ISMS STANDARDS UPDATE

March 2012

A summary of recent publications of relevance to the health informatics standards community. Content covers general NHS and social care developments, international activity, standards and journal articles.

INFORMATION STANDARDS EMIS rolls out Community Information Dataset in EMIS Web ...................................................................................1

NHS CONNECTING FOR HEALTH What the CloudStore has in store for the NHS...........................................................................................................1

NHS DATA Consultation on Quality and Outcomes Framework (QOF) publications ...................................................................1

NHS ICT Patient records to go online in Oxfordshire ...............................................................................................................1 Community information system – contract award notice .........................................................................................2

CLINICAL AUDIT HQIP unveils national clinical audit feedback mechanism .........................................................................................2 Standards and curricula for clinical audit learning and development ........................................................................2

RESEARCH DATA UK Biobank opens to researchers ..............................................................................................................................2

COMPUTER MISUSE Anonymous hacker planned to publish details of women who had abortions ..........................................................2

LEGISLATION Health and Social Care Act 2012 ................................................................................................................................3 The Care Quality Commission (Registration) and (Additional Functions) and Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2012 .............................................................................................3 The National Health Service Trust Development Authority (Establishment and Constitution) Order 2012 ..............3 The National Health Service Trust Development Authority Regulations 2012 ..........................................................4

PUBLIC ADMINISTRATION Open Public Services 2012 .........................................................................................................................................4

GOVERNMENT ICT Emergency responder interoperability - Common map symbols ..............................................................................4 PSN Transition Plans ...................................................................................................................................................4 02/12 Procurement Policy Note - Guidance on ICT Contracts less than £100m ........................................................5 Cabinet Office responds to PASC Government IT Further Report..............................................................................5 Cabinet Office and Oracle sign deal to save £75 million for taxpayers ......................................................................5 Better access to public sector information moves a step closer ................................................................................5

TECHNOLOGY STRATEGY BOARD Annual Report and Accounts 2009-2010....................................................................................................................6

DEPARTMENT OF HEALTH Department of Health capability action plan for 2011-12 .........................................................................................6

PROFESSIONAL REGULATION Regulation of health and social care professionals ....................................................................................................6

NHS COMMISSIONING BOARD Chief Nursing Officer appointed .................................................................................................................................7

CARE QUALITY COMMISSION The Care Quality Commission: regulating the quality and safety of health and adult social care .............................7

CLINICAL COMMISSIONING GROUPS Clinical Commissioning Groups (CCGs) - Completion of the IGT ................................................................................7

HEALTHCARE QUALITY IMPROVEMENT PARTNERSHIP Making HQIP more accountable and open: changes to governance .........................................................................8

HEALTHWATCH Local Healthwatch - the policy explained ...................................................................................................................8

MONITOR Compliance Framework 2012/13 ...............................................................................................................................8

QUALITY REPORTS Detailed guidance for external assurance on quality reports 2011/12 ......................................................................8

NHS OUTCOMES FRAMEWORK New information to help improve patient outcomes ................................................................................................9

PUBLIC HEALTH Alcohol Strategy published .........................................................................................................................................9

SOCIAL CARE Publication of adult social care outcomes framework ...............................................................................................9

SOCIAL CARE DATA New report analyses the adult social care workforce in England's local authorities .................................................9 NMDS-SC: More information shared with the Care Quality Commission ................................................................10

INTEGRATED CARE National evaluation of Department of Health's integrated care pilots ....................................................................10

HOSPITALS Hospitals should operate seven days a week: NHS top doctor ................................................................................10 Evaluation of consultant input into acute medical admissions management in England ........................................11

URGENT AND EMERGENCY CARE RCN calls for NHS 111 pause ....................................................................................................................................11

QUALITY STANDARDS 123 new quality standards announced ....................................................................................................................11

CANCER Personalised cancer treatments ...............................................................................................................................11

CHILDREN Health and wellbeing of looked-after children: consultation on quality standard ..................................................11 New health maps to drive children's health improvements ....................................................................................12

MATERNITY Update on the current and future maternity workforce..........................................................................................12

MEDICINES New set of prescribing comparators developed ......................................................................................................12

MENTAL HEALTH Care of people with dementia: consultation on quality standard ...........................................................................12 Prime minister’s challenge on dementia ..................................................................................................................13

OLDER PEOPLE Care home residents least likely to be hospitalised .................................................................................................13 Care of older people let down by low staffing levels ...............................................................................................13

PALLIATIVE CARE Palliative care pilot sites announced ........................................................................................................................13

PATIENT SAFETY Funding for two patient safety research centres announced ..................................................................................14

PAYMENT BY RESULTS Developing Payment by Results (PbR) for sexual health ..........................................................................................14 Payment by Results (PbR) data assurance framework: 2012/13 programme: improving the quality of contracting and commissioning data...........................................................................................................................................14

SCOTLAND Compound Healthcare Headings model ..................................................................................................................15

WALES Welsh Government announces radical reform of social services ............................................................................15

EUROPE Key specifications for interoperability......................................................................................................................15 European medicines regulators agree a common, Europe-wide approach for the identification of commercially confidential information and personal data ............................................................................................................16 European Medicines Agency launches electronic application form pilot ................................................................16

UNITED STATES Meaningful Use, round two (part 1): CMS’s proposed rule on stage two objectives and measures .......................16 NIST releases technical guidance for evaluating electronic health records .............................................................17 HHS sponsors contest for Web app to identify local health trends .........................................................................17

IHTSDO Resignation of Professor Martin Severs OBE............................................................................................................17

Recently published standards ISO/IEC TS 17022:2012 - Conformity assessment - Requirements and recommendations for content of a third-party audit report on management systems ............................................................................................................17 ISO/IEC 29175:2012 - Information technology - Mobile item identification and management - User data for Mobile AIDC services ................................................................................................................................................17 ISO/TR 14292:2012 - Health informatics - Personal health records - Definition, scope and context ......................18

ARTICLES The accuracy of real-time procedure coding by theatre nurses: A comparison with the central national system .19 Characteristics of general practices associated with numbers of elective admissions ............................................19 Community Health Map: A geospatial and multivariate data visualization tool for public health datasets ............19 Data display format and hospital ward reports: effects of different presentations on data interpretation ...........20 Exploring variations in lung cancer care across the UK - the story so far for the National Lung Cancer Audit ........20 A flexible database architecture for mining DICOM objects: the DICOM data warehouse .....................................21 Functional safety of health information technology ................................................................................................21 Giving office-based physicians electronic access to patients’ prior imaging and lab results did not deter ordering of tests ......................................................................................................................................................................21

HERALD (Health Economics using Routine Anonymised Linked Data) .....................................................................22 Icon and user interface design for emergency medical information systems: A case study ...................................23 Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added ..............................................................................................................................................23 Integration of a nationally procured electronic health record system into user work practices .............................24 Lexically suggest, logically define: Quality assurance of the use of qualifiers and expected results of post-coordination in SNOMED CT ....................................................................................................................................24 MCORES: a system for noun phrase coreference resolution for clinical records .....................................................25 Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups ...........................25 Patient-reported measures of psychosocial issues and health behavior should be added to electronic health records......................................................................................................................................................................26 Requirements for guidelines systems: Implementation challenges and lessons from existing software-engineering efforts .......................................................................................................................................................................26 Semantic similarity-based alignment between clinical archetypes and SNOMED CT: An application to observations .............................................................................................................................................................26 The SMART Platform: early experience enabling substitutable applications for electronic health records ............27 Systematic review of discharge coding accuracy .....................................................................................................27 Time to accelerate integration of human factors and ergonomics in patient safety ...............................................28 UK ethnicity data collection for healthcare statistics: The South Asian perspective ...............................................28

ISB Current Awareness Update – March 2012 - for internal use only 1

INFORMATION STANDARDS

EMIS rolls out Community Information Dataset in EMIS Web EMIS has released new software that will capture NHS data to help improve community healthcare. Community healthcare professionals are starting to use the new functionality in the EMIS Web healthcare system, enabling them to collect information required by the NHS Information Centre’s (sic) Community Information Data Set (CIDS), which comes into force on 1 April 2012. (EMIS, 28 Mar 12)

