NIH: Suggest social justice items for Electronic Health Records

My source: Spirit of 1848 list [The collaborative tool is very interesting]
Let's make suggestions for inclusion of social justice factors in Electronic Health Records by participating in the NIH activity described below.

Dear colleague,

Your input is requested to help make recommendations for a standardized set of patient-reported variables to be collected in primary care and public health electronic health records (EHRs), which will lead to unprecedented data harmonization and opportunities for health research. In order to participate in this process:

• Please visit the website for the collaborative tool: www.gem-beta.org
• Click on the blue button at the top titled "EHR Campaign." Or alternatively, click on the News tab and then the associated EHR campaign title.
• Read the summary statements written by the expert panels
• Enter your comments on the recommended measures, and if needed, suggest alternative measures (see attachment for detailed instructions).
• Forward this request to your colleagues who may be interested in this initiative

Comments will be accepted through April 4, 2011.

Background about this Collaborative Effort

Several institutes within the National Institutes of Health in collaboration with the Society of Behavioral Medicine are coordinating an effort to identify a core set of brief, practical measures to recommend for use in adult primary care and public health electronic health records (EHRs), and we are inviting you and all members of your affiliated organizations to join this collaborative effort.

The HITECH Act and the Patient Protection and Affordable Care Act place new emphasis on the widespread and meaningful use of electronic health records (EHRs). This is an important advance, with one significant exception: Currently EHRs fail to capture data reflecting crucial health behaviors and psychosocial issues. Such patient-reported variables are both health outcomes themselves, and major determinants of other health outcomes.

To address the critical need for patient-reported data, we are organizing an effort to evaluate and recommend actionable, patient-reported measures of health behaviors and psychosocial factors for use in electronic health records (EHRs) within adult primary care and public health settings. In order to facilitate broad participation in the development of standard measures we are using a three-phase process of consensus building.

In the first phase panels of subject matter experts were convened for each of 13 behavioral domains to review available measures and to recommend up to 4 reliable, practical measures for each domain that would be appropriate to utilize in primary care and public health settings and to be reported in EHRs.

*Your input is being requested for the second and third phases of the project.*

For the second phase we are using the NCIs Grid-Enabled Measures (GEM) Database to gather feedback from all stakeholders. In order to participate in this process, please visit the GEM website, www.gem-beta.org, and click on the blue button at the top titled "EHR Campaign." Or alternatively, click on the News tab and the associated header for the EHR campaign. Begin by reading the summary statements written by the expert panels, view the recommended measures, enter your comments on the recommended measures, and if needed, suggest alternative measures. Comments will be accepted through April 4, 2011.

The third phase will be a workshop/town hall meeting on May 2, 2011 at the NIH bringing together scientists, practitioners, policy makers, and patient/consumer representatives to review the results of this campaign and make recommendations on standard consensus measures for behavioral health and health behavior screening in primary care and public health settings. We encourage everyone interested in this effort to participate, and more information about this meeting will be forthcoming. Immediately following this workshop there will be a closed session meeting of key stakeholders to make final recommendations based on feedback obtained from the GEM tool and the open meeting.

Workshop participants will receive a summary of the meeting as well as information on final recommendations. Subsequent to the meeting, organizers and key stakeholders will discuss strategies to build support and implement plans to advance the adoption and incorporation of a core set of patient-reported behavioral and psychosocial measures in primary care and public health EHRs.

We truly thank you for your participation in this project to standardize the collection of behavioral data in EHRs because it will enable the collaborative group to put forth the best possible recommendations and ultimately improve patient outcomes.

Sincerely,

The EHR Measures Meeting Planning Committee
Maureen P Boyle, Ph.D.
AAAS Science and Technology Policy Fellow
Office of Behavioral and Social Sciences Research
Office of the Director, NIH
31 Center Drive, Building 31, Room B1-C19; MSC 2027
Bethesda, MD 20892-2027

'Health coaching': One application for the Health Care Domains Model?

The following message from Helen Erickson (Univ. of Texas) was received through the Modeling and Role Modeling mail list MRM-L at LISTS.UFL.EDU. It is the patient education aspect of the post that is of interest to me as it highlights why I continue to champion Hodges' model near and far.

'Coaching' (in its various forms) is a potential application for h2cm which can be used explicitly by explaining the model to the (potential!) patient / carer, or implicitly used by the health care professional as an aide memoire - a conceptual framework.

More to follow as I referred to the matter of health care delivery vs. health education in my presentation and the delegates raised the question of applications of Hodges' came up in Paipa last week.

<->

Good afternoon,

Some of you know that the healthcare bill signed last year (HR3590) includes a section aimed at revamping the healthcare system from a disease model to a health promotion, disease prevention. Section 4001 particularly addresses care for those on Medicaid and Medicare. A national advisory committee is being named to study this, make recommendations, etc (see Section 4001). Among the representatives of specific groups (orientation to health care) being named to the advisory group is the "health coach".

STTI and ICN put out a manual on coaching a year or so ago, coupled with a short CE test. When I read the manual and took the test (it took about 10 minutes total), I discounted the movement, thinking that it was just another way to define what we call MRM. The only difference is that it requires some specific strategies and skills, most of which I've discussed with you through the years, e.g. contracting, The other difference will be determined by what happens at the national scene. It is possible that "coaching" will be reimbursed. Many think that it will, thus the national group out of Harvard, the University of MN, and others are meeting, talking, defining the construct, etc.

