicity recorded in my health record, but do I always want it to be a factor in my care? I can imagine there might be times when I think it’s irrelevant, and to have it dragged into the transaction might be patronising or annoying. So there might be useful work to do around how the data is used within day-to-day practice, and how technology (I nearly used ‘affordances’ there, blimey) might or might not support what’s required.

The ‘involvement’ work that I’ve referred to elsewhere needs in part to be based on conversation pieces, and perhaps work like this could be one of these? We might touch on this when looking at building in E&D Impact Assessments into eHealth governance…

‘Public Involvement’ with the NHSScotland eHealth Programme

I’ve been given the opportunity to maybe help work on the initial shape of some work on this, and am off to see some colleagues in the policy team for eHealth this afternoon. It seemed that some notes would be a good idea to help frame the discussion, so I’ve written some. The file is attached to this post. Usual disclaimers about the content being strictly my own wild-eyed ideas apply – at least pro tem. We’ll see how the discussion goes today – undoubtedly the material will evolve quite radically, if all goes well.

To try to compress my ideas down to what I could write on a postcard, all I’m suggesting at this point is that we don’t have a fix on what public involvement with eHealth might consist of, yet, and we need to talk about it. Not very complicated really is it? But we need to take care to avoid leaping to conclusions because we feel under pressure to get a move on.

 More in separate posts soon, as I try to summarise any main points I might want to dwell upon.

 The very rough draft [remember caveats!] notes are here: scoping-public-involvement-ehealth-project-brief-v01.doc


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