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Healthcare Computing 2007: a glimpse of primary care’s future?

1 May 2007

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The 24th Healthcare Computing conference took place across three days, from 19 to 21 March 2007, at Harrogate International Conference Centre. It brought together key speakers and exhibitors of healthcare informatics. Subtitled “challenging boundaries”, the focus was on the future of healthcare IT technology.

With a wide-ranging number of IT initiatives being introduced to primary care – from the somewhat divisive Choose and Book to the Electronic Transfer of Prescriptions (ETP) and the widely debated patient care records programme – practice managers are being asked to adapt to new software systems and
technologies like never before.

The Harrogate conference suggested that, while some managers may currently consider themselves bombarded with IT requirements, such as the recent Information Management and Technology (IM&T) Directed Enhanced Service (DES), the continuing development of new technologies is likely to affect the primary care landscape even further.

Changing nature of general practice
So, the question is: how will all this impact on the practice manager’s role? Utilising IT systems may not have been high on the list of your considerations when starting out in general practice, but the demands of 21st-century patient services now mean that familiarity with such technology is set to become a central facet of the role – if this isn’t the case already.

Former practice manager Dr Bev Ellis, who is now course leader in health informatics at the University of Central Lancashire, addressed the changing demands of primary care in her presentation, entitled “The business of general practice”. Dr Ellis made the case that, as an “incredibly innovative arena … the complexion of general practice keeps reflecting what society is asking of it”.

So, while general practice may in former times have been a small, local service, times have changed and today, as Dr Ellis argued, “GPs are entrepreneurs and the business [of general practice] is an entrepreneurial environment”. It follows that such an environment necessitates sophisticated, coordinated IT systems to satisfy the demands of patients.

It is this need for coordination that has led to the development of Microsoft’s common user interface (CUI) programme, which was presented at the Harrogate conference by Andrew Kirby, Microsoft’s director of NHS engagement, and John Coulthard, Microsoft’s director of healthcare. The CUI programme is, in effect, a set of design guidelines for system suppliers, such as EMIS, to incorporate into their software so that NHS workers have a consistent, uniform desktop. The CUI has been designed for both primary and secondary care settings.

Practice managers should not be concerned, however, that this represents the need for additional IT training. According to Mr Coulthard, the design elements should be subtly incorporated into standard upgrades of existing software, so “practice managers might not even notice that the design guidelines had been implemented. There would be some CUI components designed into it, but it’s still the same software system, just with a new functionality that’s been added.”

Nonetheless, the planned adoption of a uniform desktop in primary care supports Dr Ellis’ view that general practice is becoming increasingly refined to meet the demands placed upon it. This is something Mr Coulthard agrees with.

He told Management in Practice: “As primary care is increasingly linked to more and more services associated with community health, there will be a greater complexity of relationships around those interactions.” In addition to dealing with patients, Mr Coulthard says that practices will, in the oncoming years, have their “internal health service and social care customers – such as local councils and multiple trusts – and [practice managers] will have to think about those relationships and the process of the flow”.

Streamlining data
Some may argue that current requirements, such as the Quality and Outcomes Framework (QOF), already provide practices with sufficient organisational demands. But here again, technology could help. At the conference’s exhibition hall, Dr Nick van Terheyden demonstrated the latest voice recognition technology. He showed how this could allow GPs to not only record the details of patient consultations directly onto the computer system simply through speech, but also how the technology could quickly assess the nature of the information given to it, streamline the data and enable that data to be coded and stored.

Perhaps assessing your practice’s QOF standing will not be such a tiresome administrative chore in the future? You might not even have to wait too long. Dr van Terheyden expects products to emerge based on the technology within the next three to six months. “Today, the technology is available, but it needs to be integrated into a solution,” he said. “But it does solve the fundamental problem of capturing data from the most natural form of communication, which is speech.”

Participatory patient relationships?
Yet in addition to easing clinicians’ work and simply making the process of practice administration simpler, technology could have a far greater effect upon primary care. It may even realign the traditional relationship between the patient and his/her practice.

As Mr Kirby says: “I think certainly one of the major areas of innovation is going to be how we bring the citizen into the whole picture, how we make it possible to reach out to the citizen, in their environment, through a variety of new  channels.”