As Chair of American Holistic Nurses' Certification Corporation, I have been drawn back to the topic repeatedly. Most recently, AHNCC has decided to actively explore certifying nurses who practice holistic health coaching, i.e.certifying a holistic health nurse coach. I have added a poll to the ahncc website, eager to learn if nurses are interested in the movement, etc. if you are interested in the website or want to express your position on health coaching, please visit ahncc.org.

Hope to hear from you,

Best to all,
Helen

2010-2011 posts, papers, studies and Drupal

Happy New Year everyone!

2010 saw 211 posts, 183 in 2009. As ever a mix of original material concerning h2cm, conferences and call for papers. Fingers x'd 2011 should run to approx 150 posts as I focus on work, studies and Drupal. The good thing for me is that all three of these can run along together and I intend to forge a union if at all possible.

At work my full-time role is clinical - nursing; Nursing Home Liaison. Increasingly we are finding what nurses on the ground have recognized for a long time. With this job comes an educational role, despite efforts to upscale the skills and knowledge of the residential care / nursing home sectors. H2cm is a gift in these quarters, in prompting and facilitating reflection, holistic and person-centred care.

Studies: On this front I'm trying to identify a research question from a bewildering mix of possibilities. Previously I've referred to the relevance and my interest in conceptual spaces:

Hodges' model: Background - Foreground and the Space Between

The socio-tech and conceptual space papers

Next paper? Conceptual Spaces and Hodges' model

Nursing theory - conceptual spaces: Where's my T-shirt?

Gardenfors' book - a quote and can that be, surely not ...h2cm?

That other 2nd-hand book - 'Conceptual Spaces'

This is definitely a worthwhile focus. I'm making enquiries to try to find a mentor. Strange, or maybe not actually, that I am a nurse mentor and sign-off mentor too and here I am coughing and spluttering in need of a mentor myself to help sort the wheat from the chaff. The 10K words on conceptual spaces is now 13K.

Today is a good day for throwing numbers about, but being short of time I hate wasting it. So I've been revisiting the papers situation. ...

The co-authored h2cm and forensic nursing paper is completed with two revisions, but still needs a home.

I missed an opportunity with the h2cm and substance misuse paper. Trying to complete it in the summer of 2009 before my eye surgery I did not stick to the brief. I'm hoping a new co-author can take the 5K words and help re-frame the content from a practice and service perspective. It really is refreshing to work with other people. I look forward to providing an update here later in the Winter - Spring.

Since this summer and the posts (one and two) about the Journal of Evaluation in Clinical Practice I've drafted a piece on h2cm and medical progress taking an informational perspective. I'm not sure if this will pass muster, but this 5K did not take too long and I enjoyed the process.

As to Drupal - I've hit the wall that has "styling" written all over it. It seems if you start with a basic theme like Zen you are rewarded with an easy to negotiate palette, that is - you do it yourself. With more complete themes you need to read and orientate yourself with somebody else's handiwork. This is the next job and then move to Drupal 7 - released on the 5th.

In October I received an invitation to present at an international nursing conference. I've submitted a presentation and have offered to do a workshop too. This was accepted. It all depends on travel and confirmation of arrangements so we will have to see. If they just wanted support with links they only needed to ask.

More to follow on all the above and wherever you are

may I wish you a very happy, healthy, 

peaceful and prosperous 2011!

To follow: Line of sight, lines of insight ...

Call for Papers: 1st Int. Workshop on Pervasive Care for People with Dementia and their Carers (PCPDC-2011)

(To the webmasters of http://www.pervasivehealth.org please check the status of your site - 'attack site')

Dublin, Ireland, 23 May 2011

http://trail.ulster.ac.uk/pcpdc/

To be held in conjunction with the 5th International ICST Conference on Pervasive Computing Technologies for Healthcare 2011

The global population of persons aged 60 and over is rising dramatically. Between 2006 and 2050, the number of people aged 60 and over will double from 650 million to 2 billion people representing 22% of humanity. One group of the ageing population that is particularly vulnerable to loss of independence is those affected by dementia. It is estimated that around 820,000 people in the UK have dementia. Recently emerging computing and assistive technology have been used to attempt to improve the quality of life for people with dementia..

The workshop aims to provide a forum for discussion on challenges and opportunities in bringing technology to support people with dementia. The workshop will feature the theme of ‘engaging people with pervasive technology’.

Research topics included in the workshop

This workshop will feature the theme of  ‘engaging people with pervasive technology’ in dementia research. Researchers from academic, healthcare, industrial and third party organisations are invited to contribute. Early researchers and researchers from healthcare are particularly welcome. Research areas include, but are not limited to:

Theme 1 – What are the opportunities of pervasive care technology?

Development of pervasive ICT systems
Human computer interface design
Behaviour monitoring and activity recognition
Knowledge representation and dissemination
Data analysis and interpretation
Sensor design and application

Theme 2 – User engagement

Key issues emerging when working with people who have decreased capacity for consent
Ethical issues for implementation
Methods for engagement
Pitfalls of engaging people with dementia, their carers and intermediate users

Important dates

Submission deadline:          25th February 2011
Notification of acceptance: 25th March 2011
Camera-ready copy due:    4th April 2011
Conference / Workshop:    23rd – 26th / 23rd May 2011

Format

Submitted papers should not be longer than 4 pages in standard IEEE two-column format.

For more detailed formatting instructions please see http://www.pervasivehealth.org/?page_name=author_skit.

