Head Informatics Development NHS Connecting for Health, UK.
Information has always been at the heart of healthcare delivery. Today, new information systems and technologies are becoming ubiquitous in health and give rise to new opportunities and challenges to the ways care is delivered and the way professionals work. Information sharing between professionals, care providers and sectors; and patient access to and management of their own records are driving changes in inter-professional relationships and care delivery processes.
So, information and information systems underpinned by technology are increasingly impacting directly on patient experiences of healthcare delivery and on their treatment and on the outcomes of their care. There is, as a result, an increasingly vocal group of professionals in health who would argue that if information, information systems and IT can positively impact upon patient care, then the converse must also be true. The UK Council for Health Informatics Professions (UKCHIP) has collected a catalogue of examples of healthcare delivery failures where information and IT systems are implicated in errors and even loss of life. Our information and IT systems, therefore, need to be safe; and the professionals—individuals and teams, who design, implement, support, manage and develop these systems must also be assured, as far as possible, as safe to practice. In an increasingly litigious world, is this an issue healthcare delivery organisations can continue to ignore?
Further, commercial pressures, whether in State—funded healthcare services which exists in the UK or private or insurance-based services (or indeed a mixed health economy)—have an obligation to deliver best value, high quality services that demonstrably use accepted standards and be committed to the principles of continuous improvement. Commissioners of services want to know they are buying a quality, value for money service; and service deliverers want a competitive edge in an increasingly pressured free market. In England, a further driver in the push for benchmarking and accreditation of both informatics practitioners and services and teams has been a continuing concern that recruitment and retention in informatics in health is problematic and that we just don’t have access to the right people with the right skills. When we find and appoint staff, the employment package is not sufficiently attractive to retain the best. Whilst there is a perception that pay is not as high in the public sector as it might be in the private sector, it is actually lack of status and lack of opportunities for career progression that drive staff out into the more lucrative private sector.
In the UK, UKCHIP now holds a professional register of some 700+ individuals and is in the process of applying for accreditation by the UK Accreditation Service which will authorise it to certify professional status. This will require a revision of existing standards for and levels of registration and further contribute to driving up quality and providing assurance to employers that staff are safe to practice having not only met the requisite standards but agreed to abide by a code of professional conduct and created a planned programme of continuous professional development.
IT and informatics are relatively young professions and are in the formative stages of development. They are sometimes criticised for not making faster progress but recent developments in English national informatics strategy indicate that the tide may be changing. There are a number of actions that could speed up progress, foremost of which are: 1. Giving informatics a place on Executive boards with a CIO type post reporting directly to the CEO
2. Organisations should expect professional accreditation/registration and include this in job descriptions and person specification
Developing an approach to benchmarking and accreditation of health informatics services
Let us move away from discussing the accreditation of informatics practitioners as individuals, to consider a range of issues associated with the benchmarking of health informatics services and teams.
A generally well-respected and well received scheme in England has been the Pathology Accreditation Scheme which combines an accreditation scheme with integral peer review and support for improvement through a programme of action learning to support service modernisation and continuous improvement, and the establishment of pathology (people) networks.
Quality improvement and value for money, together with large scale investment in health informatics systems, are at the heart of the need to ensure effective, efficient and safe health informatics services available to support clinical professionals twenty-four hours a day, seven days a week, 52 weeks of the year. The accreditation of individual practitioners, teams and services to agreed national / international standards are themselves at the core of service improvement goals.
In the English NHS, a Health Informatics Service Benchmarking Club has been established with support from NHS Connecting for Health but owned and managed by the constituent members (over 100 services have joined the Club at the time of writing). The next phase of the development, during early 2009 will be to appraise a number of modes and models of accreditation already in existence and to consult service commissioners and providers on the business benefits and merits of a national accreditation scheme. If such scheme is supported and there is optimism that this will be the case a service provider will be procured during 2009 with a view to the scheme becoming live in 2010.
Di Millen has worked in the area of informatics education, training and development and workforce and service development for more that fifteen years at local, regional and national levels.