• Press release

NHS CONNECTING FOR HEALTH

What the CloudStore has in store for the NHS Connecting for Health's Kevin Holland outlines what changes the G-Cloud marketplace will bring to the health service's IT departments. With the CloudStore newly launched and its first user secured, interest around cloud is increasing among public sector's IT buyers. The NHS will be no exception, according to Kevin Holland. Within 18 months, every NHS organisation will be using some sort of cloud service, he predicts. Although CFH is not naive enough to believe that NHS organisations will drop current technologies in favour of CloudStore services, Holland maintains that a spike in cloud adoption will come when existing contracts are due for renewal. At that point, he says, health bodies should examine their actual needs, and see if there are any cloud services – either singly or in combination – that can be used to meet them. (Guardian, 08 Mar 12)

• Full text

NHS DATA

Consultation on Quality and Outcomes Framework (QOF) publications The Health and Social Care Information Centre has set up a consultation to invite responses to its proposals on merging the two QOF publications for achievement data and exception data. (Information Centre, 14 Mar 12)

• IC > Consultations

NHS ICT

Patient records to go online in Oxfordshire NHS Oxfordshire is to put the medical records of around 545,000 people online in an effort to give healthcare professionals faster access to patients' information. The programme will be made up of two parts: the national summary care record (SCR) and the local Oxfordshire care summary. The SCR will hold a patient's basic medical information held on the NHS Spine, while the Oxfordshire care summary will pull in a temporary view of a patient's health information from separate health organisations across Oxfordshire so it can be accessed in one place. The summary it creates will be a read-only record accessed through an online portal. (Guardian, 30 Mar 12)

• Full text

ISB Current Awareness Update – March 2012 - for internal use only 2

Community information system – contract award notice Kent Community Health NHS Trust has announced the award of a contract worth £1 226 970 to Advanced Health and Care Limited (Adastra). The scope includes the delivery of a new clinical information system for use across Kent community services, based on 2 750 staff, 1 000 users of which 500 are concurrent across 36 services. The Contractor must have the capacity and capability to deploy the system across Kent in 2 waves across 2 years. Wave one should be completed in 6 months and provide agreed services to approximately 150 users. Wave 2 should be completed within the following 18 months (European Union, 17 Mar 12)

• Contract Award Notice

CLINICAL AUDIT

HQIP unveils national clinical audit feedback mechanism The Healthcare Quality Improvement Partnership (HQIP) has launched its feedback system for national clinical audits (NCAs) allowing anybody participating in any aspect of NCAs to have their say and help with their ongoing improvement. HQIP has developed this resource to collect information, identify common themes and ensure messages are delivered to the appropriate organisations. If good practice is to be shared and common concerns addressed, feedback from those involved in national clinical audits is essential. (HQIP, 28 Mar 12)

• Press release

Standards and curricula for clinical audit learning and development The Healthcare Quality Improvement Partnership (HQIP) has published a new educational package, Standards and Curricula for Clinical Audit Learning and Development, as part of an ongoing objective to develop clinicians' skills and commitment to audit. (HQIP, 14 Mar 12)

• Press release

RESEARCH DATA

UK Biobank opens to researchers A unique, anonymised, data resource of the health and lifestyles of half a million Britons - including 26 000 people with diabetes, 41 000 teetotallers and 11 000 heart attack patients – has become available for research. Scientists who use the UK Biobank must publish their findings and add their results to the database so other public health experts can use them. The volunteers' medical records are linked to the database, so information on their health is regularly updated. (Wellcome Trust, 30 Mar 12)

• Press release • Guardian, 30 Mar 12

COMPUTER MISUSE

Anonymous hacker planned to publish details of women who had abortions A member of the hacking collective Anonymous, James Jeffery, broke into the website of Britain's biggest abortion provider, BPAS, and planned to publicly release the details of women who used the service.

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Jeffery faced Westminster magistrates court on charges of offences under the Computer Misuse Act. The Deputy Senior District Judge adjourned the case, telling the court she did not have "sufficient" powers to pass sentence, and refused an application for bail. He will be sentenced at Southwark crown court at a later date. (Guardian, 10 Mar 12)

• Full text

LEGISLATION

Health and Social Care Act 2012 The Health and Social Care Bill has gained Royal Assent to become the Health and Social Care Act 2012.

• DH Press release

• Access to full text The Care Quality Commission (Registration) and (Additional Functions) and Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2012 These Regulations amend the Care Quality Commission (Registration) Regulations 2009, the Care Quality Commission (Additional Functions) Regulations 2011 and the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to, among others:

• The requirements for the notification of death of a service user.

• Notification of unauthorised absences of patients detained under the Mental Health Act 1983 in English NHS establishments providing secure psychiatric services.

• Notification of a request or application for the deprivation of liberty safeguards to apply at the same time as giving notification of the outcome of such a request or application.

• A new requirement for the statement of purpose to include an address for the service of any communications required by the Registration Regulations, including an electronic email address.

• Exclusion of recording of telephone calls in high security hospitals.

This Instrument was published on 27 Mar 12; coming into force on 18 Jun 12, 01 Oct 12 and 01 Apr 13.

• SI 2012/921 • Explanatory Memorandum (PDF, 25Kb)

The National Health Service Trust Development Authority (Establishment and Constitution) Order 2012 This Order provides for the establishment and constitution of a Special Health Authority under section 28 National Health Service Act 2006, to be known as the National Health Service Trust Development Authority. The Authority will exercise such of the Secretary of State’s functions in connection with the performance management and development of National Health Service trusts in England. This Instrument was published on 27 Mar 12; coming into force on 01 Jun 12.

• SI 2012/901

• Explanatory Memorandum (PDF, 30Kb)

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The National Health Service Trust Development Authority Regulations 2012 These Regulations make provision concerning the membership and procedure of the National Health Service Trust Development Authority. In particular they provide for the appointment and term of office of the chief executive, the chair and other members of the Authority. Provision is also made for requiring the Authority to furnish reports and certain other information to the Secretary of State and for requiring presentation of an annual report at a public meeting. This Instrument was published on 27 Mar 12; coming into force on 01 Jun 12.

• SI 2012/922 • Explanatory memorandum as 2012/901 (above)

PUBLIC ADMINISTRATION

Open Public Services 2012 The Government has published Open Public Services 2012 which sets out the achievements made since the publication of the Open Public Services White Paper in July 2011. Progress is notable in several areas, e.g. schools, welfare, police and healthcare. However it is acknowledged that there is much more to be done to implement further radical reform in order to make a real difference to the effectiveness and efficiency of public services by the end of this Parliament. (HM Government, Mar 12)

• Access to document

GOVERNMENT ICT

Emergency responder interoperability - Common map symbols The Civil Contingencies Secretariat in the Cabinet Office, working in partnership with the Ministry of Defence and Ordnance Survey, has created a set of common map symbols, linked to the common terminology of the Civil Protection Lexicon, to promote interoperability between emergency responders. The symbols are published as a statement of good practice, the adoption of which will promote interoperability and enable shared situational awareness. Work is now underway to make these symbols available, at no cost to end users, in a technical format that can be downloaded and used within existing Geographical Information Systems (GIS). Further to this, the core symbol set will be extended in time through collaborative work with emergency responder organisations. (Cabinet Office, 30 Mar 12)

• Cabinet Office> National Security

PSN Transition Plans The Cabinet Office has published an updated central government transition plan for the Public Services Network which shows how Departments are engaged in developing their individual roadmaps in order to “Comply , Connect, and Exploit PSN capabilities”. This includes the DH’s plans for N3/N4. In addition, the suppliers to the framework have been announced. (Cabinet Office, 23 and 31 Mar 12)

• Press release, 23 Mar 12, supplier announcement • Download transition plan (PDF. 12 pages, 715Kb)

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02/12 Procurement Policy Note - Guidance on ICT Contracts less than £100m The Cabinet Office has issued guidance relating to the procurement of ICT products and services where there is a possibility that the whole life cost could exceed £100m. The Cabinet Office Structural Reform Plan stated that this guidance, which was a coalition commitment, would be published and implemented across central government. (Cabinet Office, 29 Mar 12)

• Download document (PDF, 7 pages, 108Kb)

Implementer guide to Privacy & Electronic Communications Regulations (PECRs) for public sector websites The Government Digital Service (GDS) has published guidance on the use of cookies by public sector bodies, under the Privacy & Electronic Communication Regulations 2011, which come fully into force on 26 May 2012 and will require informed consent to the use of most cookies. The main exemption is for cookies deemed strictly necessary for a service requested by a user. The guidance classifies cookies by levels of intrusiveness and discusses how to audit and manage them. (GDS, 29 Mar 12)