Accepted papers will be published online in IEEE Xplore Digital Library (to be confirmed).

Shared Approach: 3 keys (and a certain conceptual framework)

Before we trip into 2011 let's make a quick return to 2008 and the three keys to the Shared Approach in mental health assessment [NIMHE, 2008] which are copied below.

In between each one I have highlighted how the Health Care Domains Model can contribute ...

1) active participation of the service user concerned in a shared understanding with service providers and where appropriate with their carers;

In the end (or at the beginning!) a model of care or assessment tool is only as good as the person using it.

To progress with key #1 there are in fact two locks to open. These are in the form of 'using' and 'user'. H2CM incorporates the individual from the outset. The model encourages consideration of the client's beliefs, preferences, and experiences ... Can the client and carer actually use the model themselves to help understand their needs, their care plan and interventions? Is there a homework exercise there for them?

Do they have capacity to decide? Do they need support - an advocate? How do we ensure the carer is factored into the care equation? Well, in h2cm that's through the social domain.

2) input from different provider perspectives within a multidisciplinary approach, and;

Do you know what "different provider perspectives within a multidisciplinary approach" look like?

Well just envisage that for a few moments. ...

A scary exercise, eh?

In order to take those different perspectives and integrate them a common framework is surely needed?

Artists are lucky they use perspective as an integrative lever on paper, canvas, or whatever medium.

Clients, carers, health and social care professionals need a canvas of their own, BUT one that is sufficiently generic and agnostic to be 'owned' by all. 

3) a person-centred focus that builds on the strengths, resiliencies and aspirations of the individual service user as well as identifying his or her needs and challenges. NIMHE (2008)

H2CM can support and foster person-centred care. The model is situated: there is one (changing) situation with the person at the center. Whatever the context -

strengths, resilience, stresses, vulnerabilities, aspirations, needs, challenges

- the care domains model is fit for purpose. Health and social care is dynamic, in person-centred care that focus needs to change accordingly. Our assessments and evaluations need to resolve the SCIENTIFIC, SOCIOLOGICAL, POLITICAL, INTERPERSONAL and SPIRITUAL dimensions of care while assuring the BIG picture.

Reference:
The National Institute for Mental Health in England (NIMHE) and the Care Services Improvement Partnership. 3 Keys to a shared approach in mental health assessment. London: Department of Health; 2008.
Available from: http://www.3keys.org.uk/downloads/3keys.pdf

Information Revolution and Greater Choice and Control - webchat Nov 9

Put your questions about the Information Revolution and Greater Choice and Control direct to Andrew Lansley, Secretary of State for Health, on November 9 at 1.30pm.

People can ask questions in advance by emailing:
informationrevolution AT dh.gsi.gov.uk - or -

 by Tweeting their question, using the hashtag #inforevolution.

The webchat will be available from November 9 at www.dh.gov.uk/informationrevolution and you can watch the live Q&A on screen, ask questions and leave comments. We will also be tweeting Andrew Lansley's answers and the comments we receive. A transcript of the webchat will be available on the website after the event.

I would be grateful if you could bring this to the attention of any interested individuals or groups.

With best wishes

Anne Cooper
National Clinical Lead for Nursing
Office of the Chief Clinical Officer
NHS Connecting for Health
anne.cooper AT nhs.net
http://www.connectingforhealth.nhs.uk
NHS Connecting for Health supports the NHS in providing better, safer care by delivering computer systems and services which improve the way patient information is stored and accessed.
Additional link:
http://conversations.dh.gov.uk/2010/10/17/home/
My source:
British Computer Society Nursing Specialist Group

The Empowered Patient Conference

HIFA2015 brought this conference to my attention rather late, but it is nonetheless well worth posting. Indirectly for the health career model, which can facilitate patient and carer education and empowerment. In addition to demonstrating the global potential of h2cm this announcement also demonstrates how small the world is becoming. I had the pleasure of hearing Mark Duman present in Manchester at a local BCS medical informatics meeting in the spring. I've since maintained a link to the Patient Information Forum here on W2tQ and Links III - 'Patients, Carers & Self-Care'.

If you are organising a conference or event for 2011 ... please let me know. I may be able to assist with free publicity on the care domain pages interpersonal, sciences, political or sociology - especially if your themes are similar: nursing, informatics, education, global health, self-care. ...

HELP is pleased to organize The Empowered Patient Conference in Mumbai on 20 October. The website is at http://www.patientpower.in/

Traditionally, Indian patients were passive and were quite happy to leave all medical decisions to the doctor. However, times have changed, and internet positive patients are hungry for information and want to work in partnership with their doctor. This is a huge challenge - and a great opportunity as well. We feel patients are the largest untapped health care resource and that Information Therapy is Powerful Medicine!

In partnership with the Patient Information Forum, UK, HELP is organizing The Empowered Patient Conference. Our keynote speaker will be Mr Mark Duman, President of PiF:
http://www.pifonline.org.uk/home/

Information Therapy can help patients (and health insurance companies!) save money on medical care by:

1. Promoting SelfCare and helping them to do as much for themselves as they can.
2. Helping them with Evidence-Based Guidelines, so that they can ask for the right medical treatment that they need - no more and no less.
3. Helping them with Veto Power, so they can say No to medical care they don’t need, thus preventing overtesting and unnecessary surgery.