Mr Coulthard concurs: “I think the biggest change we’ll see – and indeed we’re starting to see it now – will be EMIS giving patients access to their primary care record. That will mean that patients may start to make their own assessments of what they see on that record. So there’s a participatory element to it.”

The introduction of the NHS Care Records Service (CRS) has opened up an entire debate on patient confidentiality and the security of electronic data, as reported in the last issue of Management in Practice. But could it be that the very accessibility of patient data might pave the way for real change in how general practice operates, perhaps with patients now taking greater responsibility for their own healthcare?

As Mr Coulthard says: “I think we’ll see knowledge engines providing information to patients’ records. For example, let’s say I’m looking at my record onscreen. Now something pops up and says: ‘With this set of data, you should seriously think about the following things – a bit more exercise, a bit less food, quit smoking, etc’ – and it might give me some arguments about why I would want to do that.”

Another possibility is online consultations between GPs and their patients, and increased web-based communication. “I think that the next generation – the ‘net gen’ – have an expectation that the first interaction with any organisation will be web-based,” says Mr Coulthard. “So the idea of a visit, I think, will change, the idea of how I engage with a community will change, and I think the way that practice managers work will change.” He again echoes Dr Ellis’ sentiments: “I think there will be a new set of demands placed upon GPs by a more literate, well-educated group of consumers.”

A question of choice?
But is consumerism really applicable to the provision of healthcare services? In a presentation entitled “Is an IT strategy possible?”, Justin Keen, professor of health politics at the University of Leeds, questioned the comparison between the healthcare profession and other industries, and raised the possibility that the increased integration of IT within the NHS was due to “deeply held assumptions about healthcare systems”, rather than meticulous research.

For instance, Professor Keen maintained that there had been an assumption that electronic records and the NHS Spine system would transform healthcare, even though, he argued, the proposed benefits to patients had not been thoroughly studied.

So, could it be that assumptions about the effect that increased technology will have on healthcare provision are being handed down from the government to primary care trusts (PCTs), and in turn to practices, which may not turn out to create a great deal of change after all? And do these assumptions have little regard for the real needs of individual general practices?

Such a top-down theory of healthcare technology was similarly expressed in a paper entitled “The mythical GP System of Choice (GPSoC)” by Robert Sugden, research associate at Newcastle University’s School of Computing Science, and Robert Wilson, lecturer at Newcastle University Business School, who presented the paper at the conference. It explores the relationships between GP system suppliers and primary care professionals in England, following changes to the provision of systems for primary care.

The GPSoC was introduced by Connecting for Health (CfH) to address concerns of GPs, who may wish to have a wider choice of software system, other than that prescribed by CfH and their PCT. But the authors asked: do GPs really have a choice here, or are PCTs simply dictating what systems GPs can use, and is this limiting the autonomy of individual practices, despite the advent of initiatives such as practice-based commissioning (PbC), designed to give practices a greater say in how they are run?

Premises development
Whatever the debate about the politics of healthcare informatics, it will certainly be interesting to see how the primary landscape does develop in the oncoming years. It would surely be a mistake to believe that the impact of developing technology would be confined only to the IT department.

As Mr Coulthard says, practices could even change physically: “I think the really interesting thing for practice managers is that [technology] will fundamentally change the way in which people design primary healthcare environments. For example, practices might be much more open. The idea that you walk in, meet a glass wall and then you’re put into another room could change into an environment where you interact with people in
different ways.”

Mr Coulthard explained how the “metaphor” of an interactive web environment could impact upon general practice, so that “we’re going to see a great deal more engagement with patients through this kind of technology,” he says. “If practice managers are looking to the future they might seriously think about the kinds of web environments that will be around in five years. For example, why wouldn’t you put wireless access for anybody turning up in your GP surgery?”

Any “technophobic” practice managers should have little reason to fear from all this, as the process of technological incorporation appears to be a gradual, rather than an overnight, process. Nevertheless, managers could benefit from getting onboard with new IT technology, since it may soon be coming to a practice near you – and it looks like it will be here to stay.