• Download document (PDF, 4 pages, 220Kb)

Cabinet Office responds to PASC Government IT Further Report The Cabinet Office has issued the Government’s response to recommendations in the Public Administration Select Committee’s (PASC) Government and IT — “a recipe for rip-offs”: time for a new approach: Further Report. This update from PASC requested additional information around the recommendations on benchmarking, legacy systems and capacity/capability gaps. (Cabinet Office, 28 Mar 12)

• Press release

Cabinet Office and Oracle sign deal to save £75 million for taxpayers The Cabinet Office and Oracle have signed a new deal that will deliver in excess of £75 million in savings by 2015, the Minister for the Cabinet Office, Francis Maude, has announced. Oracle is one of the Government’s largest IT suppliers and works with almost every department across Government. (Cabinet Office, 28 Mar 12)

• Press release

Better access to public sector information moves a step closer The private sector and the open data community are to have greater influence over the release of public sector data to encourage the creation of high-value businesses and promote economic growth, the Government has announced. A new Data Strategy Board (DSB) will advise Ministers on what data should be released. At least one in three members of the DSB will be from outside government, including representatives of data re-users. The DSB will work with the Public Data Group (PDG) – which consists of the Met Office, Ordnance Survey, Land Registry and Companies House – to provide a more consistent approach to improving access to public sector information. The Government is making £7 million available from April 2013 for the DSB to purchase additional data for free release from these Trading Funds and potentially other public sector organisations, funded by efficiency savings. An Open Data User Group, which will be made up of representatives from the Open Data

ISB Current Awareness Update – March 2012 - for internal use only 6

community, will be directly involved in decisions on the release of Open Data, advising the DSB on what data to purchase from the Trading Funds and other public organisations and release free of charge. The Data Strategy Board will sit within the Department for Business Innovation and Skills (BIS) to advise the Minister of State for Universities and Science, who will consult the Cabinet Office on all spending decisions and seek agreement on Open Data decisions. The PDG will also sit within BIS as a Ministerial Advisory body.

It will advise the Minister for Employment Relations, Consumer and Postal Affairs. (Cabinet Office, 19 Mar 12)

• Press release

TECHNOLOGY STRATEGY BOARD

Annual Report and Accounts 2009-2010 This document covers the Technology Strategy Board’s second full financial year as a public body, from April 2009 to March 2010, a period in which the Board developed priority areas of energy, healthcare, the low carbon and digital economies and increased investments in those areas. The Board's purpose is to promote, accelerate and invest in technology-enabled innovation so that the UK can become a global leader in innovation. To achieve its aims, the Board has executive responsibility for delivering programmes of government financial support to encourage business investment in, and the use of, technology across all sectors of the UK economy. These programmes include continuing support for collaborative research and development for business investment, and the use of technology, in both manufacturing and service industries. The Board also supports Knowledge Transfer Networks. These are national networks that aim to improve the UK’s innovation performance by increasing the breadth and depth of knowledge transfer of technology into UK businesses. In its advisory role, the Technology Strategy Board alerts the Government to areas where barriers exist to the exploitation of new technologies. (House of Commons, 27 Mar 12)

• Download document (PDF, 71 pages, 806Kb)

DEPARTMENT OF HEALTH

Department of Health capability action plan for 2011-12 The Department of Health has carried out a review which is intended to measure the Department’s capability in three broad areas: leadership, strategy and delivery. This action plan highlights three areas for improvement: building common purpose and sustaining a strong sense of ownership of the change agenda; work differently to achieve more; and the right people, in the right place, with the right skills. (DH, 23 Mar 12)

• Download document (PDF, 25 pages, 276Kb)

PROFESSIONAL REGULATION

Regulation of health and social care professionals This consultation paper issued by the Law Commission makes provisional proposals which seek to simplify and modernise the law in respect of the system of regulation of health care professionals and, in England only, of social workers.

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The paper makes proposals and asks questions on the following areas:

• The registration and renewal of registration, appeals, protected titles and protected functions. • How the regulators oversee the quality of education and training. • How the regulators set standards for professional conduct and practice, and ensure ongoing

practice standards (for example, through revalidation). • The investigation and adjudication of fitness to practise cases. • The role of the Council for Healthcare Regulatory Excellence. • The regulation of business premises and activities. • The governance arrangements of the regulators, including the size and composition of Councils. • The systems through which the regulators can be held to account, including the roles of the Privy

Council, Government and Parliament, and duties to consult the public. The consultation closes on 31 May 2012. (Law Commission, 01 Mar 12)

• Law Commission > Consultations

NHS COMMISSIONING BOARD

Chief Nursing Officer appointed The NHS Commissioning Board Authority has announced the appointment of Jane Cummings as Chief Nursing Officer. Jane is currently Chief Nurse for NHS North of England and was previously Chief Nurse and Deputy Chief Executive for NHS North West. A core role of the Chief Nursing Officer will be to drive quality improvements in patient safety and patient experience. (NHSCB, 19 Mar 12)

• NHSCB > About us

CARE QUALITY COMMISSION

The Care Quality Commission: regulating the quality and safety of health and adult social care A report issued by the Public Accounts Committee makes a number of recommendations to improve the functioning of the Care Quality Commission (CQC). The Committee notes that the CQC plays an absolutely vital role in providing assurance to the public, both by ensuring appropriate quality standards and by deterring poor quality and unsafe care, but to date it has failed to fulfil this role effectively. The report concludes that the CQC has a long way to go to become an effective regulator. It is not yet ready to take on the functions of other organisations, such as the Human Fertilisation and Embryology Authority, as the Department of Health has proposed. (PAC, 30 Mar 12)

• Download document (PDF, 68 pages, 454Kb)

CLINICAL COMMISSIONING GROUPS

Clinical Commissioning Groups (CCGs) - Completion of the IGT The bodies mandated to complete the IGT are the legal entities except where pragmatic reasons dictate otherwise, e.g. PCT clusters rather than the PCT legal entities. Although CCGs will not become legal entities until 2013, Sir David Nicholson has directed that IGT completion should be part of the CCG authorisation process which will be needed before then.

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Therefore, CCGs must complete IGT version 10 and provide an acceptable improvement plan for any shortfalls as part of the authorisation process later this year. They may complete a version 9 assessment at 31 March 2012 if this helps focus management attention and helps them prepare for authorisation. (NHS CFH, 19 Mar 12)

• IGT News

HEALTHCARE QUALITY IMPROVEMENT PARTNERSHIP

Making HQIP more accountable and open: changes to governance HQIP has announced changes to its membership and governance structure. The board changes will see formal representation with full membership and trustee status of an appropriate social care professional group, agreement of which is underway. In addition the board has agreed the establishment of an advisory group, to ensure a mix of national and local organisations and interests are represented. There will be scope for individuals as well as organisations, where they have a defined expertise or role. The group will form a useful sounding board for ideas and approaches, but will be expected to challenge where needed. (HQIP, 14 Mar 12)

• Press release

HEALTHWATCH

Local Healthwatch - the policy explained The briefing sets out the role of local Healthwatch and the functions, responsibilities and relationships within the modernised health and care system. The intention is for Healthwatch England to be established in October 2012 and for local Healthwatch organisations to start in April 2013. In addition, David Behan, DH Director General for Social Care, Local Government and Care Partnerships, has written to local authority chief executives to clarify their statutory duty to commission effective and efficient local Healthwatch organisations. (DH, 02 Mar 12)

• DH > Policy News

MONITOR

Compliance Framework 2012/13 Monitor has published the 2012/13 Compliance Framework which sets out the approach being taken to assess the compliance of foundation trusts with their terms of Authorisation and to intervene where necessary. As the Health and Social Care Bill has now gained Royal Assent to become the Health and Social Care Act (2012), this Compliance Framework will apply until the commencement of Monitor's new licensing regime. (Monitor, 30 Mar 12)

• Access to document

QUALITY REPORTS

Detailed guidance for external assurance on quality reports 2011/12 This document sets out detailed guidance for NHS foundation trusts and their auditors to enable them to carry out the external assurance engagement on Quality Reports from 2011/12. (Monitor, 15 Mar 12)

• Access to document

ISB Current Awareness Update – March 2012 - for internal use only 9

NHS OUTCOMES FRAMEWORK

New information to help improve patient outcomes As part of the government’s drive to improve results for patients, new detailed information on 20 of the 30 NHS Outcomes Framework indicators has been published by the Information Centre. The figures provide a regional and local snapshot of how the NHS is performing against the Outcomes Framework, illustrating where there are variations in outcomes. For example, liver disease mortality rates have increased nationally over the last decade, but have decreased in the last few years in London and the South East, while rates were twice as high in the North West compared to the East of England in 2009. (DH, 27 Mar 12)

• Press release

PUBLIC HEALTH

Alcohol Strategy published This strategy sets out government proposals to crack down on the binge drinking culture, cut down on alcohol fuelled violence and disorder, and reduce the number of people drinking to damaging levels. It includes commitments to introduce a minimum unit price for alcohol; consult on a ban on the sale of multi-buy alcohol discounting; introduce stronger powers for the control of the density of licensed premises; and pilot innovative sobriety schemes to challenge alcohol-related offending. (Home Office, 23 Mar 12)

• Home Office press release • DH > News

SOCIAL CARE

Publication of adult social care outcomes framework The Department of Health has issued an update to the Adult Social Care Outcomes Framework (ASCOF). The document:

• Describes the principles for the way in which the ASCOF should be used, and its relationship with local outcome measurement.