Information Therapy is good for doctors and hospitals as well, as patients who are well-informed have realistic expectations of their treatment. They are much more likely to have a good medical outcome and much less likely to sue.

How can we all work together - doctors, patients, hospitals, health insurance companies and IT companies, to ensure that patients are at the heart of everything we do in healthcare?

Dr Aniruddha Malpani, MD
Medical Director
HELP - Health Education Library for People
Excelsior Business Center,
National Insurance Building,
Ground Floor, Near Excelsior Cinema,
206, Dr.D.N Road, Mumbai 400001

Helping patients to talk to doctors! Information Therapy is the Best Prescription!
Read over 20 health books free at www.helpforhealth.org
Read my blog about improving the doctor-patient
Relationship at http://doctorandpatient.blogspot.com/
Join India’s first health wiki at www.myhealthpedia.in

Naivety [I] ever unfolding : ever present - SCIENCES

naivety [naɪˈiːvtɪ], naiveté, naïveté [ˌnɑːiːvˈteɪ]n pl -ties, -tés

1. the state or quality of being naive; ingenuousness; simplicity

2. a naive act or statement

My source:
http://www.thefreedictionary.com/naivety

There are times when we are all naive. It can be so embarrassing! When you realise, or more severely are made aware by others the abrupt learning is suddenly resolved. Within the bounds of the health career model, naivety can be found and is expressed in so many ways.

Hodges' model may appear naive in its simplicity, but behind that simplicity there are several assumptions. When you act as scribe, reader or doer you exercise the model's structure. You potentially demonstrate several levels of literacy.

If the health career model can represent most 'everything', then naivety should be no problem. So, if we visit each of the care domains in turn what can we find?

SCIENCES

I came across a post: 'We are all naive scientists' on The Financial Philosopher blog which includes this quote:

"It is clear, then, that the idea of a fixed method, or a fixed theory of rationality, rests on too naive a view of man and his social surroundings." ~ Paul Feyerabend

Regularly, I ask myself if I am naive in this particular domain. Am I right to assume that there are questions in nursing that can be answered (or at least reflected upon) using Hodges' model? Furthermore, can this use, this application be demonstrated in a scientific (evidenced) way?

Does experience of programming in BBC Basic as an enthusiast really help equip me now to get to grips with PHP, using Drupal and even Ruby?

Is information (and informatics) really the all encompassing Swiss army knife of a concept I take it to be?

The most extreme naivety here is not mine, however; it is as Feyerabend suggests the one that is in diagonal opposition. It is the scientific naivety of the masses in the social domain. Is this ignorance? In some cases, yes. But the tabloid (gutter) press shouts aloud when science gets it wrong; or, more accurately industrial porcesses based on science totally mess up.

The masses are not divorced from science. True, there was (still is?) a promised intimate relationship borne of equality and egalitarian ideals (education), but this naivety matures in real (social) time also known as life-chances. Its cost is not just red-faced, but illiteracy and exclusion at a time when literacy, inclusion and engagement are paramount.

FROM: A community mental health context TO: Acute EMR/EHR and other ...

or: Will 21st Century health and social care informatics truly begin on Sunday 10 10 10 ?

I've been a nurse AND info tech / informatics enthusiast since 1981. As an advocate of info-tech as a means to improve the quality, effectiveness and safety of health care - I must confess; I feel I have let down those colleagues purely there to 'nurse'. (Don't worry, I am also a realist and post-therapy!).

After 20+ plus years the nearest we (the team and I) got to a system that answered our questions was a small PICK database and a later MS Access database. These focused on referrals and data capture - demographics, problems, interventions (WHO and what) and outcomes. Although the number of data items was not great, no more than 30 the insights we could glean from queries was surprising. People versed with databases, datasets and research readily appreciate how even small datasets, carefully thought out and planned, can answer a diverse range of questions (and generate countless new ones too!).

I noticed in the mid-1980s to mid-1990s the development of customer management software and recognised that clinicians have a need: caseload management.

Even now the requirement of 'X' visits per day, the number of information systems and lack of integration (health - social care) mean that in many instances there is still no readily accessible caseload manager for the individual practitioner. This is an outcome and amid all the talk around 'engagement' (with a 'E').

Perversely, ironically, paradoxically (take your pick) at a time when Lean is (presented and) needed, there are scarce resources to do the things that should now be embedded (routinised) into the life history of the professional. This includes what the professionals do WITH the patients, carers, data, information ...

I speak to student nurses (and other disciplines) regularly as a nurse mentor and sign-off mentor. Their exposure to health care informatics to me is minimal, adhoc, and when it has happened it has signally failed to strike a cord. A very small (and so non-significant*?) sample admittedly.

Informatics remains an academic 'must do'.

Perhaps 21st century informatics only begins on Sunday -

101010

Whatever:
as it stands informatics is a management pursuit.

Slippage is a fact of project management, but words present their own challenge when target driven 'secondary' uses become 'primary'.

*surely not.

[A version of this post first appeared on the Healthcare Information and Management Systems Society HIMSS group on LinkedIn.]

Healthy Active Ageing Virtual Global Discussion Forum: Int. Day of Older Persons 2010

Dear Colleagues,

The World Health Organization, Departments of Reproductive Health and Research, Human Resources for Health, University of Iowa Hartford Center of Geriatric Nursing Excellence, and Partners would like to invite you to join Healthy Active Ageing Virtual Global Discussion Forum - 1-12 October 2010.