• Sets out the detail for each of the domains in the ASCOF, including the specific measures agreed for 2012-13.

• Outlines details of the next steps for future development of the outcomes-based approach and improvements to the ASCOF over coming years.

The accompanying handbook of definitions has also been updated. (DH, 30 Mar 12)

• Access to document and definitions

SOCIAL CARE DATA

New report analyses the adult social care workforce in England's local authorities A new report Personal Social Services: Staff of Social Services Departments, England analyses the adult social care workforce in England's 152 local authorities and is based on information held in the National Minimum Data Set for Social Care (NMDS-SC). The dataset replaces the SSDS001 as the method of collecting workforce data in this part of the sector.(Skills for Care, 29 Mar 12)

• Press release

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NMDS-SC: More information shared with the Care Quality Commission The Care Quality Commission (CQC) is developing Quality and Risk Profiles (QRPs) for each regulated provider of adult social care services, including where services are provided in health settings. QRPs are being developed to enable the CQC to assess the level of risk of a provider not meeting the essential standards and prompt front line regulatory activity where necessary. A new set of 11 indicators based on worker level data in the National Minimum Data Set for Social Care (NMDS-SC) appears in the QRPs; this means there are now 30 indicators based on NMDS-SC. Skills for Care and CQC will regularly review the arrangements in place for sharing data between the two organisations and the indicators that have been developed. (Skills for Care, 21 Mar 12)

• Skills for Care / CQC Joint Statement

INTEGRATED CARE

National evaluation of Department of Health's integrated care pilots This two-year study, commissioned by the Department of Health, looked at 16 sites across England which formed the Integrated Care Pilot programme. The research carried out by Ernst & Young, RAND Europe and the University of Cambridge considered the impact of better integrated care on elderly people at risk of emergency hospital admissions and the treatment of conditions including dementia and mental health problems. It analysed staff and patient views on the work of the pilots as well as the impact on hospital admissions and length of stay. The research found no evidence of the anticipated reduction in emergency admissions for patients who received an intervention. Balancing the unanticipated persistence of emergency admissions, there were reductions in outpatient attendances, which may have been due to moving services into primary care settings, an aim of several of the sites. Reasons for the observed reduction in elective admissions (especially in chemotherapy for cancer) are less clear. Taking these changes together, there was no significant impact of the pilots on secondary care costs. In conclusion, integrated care activity throughout the 16 pilot sites has to date resulted in changes to the delivery of care that have led to improvements in staff experience and organisational culture. The interventions had high appeal to staff involved, and it is suggested that if continued they may bring about improvements in outcomes relating to patient care and longer-term cost savings. (DH, 22 Mar 12)

• DH > Publications

HOSPITALS

Hospitals should operate seven days a week: NHS top doctor Sir Bruce Keogh, Medical Director of the NHS, has criticised the culture in hospitals of only treating emergency cases at the weekend with little or no routine surgery or diagnostic testing done outside normal office hours. He said the current system "lacks compassion" because patients are forced to wait for investigations or take time off work in order to be seen. Sir Bruce is attempting to reform NHS hospital working hours by talking to hospital chief executives around the country to identify which services can be opened at the weekend first. (Daily Telegraph, 21 Mar 12)

• Full text

ISB Current Awareness Update – March 2012 - for internal use only 11

Evaluation of consultant input into acute medical admissions management in England A survey of over 100 hospitals in England by the Royal College of Physicians (RCP) has found that patients have better outcomes and are less likely to be readmitted to hospital if cared for on wards where the physicians practising acute medical care are on call for more than one day at a time. As a result, the RCP will now recommend this system of cover above all others. (RCP, 02 Apr 12)

• Press release

URGENT AND EMERGENCY CARE

RCN calls for NHS 111 pause The Royal College of Nursing has urged the Government to evaluate the evidence and reconsider the move from NHS Direct to NHS 111 services in England. The free one-stop number for patients with urgent, but not life-threatening symptoms, is due to be introduced in April 2013. (RCN, 30 Mar 12)

• Press release

QUALITY STANDARDS

123 new quality standards announced The latest set of quality standards covering a wide range of topics, including heart failure, irritable bowel syndrome, skin cancer, and obesity in adults, has been referred to NICE. NICE will also, for the first time, develop public health quality standards in areas that relate to the NHS. The topics cover standards for smoking cessation, encouraging physical activity in all people in contact with the NHS and for preventing and managing alcohol misuse. This is in line with a recommendation by the NHS Future Forum for NICE to develop quality standards setting out the evidence-based action that the NHS can take in relation to the main lifestyle risk factors. NICE's quality standards outline the vision of what high-quality care should look like on the NHS, and will form the basis of commissioning decisions taken by the NHS Commissioning Board. (NICE, 21 Mar 12)

• Press release

CANCER

Personalised cancer treatments Recent technological advances in both diagnostics and therapeutics have the potential to make the treatment of cancer more personalised. This briefing from the Parliamentary Office of Science and Technology (POST) discusses the current application of these technologies in the NHS and the financial and logistical challenges involved in providing such treatments. (POST, 15 Mar 12)

• Download document (PDF, 4 pages, 334Kb)

CHILDREN

Health and wellbeing of looked-after children: consultation on quality standard NICE has been asked by the Department of Health to pilot the development of a social care quality standard on the health and wellbeing of looked-after children and young people for use in England. The draft scope defines the proposed settings, areas and activities the quality standard will consider and to whom it will

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apply. Registered stakeholders for this quality standard are invited to submit comments on the scope. The consultation runs until 13 April 2012. (NICE, 14 Mar 12)

• NICE > Consultations

New health maps to drive children's health improvements The NHS Atlas of Variation in Healthcare for Children and Young People maps out the variation in healthcare for 27 different child health issues across England. Although variation can be a sign of services being tailored to the needs of local patients, unwarranted variation - which cannot be explained by variation in patient illness or preferences - is not acceptable. The Atlas will help hospitals, community services, Primary Care Trusts and emerging Clinical Commissioning Groups to see how their area compares to others around the country, analyse the reasons why and if necessary put plans in place to make improvements. (DH, 14 Mar 12)

• Press release

MATERNITY

Update on the current and future maternity workforce The Department of Health has commissioned the Centre for Workforce Intelligence to undertake an in-depth analysis of the nursing and midwifery workforce, and to make policy and strategic recommendations for the future of the workforce. The project is expected to report this summer. Jan Sobieraj, Managing Director for NHS and social care workforce, has written to the strategic health authority cluster workforce directors, providing an update on progress. (DH, 19 Mar 12)

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MEDICINES

New set of prescribing comparators developed To help the NHS monitor prescribing of the key therapeutic topics the National Prescribing Centre, in conjunction with the Information Centre and NHS Prescription Services, has developed a set of 14 QIPP comparators. The comparators cover 10 of the 13 key therapeutic topics and aim to support organisations and prescribers to review the appropriateness of current prescribing, revise it where appropriate and monitor implementation. The comparators are not intended to be used as targets or performance tables. (DH, 19 Mar 12)

• DH > Policy News

MENTAL HEALTH

Care of people with dementia: consultation on quality standard NICE has been asked by the Department of Health to pilot the development of a social care quality standard on care of people with dementia for use in England. The draft scope defines the proposed settings, areas and activities the quality standard will consider and to whom it will apply. Registered stakeholders for this quality standard are invited to submit comments on the scope. Comments must be submitted by 13 April 2012. (NICE, 14 Mar 12)

• NICE > Consultations

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Prime minister’s challenge on dementia This document sets out the Prime Minister’s challenge on dementia, a programme of work to deliver major improvements in dementia care and research by 2015, building on the achievements of the existing National Dementia Strategy. There are 14 main commitments, including increased diagnosis rates through regular checks for over-65s; financial rewards for hospitals offering quality dementia care; dementia-friendly communities across the country; and increased funding for dementia research to over £66m by 2015. (DH, 26 Mar 12)

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OLDER PEOPLE

Care home residents least likely to be hospitalised A new study by the Nuffield Trust linking the normally separate health and social care records of more than 133,055 people – aged 75 and over – has found that local authority funded care home residents had fewer hospital admissions than those receiving high intensity social care support in their own homes. Records for a single year (2006-2007) were extracted from the operational information systems of four primary care trust areas and their corresponding local authority areas. People who died during the year were excluded, meaning that patterns of use were not affected by care in the final few weeks of life. The study demonstrates the power of linking data across the public sector to gain a deeper understanding of the costs and benefits of expenditure from tax funds. The research team acknowledges that there were methodological challenges. For example, the geographical areas examined in the study may have been unrepresentative of England as a whole; information from other health care services including NHS primary and community health services was not included; nor was the team able to identify people who paid for all of their own social care, estimated to be around 25 per cent of older people. Improvements to how data is collected and shared may allow these issues to be addressed. (Nuffield Trust, 29 Mar 12)

• Press release

Care of older people let down by low staffing levels A report from the Royal College of Nursing sets out a threshold of staffing levels below which care becomes compromised on older people’s wards. The RCN has said that most hospitals are currently failing to meet this level of care. Despite older people often having the most complex needs, RCN evidence suggests they regularly suffer from a severe shortage of nurses and health care assistants (HCAs), coupled with an inappropriate skill mix of HCAs to nurses. The RCN has said that important tasks such as comforting and talking with patients, promoting mobility and self care and helping patients with food and drink are being compromised. (RCN, 20 Mar 12)

• Press release

PALLIATIVE CARE

Palliative care pilot sites announced The Department of Health has announced the seven adult and one children’s pilot sites which will collect data to help the Government develop a fairer funding system for palliative care in England.

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The seven adult sites involve a total of 54 organisations, including hospitals, voluntary sector providers, Primary Care Trusts, Clinical Commissioning Groups, Local Authorities, nursing home providers, community health trusts, a university and a health and social care partnership trust. They cover a combined population of around 5.4 million people, distributed across six different regions: Yorkshire and the Humber, London, South Central, South East Coast, South West and the West Midlands.

The pilot for children’s services involves 39 organisations, including hospitals, voluntary sector providers, PCTs, community health trusts, universities and children’s palliative care networks.

The pilot sites will collect cost and activity data over a two-year period beginning from April 2012. This work will be overseen by the Palliative Care Funding Working Group, chaired by Professor Sir Mike Richards, National Clinical Director for End of Life Care. (DH, 20 Mar 12)

• DH > News

PATIENT SAFETY

Funding for two patient safety research centres announced The National Institute for Health Research has announced funding for patient safety research at two centres. Imperial College Healthcare NHS Trust will receive just over £7.2 million, and NHS Greater Manchester will receive just over £6.2 million. Examples of projects that will be carried out at the research centres include a medication passport; an internet based tool to help improve diagnoses made in GP surgeries; and better safety standards for surgeons. (DH, 16 Mar 12)

• DH > Policy News

PAYMENT BY RESULTS

Developing Payment by Results (PbR) for sexual health A range of documents, resources and guidance has been published by the PbR team for sexual health services, which fall into two development projects: integrated sexual health and HIV outpatient services. The HIV National Reference Group has also developed a simple guide to aid commissioners and providers apply the new currency in 2012/13. (DH, 03 Apr 12)

• DH > Policy News

Payment by Results (PbR) data assurance framework: 2012/13 programme: improving the quality of contracting and commissioning data The Audit Commission is changing the arrangements for delivering the PbR data assurance framework. Following a competitive procurement process, the Commission has appointed Capita to manage and deliver the programme in 2012/13. Capita will be responsible for delivering all of the audit work and maintenance of the PbR National Benchmarker. Members of the Commission’s PbR team, including Peter Saunders, will transfer to Capita.

As the 2012/13 programme is likely to be the final year managed by the Audit Commission, the Commission is working with the DH, the NHS Commissioning Board, Monitor and the Information Centre to ensure the

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assurance checks form part of future pricing and wider data quality programmes. (Audit Commission, 02 Mar 12)

• Audit Commission > Health Studies

SCOTLAND

Compound Healthcare Headings model The NHS Scotland Data Recording Advisory Service has published the 4th edition of the Compound Healthcare Headings (CHH). The CHH Model has two functions. It provides navigation to a range of national and international information resources, which can help health and care providers understand and share information consistently, effectively and efficiently across all care settings. It provides a structure with a hierarchy and defined headings, which can aid system management as information can be stored consistently under agreed headings to allow consistent storage to support easier retrieval and sharing of information. (ISD Scotland, 01 Apr 12)

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WALES

Welsh Government announces radical reform of social services New proposals to reform social services have been announced by the Welsh Government. The proposed Social Services (Wales) Bill aims to give people greater freedom to decide which services they need while offering consistent, high-quality services across the country. (Welsh Government, 12 Mar 12)

• Press release

EUROPE

Key specifications for interoperability The European Commission has reached an agreement with the World Wide Web Consortium (W3C) on the sustainability of key specifications to facilitate interoperability, across borders and sectors. The Asset Description Metadata Schema (ADMS), together with three Core Vocabularies (Core Person, Core Business, and Core Location) created by the EU’s ISA programme, will be handed over to the W3C’s Government Linked Data (GLD) Working Group. The GLD Working Group was set up in 2011 to provide standards and other information which help governments around the world to publish their data as effective and usable Linked Data using Semantic Web technologies. The ISA Programme outputs will be published by the GLD WG as First Public Working Drafts for further consultation within the context of the typical W3C standardisation process. The desired outcome of that process will be the publication of these vocabularies as open Web standards available under W3C's Royalty-Free License. (European Commission, 30 Mar 12)

• Information Society News

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European medicines regulators agree a common, Europe-wide approach for the identification of commercially confidential information and personal data The Heads of Medicines Agencies (HMA) and the European Medicines Agency (EMA) have adopted a joint guidance document, providing for the first time for a consistent Europe-wide approach to the identification of commercially confidential information and personal data in a marketing-authorisation application. This is a major step for transparency. In future, regulatory authorities in the European Economic Area (EEA) will apply the same principles to identify which parts of an application dossier can or cannot be released in response to access-to-documents requests. This is regardless of whether the medicine concerned has been authorised using the centralised, mutual-recognition or decentralised procedures. The guidance document sets out how personal data as defined by the EU Directive 95/46/EC will be protected if it can lead to the identification of a person. The document gives further guidance on how to identify personal data relating to experts, staff or patients that should be redacted. (EMA, 27 Mar 12)

• Press release

European Medicines Agency launches electronic application form pilot The European Medicines Agency has launched a pilot of electronic application forms for submissions of centralised marketing authorisation applications. Scheduled to run until mid-July 2012, the pilot allows pharmaceutical companies to apply for initial marketing authorisation applications for human medicines, and variation and renewal applications for human and veterinary medicines, using an interactive PDF form.