Join us in creating an interprofessional network involving representatives from health professions, policy makers, programme managers, international organizations/agencies, universities, research institutes and our clients to share our knowledge and experience on issues that affect healthy ageing.

REGISTER NOW! http://knowledge-gateway.org/ahaa

Share your experience, your opinion on issues that affect us all, as individuals, families and health practitioners. Contribute through this forum to the policy and practice dialogue.

During this twelve day forum you will receive two emails per day; one email to introduce the day’s questions and one daily digest of the contributions. Daily questions will be disseminated within three topic areas:

• Challenges and opportunities to support healthy active ageing
• Sharing of success stories
• Caring for older persons with dementia

Once you have registered you can participate in the forum simply by responding to the daily emails or sending a message directly to ahaa at knowledge-gateway.org

You can also log into http://knowledge-gateway.org/ahaa to browse the archived discussions and resource materials.

For any questions on this Virtual Global Discussion Forum please contact the forum facilitator: 
Christina Fusco christyfusco at gmail.com

Please pass this invitation onto your colleagues and networks.

With kind regards,

Maggie Usher-Patel
Scientist/IBP Secretariat
WHO/RHR

My source: HIFA2015

Additional links:
Full of Life  - http://www.dwp.gov.uk/policy/ageing-society/full-of-life/
International Day of Older Persons - http://www.timeanddate.com/holidays/un/international-older-persons-day

Report: Open data, democracy and public sector reform

From: Tim Davies tim@practicalparticipation.co.uk
Date: Wed, Sep 8, 2010 at 2:35 AM

Open data, democracy and public sector reform is a report based on a recent MSc dissertation taking a look at the policy and practice of using open government data from data.gov.uk. It's now up as an online document at -
http://practicalparticipation.co.uk/odi/report/

In looking at how open government data is being used in practice it draws out a number of themes, including:

Data is not just for developers
- there is a tendency to focus on machine-readable data for large scale visualisations and mash-ups; but data can be useful to individual citizens or local citizen activists, finding facts within spreadsheets and campaigning for change locally.

Open government data changes the gatekeepers, and the role of civic actors
- now mainstream media, independent citizens, companies and different levels of government are all afforded the possibility of advancing their own interpretations of data. Government, however, retains some (significant?) gate-keeping power by setting the categories and structure in which data is recorded and released. Debates over the meaning of data become more important - and the capacity of local democratic actors to be part of those debates again needs to be developed.

Open government data can support innovation in public services
- predominantly through improving the 'markets' for public service innovation - allowing social and commercial entrepreneurs to work with government data, and preventing exclusive access to data being an anti-competitive advantage for certain firms. However, the research didn't find cases where open government data was successfully facilitating 'citizen led' forms of public service innovation involving local communities discussing and debating how services operated.

A focus on digitizing government underlies much open government data supply and use, and can lead to concerns of politics, power and justice being under-valued in the development of open government data infrastructure
- and we need more articulation and focus on real-live civic use-cases of open government data to inform the development of open data infrastructures.

All comments and feedback on the report welcome - particularly to help shape thinking about what to do with the research next.

http://www.timdavies.org.uk
@timdavies

Co-director of Practical Participation:
http://www.practicalparticipation.co.uk

My source:
ciresearchers at vancouvercommunity.net

compose, direct, conduct and 'dilute to taste' outcomes

In Drupal musings 12 I mentioned that the classification of nursing practice is not necessarily at the forefront of nursing's mind set against the turbulence and rush of clinical areas.* This is especially so at the moment as nurses on wards, clinics and community try to identify savings.

I am interested in classification in part as this is the raison d'être for the health career model; on a mental (cognitive) level, in practice and potentially in virtual representations of health care activities. For learners it is an extra to hold the bicycle saddle for those first turns of the pedals. Additionally, for those who have completed many rides and races (lifelong learners) they can reflect on how they got there, and plan for the next round.

As a conceptual framework then h2cm is, like classification, in the background. The model can help to compose, direct and conduct (c-d-c) nursing (health and social) care. Classification matters to ALL nurses because we need to know not only the c-d-c of nursing but the outcomes too.

If all the above is in the background, then together with classification the health career model can help differentiate nursing as a discipline and make nursing visible. We can only take heed of the adage "divide and conquer" by being able to differentiate nursing from other disciplinary contributions. Then perhaps we can truly identify and so define the facets of integrated, interprofessional and multidisciplinary care that must also be person-centred. As nurses and the team respond to the individual's trauma (assault, illness, chronic disease ...), they can also assure their combined values, which must be defined and articulated if there is to be a unified philosophy.

If the respective professions have not noticed (I am sure they have) 'professionalism' is itself under assault in terms of unique knowledge and skills, respect, power and status. To a degree this a good thing. It is also called 'progress': countering restrictive practices, improving service access and challenging institutionalised and state paternalism. Professionalism is accorded for reasons of accountability, education, responsibility, integrity and advocacy. Amid the public (mental) health disaster that we face - the professions - are needed more than ever and if the assault is taken too far ... ?

* Should you know of examples where classification IS at the forefront of nursing practice please let me know - h2cmng @ yahoo.co.uk.

Music Gym - flexes its muscles

Hi,

My name's Matt, and I'm the Roadshow Coordinator for Decoda with some information which I hope will be of interest to those of you in or around the area of Lancaster and Preston.

Decoda have been successfully running a Music Gym down in Hastings for the past five years, continually developing and refining their techniques and technologies, whilst building a rapport with those who attend week after week. Using an innovative combination of music, images, space and fun the Music Gym provides an effective, flexible platform to engage and entertain people with a variety of complex needs. It’s also a great opportunity for parents, carers and those they care for to meet others from the local area and socialise. Others have described us as:

'fantastic use of colour and music, very interactive and inviting.'

'A really intriguing and dynamic approach'

'An excellent resource – we need more like this.'

'A great range of innovative, creative equipment... lots and lots of fun.'

'... a wonderful innovative idea.'

We have been invited to bring the Music Gym to Lancashire this month, and so we’ll be at the Salt Ayre Sports Center in Lancaster on the 16th and 17th of August, and at the Caritas Deafway home in Preston on the 18th [Deafway, Brockholes Brow, Preston, Lancashire, PR2 5AL].

If you would like to see the gym in action prior to making a decision (Or just see it in action without attending), I see no reason why you would not be allowed to observe any of the sessions we’re holding at the Salt Ayre. I appreciate that it is very difficult to form an opinion of what we do without seeing it in action, and this is a really good chance to do so. The 16th has been set aside for children under 16 years of age, whilst the 17th is for adults. Preston is undecided to be totally honest, we were contacted towards the end of last month, and are in the process of ironing out the final details. One benefit of this is that it’s an ideal date for those individuals who require a less busy venue, as we have not that long to publicise it. It is however a smaller venue than the Salt Ayre, so we may not be able to have our full facilities on offer on that date.

The days have been divided into 5 slots each as follows: 10.00-10.45 11.00-11.45 12.00-12.45 13.00-13.45 14.00-14.45

From our experience in Hastings, I would predict that the 11.00 slot will be the quietest, whilst the 14.00 slot will be the busiest, should that have any bearing in your decision.

In our continuing efforts to bring this to as many people as possible we are offering these places at £7.50 each if booked in advance £10 at the door (carers come free), additionally where this may be helpful, siblings can attend the session for £2.50. This is a great opportunity for people in the local area to get together, try out the facilities and enjoy the real benefits of the Music Gym.

Places can be booked online http://www.decoda.org/node/50 by phone or by post (contact details below).

If you require any more details, or have any questions at all please do not hesitate to contact me roadshow@decoda.org

Many thanks, Matthew Saunders, Roadshow Coordinator

Decoda - a social enterprise benefiting the local community South East Coast Regional winners of the Innovative Health and Social Care Technology Award at the NHS Health & Social Care Awards June 2009

Theaklen House Theaklen Drive St. Leonards on Sea TN38 9AZ Tel: 0845 2938354 websites: www.decoda.org www.musicgym.org www.myspace.com/decodamusicgym www.soundtherapy.org.uk BBC's South East Today film about the Music Gym is at http://www.youtube.com/watch?v=8j7v7pQ9kYQ

My source:
Foundation for People with Learning Disabilities

BBC R4 Friday 8th Jan: NHS Punters Speak Out

This programme (episode 1) is on BBC Radio 4 on Friday 11.00:

With the help of dissatisfied NHS patients, Liz Barclay asks if the growing popularity of online feedback can really make a difference to standards of health care and treatment.

The culture of customers offering brickbats and bouquets to service providers has now extended beyond hotels and coffee chains to the NHS. Hospital rating websites invite patients to grade their hospital stay out of five stars, and to leave comments about the care they received.

Liz invites NHS patients who have used one of these patient rating websites to discuss their experiences and puts their points to the hospitals where they were treated.

She asks if the idea of online feedback can be really be applied to our health service and if it can genuinely improve standards of care. Critics suggest the sites are merely window-dressing and that NHS patients are not 'consumers'. Some health professionals claim that the sites can easily just become places where personal scores are settled against NHS staff.

<->

Introductions to Hodges' model for different audiences -

"Patiency" (person-centred care)	Health, Social Care professionals (inc. all in a student capacity)
The Public, Citizens	Managers, Policy Makers

These introductions will be re-written for the new website and represent possible projects for volunteers / students...?

h2cm - Being at the center of things [I]

The center of Hodges' model can represent many things:

an epistemological nexus for the transdisciplinary dependencies of our times
multidisciplinary coffee shop
self-care engagement stage
the chaos of all things
holistic harmony
integrated idyll*

More down to Earth and acknowledging this cruciform '+' structure as a mythic device, in addition to searching for the mysteries of the universe at the center we can also place the 'well' person there.

As the previous post on ADLs suggests the 'well' person can function on a basic level and has negotiated the four axes and the four and five fold knowledge domains. They can therefore be considered (sufficiently) wholly integrated. We are all travellers, constantly traversing these domains of experience consciously, unconsciously, expertly or with the awkwardness that denotes the novice.

Conversely and reflecting the model's utility: it is also possible to locate the unwell individual in the center too. In this instance the placement suggests impoverishment of experience, ongoing personal and social stasis and in the case of substance misuse the presence of specific disruptive focus and preoccupations. The person becomes lost to their potential, stuck in a 4:5-fold minima. They continue to travel chronologically, but the journey is spiral, self-iterative and diminishing by return.


However: what you can see you can change, or come to terms with.

*from Greek eidyllion, little picture (h2cm as a snapshot).