The pilot is a key step forward in the Agency's drive towards the use of electronic applications as standard, using the Electronic Common Technical Document (eCTD) format. The forms were developed by the European Medicines Agency, working together with the European Commission and medicines regulatory authorities in European Union Member States. (EMA, 12 Mar 12)

• Press release

UNITED STATES

Meaningful Use, round two (part 1): CMS’s proposed rule on stage two objectives and measures Two Notices of Proposed Rule Making (NPRMs) from the US Department of Health and Human Services (HHS) have been published in the Federal Register. The proposed rule for Stage Two Meaningful Use objectives and measures from the Centers for Medicare and Medicaid (CMS) was quickly followed by the proposed new 2014 standards and certification criteria for electronic health record (EHR) technology from the Office of the National Coordinator (ONC). Both describe how providers qualify for incentive payments. The proposed rules initially engendered considerable excitement, but interested parties have now moved on to the detailed work of thorough review, analysis, and public comment, due by 07 May. CMS and ONC will then incorporate public commentary as appropriate and publish the final rules later this year. (Certification Commission for Health Information Technology, 21 Mar 12)

• CCHIT Blog: From the Chair

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NIST releases technical guidance for evaluating electronic health records The National Institute of Standards and Technology (NIST) has outlined formal procedures for evaluating the usability of EHR systems. The proposed usability protocol encourages a user-centred approach to the development of EHR systems. It provides methods to measure and address critical errors in user performance before those systems are deployed in a medical setting. The protocol is a three-step process consisting of an analysis of how the application functions, expert review, and validation testing of the user interface to make sure it works as intended. The protocol includes general steps and guidance for evaluating an EHR user interface from both clinical and human factors perspectives. The interface is then tested by representative user groups performing realistic tasks. (NIST, 20 Mar 12)

• NIST Tech Beat

HHS sponsors contest for Web app to identify local health trends The US Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) has launched a contest to develop a Web-based app to use social media data as an advance signal of a public health emergency. The online challenge runs until June 2012. The person or team developing the best application will receive $21,000 from ASPR. In addition, the winner will be invited to present the winning tool at a Fusion Forum, a discussion series sponsored by ASPR’s Fusion Cell for state and local health officials to help identify pioneering ways to move from open source information into use as a public health response. The winning application will be made available to state, territorial, tribal and local health agencies across the nation for use in their communities. (HHS, 20 Mar 12)

• Press release

IHTSDO

Resignation of Professor Martin Severs OBE The International Health Standards Development Organisation (IHTSDO) has announced the resignation of Professor Martin Severs OBE as the Chair of the Management Board. (IHTSDO, 16 Mar 12)

• Press release

Recently published standards

ISO/IEC TS 17022:2012 - Conformity assessment - Requirements and recommendations for content of a third-party audit report on management systems This technical specification contains requirements and recommendations to be addressed in a third-party management system certification audit report based on the relevant requirements in ISO/IEC 17021. (ISO, 19 Mar 12)

• Not yet adopted by BSI, so only available at a cost

ISO/IEC 29175:2012 - Information technology - Mobile item identification and management - User data for Mobile AIDC services This standard provides for the identification of user data for the purpose of encoding and identifying user data in Mobile AIDC services using ISO/IEC 29143 radio frequency (RF) tags, ISO/IEC 18000-63 RF tags, and

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ISO/IEC 15434-applied optically readable media such as linear bar codes and two-dimensional symbols. (ISO, 21 Mar 12)

• Not yet adopted by BSI, so only available at a cost

ISO/TR 14292:2012 - Health informatics - Personal health records - Definition, scope and context This ISO Technical Report defines a Personal Health Record (PHR). This definition is intended to help clarify the kinds of systems, on paper and electronically, that should be called PHR systems, in recognition of the lack of consistency in how this term is presently used. This Technical Report considers the PHR from the perspective of the personal information contained in it and the core services needed to manage this information; the many kinds of end user application that might be implemented and used to deliver PHR system functionality are not in its scope. However, the PHR is not a singular entity but rather the concept encompasses a spectrum of possible information repositories and services that meet different purposes consistent with the definition. This Technical Report therefore also discusses the scope of the PHR in terms of this spectrum, as a series of dimensions by which a PHR may be classified and therefore equivalent PHR products compared. One dimension to classify the kinds of collaborative care PHR provided by healthcare organisations is also included. (ISO, 09 Mar 12)

• Available on request – no cost

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ARTICLES

The accuracy of real-time procedure coding by theatre nurses: A comparison with the central national system The recent introduction of computerised theatre management systems has enabled real-time (point-of-care) operative procedure coding by clinical staff. However the accuracy of these data is unknown. The aim of this Scottish study was to compare the accuracy of theatre nurses’ real-time coding on the local theatre management system with the central Scottish Morbidity Record (SMR01). Paired procedural codes were recorded, qualitatively graded for precision and compared (n = 1038). In this study, real-time, point-of-care coding by theatre nurses resulted in significant coding errors compared with the central SMR01 database. Health Informatics Journal, Vol 18(1), Mar 12, 3-11 / Donald Maclean, Hakim Ben Younes, Margaret Forrest, Hazel K Towers

• Article available on request - cost

Characteristics of general practices associated with numbers of elective admissions In England both emergency and non-emergency hospital admissions have been increasing. Some elective admissions are potentially avoidable. The aim of this study was to identify the characteristics of general practices and patients associated with elective admissions. A cross-sectional study, in Leicestershire, was conducted using admission data (2006–07 and 2007–08). Practice characteristics (list size, distance from principal hospital, quality and outcomes framework score, general practitioner (GP) patient access survey data) and patient characteristics (age, ethnicity, deprivation, gender) were used as predictors of elective hospital admissions in a negative binomial regression model. Practices with a higher proportion of patients aged 65 years or greater and of white ethnicity had higher rates of elective hospital admissions. Practices with more male patients and with more patients reporting being able to consult a particular GP had fewer elective hospital admissions. For 2007–08 practices with a larger list size were associated with higher elective hospital admissions. Quality and outcomes framework performance did not predict admission numbers. As for unplanned admissions, elective admissions increase as being able to consult a particular GP declines. Interventions to improve continuity should be investigated. Practices face major problems in managing the increased need for planned care as the population ages. Journal of Public Health, Available online 23 Mar 12 / Mitum Chauhan, M John Bankart, Alexander Labeit, Richard Baker

• Article available on request - cost

Community Health Map: A geospatial and multivariate data visualization tool for public health datasets The US Department of Health and Human Services keeps track of a variety of health care indicators across the country, resulting in a large geospatially multivariate data set. Current visualization tools for such data

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sets make it difficult to make multivariate comparisons and show the geographic distribution of the selected variables at the same time. This article reports on the use of the Community Health Map, a web application that enables users to visualize health care data in multivariate space as well as geospatially. It is designed to aid exploration of this huge data repository and deliver deep insights for policy makers, journalists, consumer groups, and academic researchers. Users can visualize the geospatial distribution of a given variable on an interactive map, and compare two or more variables using charts and tables. By employing dynamic query filters, visualizations can be narrowed down to specific ranges and regions. Government Information Quarterly, Available online 13 Mar 12 / Awalin Sopan et al

• Article available on request - cost

Data display format and hospital ward reports: effects of different presentations on data interpretation Graphs are often used in medical communication, both in clinical practice and health management. They can help the processing of quantitative information but may also contribute to drawing wrong conclusions. The aim of this survey was to study the graphical perception of the data at the management level and its possible effects, showing how some criteria of appraisal of a phenomenon are influenced by the graphical format. One hundred and five medical doctors and health direction professionals of hospitals in Naples, Rome, Siena and Turin were interviewed. Four different graphs or table related to the same hypothetical data on average hospital stay in the period January 2000 to September 2003 were shown to participants, and their impressions were recorded. Less than one-fourth of the participants understood that the data set was the same for the different diagrams. The process of understanding is mostly correlated with being a director, having a degree in medicine and working in central–northern cities. The table seems easier for interpretation (98.1%), more suitable (84.8%), more used (92.4%) and more pleasant than other data presentation. On the other hand radar format had worse results in all questions. The choice of a graphical format may influence the understanding of data. Further research is needed in order to sustain the improvement of medical and health professionals’ knowledge in the display data format. European Journal of Public Health, Available online 20 Mar 12 / Alessandro Agostinelli et al

• Article available on request - cost

Exploring variations in lung cancer care across the UK - the story so far for the National Lung Cancer Audit The National Lung Cancer Audit was developed to improve the quality and outcomes of services for patients with lung cancer, knowing that outcomes vary widely across the UK and are poor compared to other western countries. After five years the audit is capturing approximately 100% of the expected

ISB Current Awareness Update – March 2012 - for internal use only 21

number of incident cases across hospitals in England, Wales, Scotland, Northern Ireland and Jersey. Measures of process and outcome have improved over the audit period, such as the histological confirmation rate (64-76%), the proportion of patients discussed in a multidisciplinary team meeting (78-94%), and the proportion of patients having anti-cancer treatment (43-59%), surgical resection (9-14%) and small cell lung cancer chemotherapy (58-66%). These national averages hide wide variations between hospitals providing lung cancer care which cannot be accounted for by differences in casemix. This paper describes the evolution of the audit and the ways in which it may have improved clinical practice. Clinical Medicine, Vol 12(1), Feb 12, 14-18 / P Beckett, I Woolhouse, R Stanley MD Peake

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A flexible database architecture for mining DICOM objects: the DICOM data warehouse Digital Imaging and Communications in Medicine (DICOM) has brought a very high level of standardisation to medical images, allowing interoperability in many cases. However, there are still challenges in attempting to data mine DICOM objects. Images (and other objects) from different vintage equipment will encompass different levels of the standard, and there are also proprietary "shadow" tags to be aware of. The database architecture described in this article "flattens" such differences by compiling a knowledge base of specific DICOM implementations and mapping variable data elements to a common lexicon for subsequent queries. The project is open sourced, built on open infrastructure, and is available at GitHub. Journal of Digital Imaging, Vol 25(2), Apr 12, 206-212 / Steve G Langer

• Article available on request - cost

Functional safety of health information technology This article introduces the conventional safety-related systems development standard IEC 61508 to the medical domain. It is proposed that the techniques used in conventional safety-related systems development should be utilised by regulation bodies, healthcare organisations and health information technology (HIT) developers to provide an assurance of safety for HIT systems. In adopting the IEC 61508 methodology for HIT development and integration, inherent problems in the new systems can be identified and corrected during their development. Also, IEC 61508 should be used to develop a healthcare-specific standard to allow stakeholders to provide an assurance of a system’s safety. Health Informatics Journal, Vol 18(1), Mar 12, 36-49 / Liam Chadwick, Enda F Fallon, Wil J van der Putten, Frank Kirrane

• Article available on request - cost

Giving office-based physicians electronic access to patients’ prior imaging and lab results did not deter ordering of tests Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. This article tests the generalisability of findings that support this

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assumption, based on an analysis of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Results shows that physicians’ access to computerised imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40–70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. The availability of an electronic health record in itself had no apparent impact on ordering; the electronic access to test results appears to have been the key. These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. The authors conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests. Health Affairs, Vol 31(3), Mar 12, 488-496 / Danny McCormick, David H Bor, Stephanie Woolhandler, David U Himmelstein

• Article available on request - cost

HERALD (Health Economics using Routine Anonymised Linked Data) Health economic analysis traditionally relies on patient derived questionnaire data, routine datasets, and outcomes data from experimental randomised control trials and other clinical studies, which are generally used as stand-alone datasets. This article outlines the potential implications of linking these datasets to give one single joined up data-resource for health economic analysis. The linkage of individual level data from questionnaires with routinely-captured health care data allows the entire patient journey to be mapped both retrospectively and prospectively. This is illustrated with examples from an Ankylosing Spondylitis (AS) cohort by linking patient reported study dataset with the routinely collected general practitioner (GP) data, inpatient (IP) and outpatient (OP) datasets, and Accident and Emergency department data in Wales. The linked data system allows: (1) retrospective and prospective tracking of patient pathways through multiple healthcare facilities; (2) validation and clarification of patient-reported recall data, complementing the questionnaire/routine data information; (3) objective measure of the costs of chronic conditions for a longer time horizon, and during the pre-diagnosis period; (4) assessment of health service usage, referral histories, prescribed drugs and co-morbidities; and (5) profiling and stratification of patients relating to disease manifestation, lifestyles, co-morbidities, and associated costs. Using the GP data system, the authors tracked 183 AS patients retrospectively and prospectively from the date of questionnaire completion to gather the following information: (a) number of GP events; (b) presence of a GP 'drug' Read codes; and (c) the presence of a GP 'diagnostic' Read codes. 236 and 296 AS patients were tracked through the OP and IP data systems respectively to count the number of OP visits and IP admissions and duration.

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The authors conclude that the linked data system offers unique opportunities for enhanced longitudinal health economic analysis not possible through the use of traditional isolated datasets. Additionally, this data linkage provides important information to improve diagnostic and referral pathways, and thus helps maximise clinical efficiency and efficiency in the use of resources. BMC Medical Informatics and Decision Making, Available online 29 Mar 12 / Muhammad J Husain et al

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Icon and user interface design for emergency medical information systems: A case study This article reports on the design of a graphical user interface for a medical information system to be used in two Turkish hospitals. A participatory process ensured the participation of clinical staff at all stages of the design and installation. The process consisted of task and user analysis, an icon design survey, initial icon design, final icon design and evaluation, and installation of the iconic medical information system with the icons.

International Journal of Medical Informatics, Vol 81(1), Jan 12, 29-35 / Y Batu Salman, Hong-In Cheng, Patrick E Patterson

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Integrating a health-related-quality-of-life module within electronic health records: a comparative case study assessing value added Health information technology (HIT) applications that incorporate point-of-care use of health-related quality of life (HRQL) assessments are believed to promote patient-centred interactions between seriously ill patients and physicians. However, it is unclear how willing primary care providers are to use such applications. The specific aim of this study was to explore factors that providers consider when assessing the value added of an HRQL application for their geriatric patients.

The primary factors providers considered when assessing value added were whether the HRQL information from the module was (1) duplicative of information gathered via other means during the encounter; (2) specific enough to be useful and/or acted upon; and (3) useful for enough patients to warrant time spent reviewing it for all geriatric patients. Secondary considerations included level of integration of the HRQL and EHR, impact on nursing workflow, and patient reluctance to provide HRQL information.

The authors conclude that HRQL modules within electronic health record systems offer the potential benefit of improving patient centredness and quality of care. However, the modules must provide benefits that are substantial and prominent in order for physicians to decide that they are worthwhile and sustainable. Implications of this study for future research include the identification of perceived "costs" as well as a foundation for operationalising the concept of "usefulness" in the context of such modules. Finally, developers of these modules may need to make their products customisable for practices to account for variation in EHR capabilities and practice workflows.

BMC Health Services Research, Available online 19 Mar 12 / Christopher M Shea, Jacqueline R Halladay, David Reed, Timothy P Daaleman

• Access to full text (open access)

ISB Current Awareness Update – March 2012 - for internal use only 24

Integration of a nationally procured electronic health record system into user work practices Evidence suggests that many small- and medium-scale electronic health record (EHR) implementations encounter problems, often stemming from users' difficulties in accommodating the new technology into their work practices. There is the possibility that these challenges may be exacerbated in the context of the larger-scale, more standardised, implementation strategies now being pursued as part of major national modernisation initiatives.

The authors sought to understand how England's centrally procured and delivered EHR software was integrated within the work practices of users in selected secondary and specialist care settings, through a qualitative longitudinal case study-based investigation drawing on sociotechnical theory in three early adopter sites.

Results suggest that the nationally led "top-down" implementation and the associated focus on interoperability limited the opportunity to customise software to local needs. Lack of system usability led users to employ a range of workarounds unanticipated by management to compensate for the perceived shortcomings of the system. These had a number of knock-on effects relating to the nature of collaborative work, patterns of communication, the timeliness and availability of records (including paper) and the ability for hospital management to monitor organisational performance.

This work has highlighted the importance of addressing potentially adverse unintended consequences of workarounds associated with the introduction of EHRs. This can be achieved with customisation, which is inevitably somewhat restricted in the context of attempts to implement national solutions. The tensions and potential trade-offs between achieving large-scale interoperability and local requirements is likely to be the subject of continuous debate in England and beyond with no easy answers in sight.

BMC Medical Informatics and Decision Making, Available online 08 Mar 12 / Kathrin M Cresswell, Allison Worth, Aziz Sheikh

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Lexically suggest, logically define: Quality assurance of the use of qualifiers and expected results of post-coordination in SNOMED CT

A study of the use of common qualifiers in SNOMED CT definitions and the resulting classification was undertaken using combined lexical and semantic techniques. The accuracy of SNOMED authors in formulating definitions for pre-coordinated concepts was taken as a proxy for the expected accuracy of users formulating post-coordinated expressions. The study focused on "acute" and "chronic" as used within a module based on the UMLS CORE Problem List and using the pattern of SNOMED CT’s definition Acute disease and Chronic disease. Scripts were used to identify potential candidate concepts whose names suggested that they should be classified as acute or chronic findings. The potential candidates were filtered by local clinical experts to eliminate spurious lexical matches. Scripts were then use to determine which of the filtered candidates were not classified under acute or chronic findings as expected. The results were that 28% and 20% of candidate chronic and acute concepts, respectively, were not so classified.