Image source: http://www1.lsbu.ac.uk/water/protein2.html

Innovation and the 'middle' in NHS computing

Let's start with a quote:

Information systems are no longer associated mainly with data processing; they are increasingly seen as a management tool and an aid to action. This means that the costs of failure are much greater, and these costs are incurred when expensive systems are not used or are inadequately used. Surveys have shown that in as many as half of systems there are large gaps between users' expectations and the system's performance.

When do you think the above was written?

Here's the reference:

Mumford Enid (1991) Need for relevance in management information systems: what the NHS can learn from industry. BMJ. June 29; 302(6792): 1587–1590

1991: quite sobering really.

Previous - part-time - work reviewing data standards proposals focuses the mind in terms of the role of standards in interoperability, service impact and other essential assessment qualities. As the NHS has sought to implement standards as with the National Programme for IT you are also aware of the clamour for creativity and innovation. Innovation is there in the title of agencies.

I have long pondered about the extent to which - like Nature and vacuums - standards abhor innovation and creativity. How much is the 'standard' about doing things by the 'book' ... page 57 : para.3 ...

My eye caught the viewpoint piece in this week's Computing -

If you approach the world positively, a downturn is a good time for innovation. The shortage of people and money can create the pressure that leads to creativity. There are three areas where action will help organisations succeed in exploiting IT to enable business innovation:

Kick out Prince2

What more is there to say about innovation and Prince2? The focus of the Prince2 project management methodology – on organisation and control, and defining what to deliver before you have begun – is death to innovation. It is a bad solution trying to solve the wrong problem. It takes the IT profession in the wrong direction if we want to contribute to business innovation. It has to go. The agile development movement provides much stronger foundations for succeeding with projects that result in business innovation.

Ashurst, Colin, Viewpoint: How to use IT to enable innovation, Computing, 5 November, 2009.

Of course there IS a world of difference between information standards and project management standards, but there is no escape from the need for (effective) management of transition and change WITH business continuity. Within that management - engagement approach (as per agile) -

+++++++ socio-technical +++++++

- perspectives, as highlighted by Mumford (and others) all those years ago must have a place.

Additional links:

Computing, Letter of the week, UK is cursed with an anti-innovation culture, 5 November

BCS Sociotechnical Specialist Group

eHealthNews NHS Bury Primary Care Trust Goes Live with iSOFT Lorenzo RC 1.9

Workshop - Delivering High Quality Health Care for All: Bringing the social and technical together...

My SOURCE: SOCIOTECH at JISCMAIL.AC.UK

Dear Colleague,

Please find details attached of a Think Tank focused on developing socio-technical approaches to the provision of healthcare (in the context of the National Programme for IT in the NHS).
Please note that attendance is restricted to around 30 people and that anyone wishing to contribute will need to apply (as specified in the attachment) - which follows below PJ.

Thanks and best wishes

Chris
P.S. please feel free to circulate these details to colleagues who you think may be interested. Thank you.

Professor Chris W Clegg
Centre for Socio-Technical Systems Design
Leeds University Business School
University of Leeds
Leeds
LS2 9JT
c.w.clegg at leeds.ac.uk

Delivering High Quality Health Care for All:
Bringing the social and technical together for a joined-up approach to deliver supporting systems and technologies
10th/11th December 2009

Call for contributions to an event organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group

Core idea
This 2-day Think-Tank event has been set up to discuss and report on how Health and Social Care employers and other key stakeholders in the Informatics field might bring about a joined-up approach to the implementation of electronic health records, one that brings together changes both in technology and in the social practices around it.

Rationale
The National Audit Office’s report on “Delivering successful IT-enabled business change” see: www.nao.org.uk/publications/nao_reports/06-07/060733es.pdf and the University College London Evaluation report on the Early Adopters of the Summary Care Records project (see: http://www.ucl.ac.uk/openlearning/documents/scrie2008.pdf) both highlight the challenges of implementing technology-based projects within a fixed time line and how this can reduce the opportunities to get a more “user-centred” approach to change.

In many sectors of the UK economy the drive to get the technology ‘on desk, on time, and on budget’ can mitigate against developing a full understanding and consideration of how the changes may be of real practical value to users and customers.

It is increasingly recognised that ‘technology-push’ will not be enough in its own right to achieve the full benefits and efficiencies that are being sought in service delivery. Rather, we need to bring about innovations both in the technical systems, and in the working practices, work roles and processes that surround them. Put bluntly we need a more joined-up approach to change. This has been variously called ‘user-centred’ or ‘socio-technical’ or ‘holistic’.

Objectives
The objectives of this event are to discuss and subsequently report on –
• What does such a joined-up approach mean in practice?
• What examples exist from across the UK Health and Social care sector where such approaches have been used?
• Who has to do what, to make it happen consistently across the NHS and Social Care services?
• How will we know if it is succeeding?

Organisers
The event has been organised by the UK Faculty of Health Informatics and the BCS Socio-Technical Group.

The event will be chaired jointly by Professor Chris Clegg, Chair of the British Computer Society’s Socio-Technical Group the and Doctor Beverley Ellis, Joint Vice-Chair of the UK Faculty of Health Informatics.

Getting involved as a contributor or delegate at the event
If you wish to attend the Think Tank, please submit an Expression of Interest (EOI) to Bruce Elliott, Co-ordinator of the UK Faculty of Health Informatics at bruceelliott@nhs.net by 28th September 2009.

Your EOI should include brief summary (of up to 200 words) of your role, experience and expertise in this context.