Of these candidate misclassifications, the large majority occurred because acute and chronic are sometimes specified by qualifiers for clinical course and sometimes for morphology. This heterogeneous representation reflects a potential conflict between common usage in patient care and SNOMED’s origins in pathology. The effort required for the study was kept modest by using module extraction and scripts, showing that such quality assurance of SNOMED is practical.

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The results of a preliminary study using proxy measures must be taken with caution. However, the high rate of misclassification indicates that, until the specifications for qualifiers are better documented and/or brought more in line with common clinical usage, anyone attempting to use post-coordination in SNOMED CT must be aware that there are significant pitfalls.

Journal of Biomedical Informatics, Vol 45(2), Apr 12, 199–209 / Alan Rector, Luigi Iannone

• Article available on request - cost

MCORES: a system for noun phrase coreference resolution for clinical records Narratives of electronic medical records contain information that can be useful for clinical practice and multi-purpose research. This information needs to be put into a structured form before it can be used by automated systems. Coreference resolution is a step in the transformation of narratives into a structured form. This study presents a medical coreference resolution system (MCORES) for noun phrases in four frequently used clinical semantic categories: persons, problems, treatments, and tests. The authors conclude that in comparison with other systems MCORES has enhanced features which lead to superior performance. Journal of the American Medical Informatics Association, Available online 14 Mar 12 / Andreea Bodnari, Peter Szolovits, Özlem Uzuner

• Article available on request - cost

Mining geriatric assessment data for in-patient fall prediction models and high-risk subgroups Hospital inpatient falls constitute a prominent problem in terms of costs and consequences. Geriatric institutions are most often affected, and common screening tools cannot predict inpatient falls consistently. The objective of this study was to derive comprehensible fall risk classification models from a large data set of geriatric inpatient assessment data, and then to evaluate their predictive performance and to identify high-risk subgroups from the data. The study data set comprised all inpatient episodes from July 2006 to December 2007 at the Evangelisches Geriatriezentrum Berlin, being the largest geriatric clinic in Germany. Results suggest that classification models derived from a large data set using data mining methods can compete with current dedicated fall risk screening tools, yet lack diagnostic precision. High-risk subgroups may be identified automatically from existing geriatric assessment data, especially when combined with domain knowledge in a hybrid classification model. Further work is necessary to validate our approach in a controlled prospective setting. BMC Medical Informatics and Decision Making, Available online 14 Mar 12 / Michael Marschollek et al

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ISB Current Awareness Update – March 2012 - for internal use only 26

Patient-reported measures of psychosocial issues and health behavior should be added to electronic health records Recent legislation and delivery system reform efforts are greatly expanding the use of electronic health records. For these efforts to reach their full potential, they must actively involve patients and include patient-reported information about such topics as health behaviour, preferences, and psychosocial functioning. The authors offer a plan for including standardised, practical patient-reported measures as part of electronic health records, quality and performance indexes, the primary care medical home, and research collaborations. These measures must meet certain criteria, including being valid, reliable, sensitive to change, and available in multiple languages. Clinicians, patients, and policy makers must also be able to understand the measures and take action based on them.

Health Affairs, Vol 31(3), Mar 12, 497-504 / Russell E Glasgow et al

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Requirements for guidelines systems: Implementation challenges and lessons from existing software-engineering efforts A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. When analysing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies. BMC Medical Informatics and Decision Making, Available online 09 Mar 12 / Hemant Shah et al

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Semantic similarity-based alignment between clinical archetypes and SNOMED CT: An application to observations One of the main challenges of eHealth is semantic interoperability of health systems and this will only be possible if the capture, representation and access of patient data is standardised. Clinical data models, such as OpenEHR Archetypes, define data structures that are agreed by experts to ensure the accuracy of health information. In addition, they provide an option to normalise clinical data by means of binding terms used in the model definition to standard medical vocabularies. Nevertheless, the effort needed to establish the association between archetype terms and standard terminology concepts is considerable. Therefore, the purpose of this study was to provide an automated approach to bind OpenEHR archetypes terms to the external terminology SNOMED CT, with the capability to do it at a semantic level. This research uses lexical techniques and external terminological tools in combination with context-based techniques, which use information about structural and semantic proximity to identify similarities between terms and so, to find alignments between them. The approach exploits both the structural context of

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archetypes and the terminology context, in which concepts are logically defined through the relationships (hierarchical and definitional) to other concepts. This research shows that it is possible to automatically map archetype terms to a standard terminology with a high precision and recall, with the help of appropriate contextual and semantic information of both models. Moreover, the semantic-based methods provide a means of validating and disambiguating the resulting bindings. Therefore, this work is a step forward to reduce the human participation in the mapping process. International Journal of Medical Informatics, Available online 13 Mar 12 / María Meizoso García et al

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The SMART Platform: early experience enabling substitutable applications for electronic health records This article reports on the status of the Substitutable Medical Applications, Reusable Technologies (SMART) Platforms project, which seeks to develop a health information technology platform with substitutable applications (apps) constructed around core services. The authors believe this is a promising approach to driving down healthcare costs, supporting standards evolution, accommodating differences in care workflow, fostering competition in the market, and accelerating innovation. Journal of the American Medical Informatics Association, Available online 17 Mar 12 / Kenneth D Mandl et al

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Systematic review of discharge coding accuracy Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. The authors conclude that accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making. Journal of Public Health, Vol 34(1), 2012, 138-148 / E M Burns et al

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There are important reasons for delaying implementation of the new ICD-10 coding system Federal authorities in the United States have recently signalled that they would consider delaying some aspects of implementation of the newest version of the International Classification of Diseases, ICD-10-CM. Some industry groups have reacted with dismay, and many providers with relief. The authors express concern that adopting this classification system for reimbursement will be disruptive and costly and will offer no material improvement over the current system. Because the health care community is also working to integrate health information technology and federal meaningful use specifications that require the adoption of other complex coding standardisation systems (such as SNOMED CT), they recommend that the Centers for Medicare and Medicaid Services consider delaying the adoption of ICD-10-CM. Policy makers should also begin planning now for ways to make the coming transition to ICD-11 as tolerable as possible for the health care and payment community. Health Affairs, Available online 21 Mar 12 / Christopher G Chute et al

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Time to accelerate integration of human factors and ergonomics in patient safety Progress toward improving patient safety has been slow despite engagement of the health care community in improvement efforts. A potential reason for this sluggish pace is the inadequate integration of human factors and ergonomics principles and methods in these efforts. Patient safety problems are complex and rarely caused by one factor or component of a work system. Thus, health care would benefit from human factors and ergonomics evaluations to systematically identify the problems, prioritise the right ones, and develop effective and practical solutions. This paper gives an overview of the discipline of human factors and ergonomics. It describes its role in improving patient safety and provides five major recommendations to better integrate human factors and ergonomics in patient safety improvement efforts. BMJ Quality & Safety, Available online 21 Mar 12 / Ayse P Gurses, A Ant Ozok, Peter J Pronovost

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UK ethnicity data collection for healthcare statistics: The South Asian perspective Ethnicity data collection has been proven to be important in health care but despite government initiatives remains incomplete and mostly un-validated in the UK. Accurate self-reported ethnicity data would enable experts to assess inequalities in health and access to services and help to ensure resources are targeted appropriately. The aim of this paper is to explore the reasons for the observed gap in ethnicity data by examining the perceptions and experiences of healthy South Asian volunteers. South Asians are the largest ethnic minority group accounting for 50% of all ethnic minorities in the UK 2001 census. The findings of this Cancer Research UK commissioned study revealed that participants felt that accurate recording of ethnicity data was important in health care with several stating the increased prevalence of

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certain diseases in minority ethnic groups as an appropriate justification to improve this data. The overwhelming majority raised no objections to providing this data when the purpose of data collection is fully explained. This study confirmed that the collection of patients' ethnicity data is deemed important by potential patients but there remains uncertainty and unease as to how the data may be used. A common theme running through the focus groups was the willingness to provide these data, strongly accompanied by a desire to have more information with regard to its use. BMC Public Health, Available online 27 Mar 12 / Gulnaz Iqbal et al

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