Please note we are seeking people from a range of stakeholder groups including:

• Acute Hospitals
• Suppliers
• Health and Care Commissioning organisations
• Primary and Community Care Providers
• End users of nationally-led systems, e.g., CMS, SCR, ECR
• Connecting for Health, Informing Healthcare and the Scottish Government’s E-Health Programme
• Academics
• Patient Leads

In the event that we are over-subscribed, we will select people so as to provide an appropriate balance of experience and expertise, to ensure the Think Tank can meet its objectives.

Please make it clear in your EOI if you would also like to present a short paper at the event. In such a case please also add a brief abstract of your proposed paper (of up to 200 words).

If you have been allocated a place you will receive written confirmation along with a copy of the final programme by 16th October 2009.

Associated papers
In November 2009, a Position paper capturing some of the Key Challenges in adopting Socio-Technical approaches will be shared with the participants to identify some of the key issues that will be addressed at the event.

Following the event, up to 5 contributors to the event will be commissioned to write papers on the topics and issues emerging, with the aim of informing key stakeholders in how Socio-Technical approaches can be utilised effectively across the NHS and Social Care. These papers will be completed by the end of January 2010, for inclusion in an overall Briefing report. We will also be actively exploring avenues for wider publication in order that the good ideas can be spread and acted on.

Location
Weetwood Hotel and Conference Centre, Leeds

Self-care in e-space and the need to Impress

Working with older adults you realise how unselfish a group they are with regards to their care needs: "spend the money on the children who need it, they are the future."

You also realise that although there are growing numbers of 'silver surfers' (sorry) and their number will swell - the use of digital technology by the general public remains yet another potential source of inequality.

Many years ago I came across HealthSpace (UK) as a fledgling approach and application. I was really impressed as it underlined the need for a generic conceptual framework for health and social care - from senior school through to older age.

It is often said that effective communication needs a channel that is noise free - well here in Hodges' model is a resource to reduce noise for health information across many contexts:

• education
• prevention
• consultation
• social marketing
• self-care
• care planning, evaluation and management
  
• carer support
• supervision

Demographics also underlines the opening remark in this post and for older adults and many younger that matter of choice arises when it comes to the deployment of digital technology. Yes, many forward thinking people will readily jump on board and use ICT to study, learn, commission, record and co-ordinate their own care - or that of a relative. But what about those who will not use HealthSpace or another personal health records [PHRs]?

For those who do not want to engage - are they to be literally pressed into service? Obviously not - and besides recruitment to the UK services is growing. Jokes aside though the pressure to get the public to add value to their own care is critical to the future sustainability of the health and social care system.

Which brings me back to HealthSpace and the following news on e-Health Insider:

'HealthSpace expansion plans shelved'

Last year’s Health Informatics Review outlined a wide-ranging role for HealthSpace, but the DH has now done a U-turn and demanded more evidence of the site’s value to patients before pushing ahead with further expansion.
...
An outline business case worth £80m to £90m – one source puts the figure at £98m - had been developed by CfH, which was to have been submitted to the Treasury earlier this year.

However, the DH is understood to have spiked the business case, seeking more evidence for the value of HealthSpace, which has not received the backing of Christine Connelly, director general of informatics.

Dr Neil Bacon, founder of the doctors’ website doctors.net and the patient website iwantgreatcare.org, said he was unsurprised that the DH had shelved its plans.

“I think this is their way of quietly getting rid of it,” he told EHI Primary Care. “In the commercial world, if a solution with more than 250,000 potential users had only been used by 400 people it would already have been put out of its misery.”

Dr Bacon said he believed there was a clear and growing demand for patients to manage their own health records but that innovative, entrepreneurial solutions rather than government-led solutions would meet that demand.

More to follow no doubt - but do take care even now if you live by the coast ....

Additional links:

Google Health

HealthVault Microsoft

DIY doctors: patients can boost NHS's value, 30 April 2009, HSJ, Paul Corrigan

Digital Britain

The Impress Service

The Royal Navy

Image source: Press Gang stamp

Congratulations to Paul Streets new Patient Voice Lead

Staying with the HSJ, this week (21 May) an 'in brief' item announces the appointment of the new Patient Voice Lead, Paul Streets - to whom I extend many congratulations! I note that:

His role includes developing methods of collecting near time patient feedback. p.8

Mr Streets could do worse than look (and listen) over here....

Hodges' model provides a person-centred, situated and multicontextual framework (across health and social care) that can be employed explicitly or implicitly. The model would also greatly benefit from and needs research and development.

While some of the comments in response to this on the HSJ site may reflect the current political-public pyrexia, perhaps they also demonstrate the need for a structured approach - an integrative and collaborative model?

Guidance: Breakthrough to real change in local healthcare - a guide for applications to create Health Innovation and Education Clusters (HIECs)

6 May 2009: The Department of Health is investing £10 million in the introduction of Health Innovation and Education Clusters (HIECs) across England. HIECs will be partnerships between NHS, higher education, industry and other public and private sector organisations. They will support the spread and adoption of innovation locally and strengthen professional education and training.

This guide describes the vision for HIECs, the role of HIECs in education and training, how HIECs will support innovation and the application process. This starts a period of informal dialogue with strategic health authorities (SHAs) and prospective HIEC partners, leading to expressions of interest in early September 2009 and a final announcement on the first wave of HIECs in December 2009. SHAs are co-ordinating applications and, as part of the process, they are arranging regional stakeholder events.

Contact details for the SHA in your area are included.

Published by Department of Health, UK