Hodges' Model: Welcome to the QUAD: June 2010

- learn about the conceptual framework Hodges' model. A tool that can help integrate HEALTH and SOCIAL CARE, INFORMATICS and EDUCATION. The model is situated, facilitates person-centredness, integrated - holistic care and reflective practice. A new site using Drupal is an ongoing aim - the creation of a reflective workbench. Email: h2cmng @ yahoo.co.uk Welcome

Tuesday, June 29, 2010

Knowledge Management & E-Learning: An Int. Journal (KM&EL)

As Editors-in-Chief of Knowledge Management & E-Learning: An International Journal (KM&EL), we are very pleased to announce the release of the special issue "E-Health: Accessing Knowledge for Global Health". Please see below for a detailed description of the contents.

A FREE copy of this Issue can be downloaded at Knowledge Management & E-Learning: An Int. Journal (KM&EL)



The contents of the special issue

Editorial: E-Health: Accessing Knowledge for Global Health
By Patricia Abbott

The Relevance of Telehealth across the Digital Divide: The transfer of knowledge over distance
By Ton AM Spil, Roel W Schuring, Margreet B Michel-Verkerke, Reuben Mugisha, Peter JB Lagendijk

Knowledge Networking for Family Planning: The Potential for Virtual Communities of Practice to Move Forward the Global Reproductive Health Agenda
By Megan O'Brien, Catherine Richey

Developing Nursing and Midwifery Communities of Practice for Making Pregnancy Safer
By Jody Rae Lori, Debbie Diaz Ortiz, Sandra Oyarzo, Patricia Abbott, Sandra Land

Managing knowledge across boundaries in healthcare when innovation is desired
By Mats Edenius, Christina Keller, Staffan Lindblad

The use of synchronous video-conference teaching to increase access to specialist nurse education in rural KwaZulu-Natal, South Africa
By Jennifer Chipps

Learning AIDS in Singapore: Examining the effectiveness of HIV/AIDS efficacy messages for adolescents using ICTs
By Arul Indrasen Chib, May O. Lwin, Zhuomin Lee, Victoria W. Ng, Priscilla H. P. Wong

Development of an online sleep diary for physician and patient use
By Jacqueline Blake, Don Kerr

Forthcoming Issue Vol.2, No.3, Sep 2010
Special Issue on "Advanced Learning and Performance Technologies, Open Contents, and Standards" - Best Papers Selected from the Conference ICCE C3 2009

Table of Contents

Editoral: Advanced Learning and Performance Technologies, Open Contents, and Standards
By Kiyoshi Nakabayashi, Fanny Klett (IEEE Fellow), Stephen J.H. Yang

Automatic Generation System of Multiple-choice Cloze Questions and its Evaluation
By Takuya GOTO, Tomoko KOJIRI, Toyohide WATANABE, Tomoharu IWATA, Takeshi YAMADA

The Effects of Blended Instruction on Oral Reading Performance and their Relationships to Five-Factor Model of Personality
By Noritake Fujishiro, Isao Miyaji

Design and Implementation of Extensible Learner-adaptive Environment
By Kiyoshi Nakabayashi, Yosuke Morimoto, Yoshiaki Hada

Specifying Cases for TEL in an SME
By Vladan Devedžić, Sonja Radenković, Jelena Jovanović, Viktor Pocajt

The Design of a Sustainable Competency-Based Human Resources Management : A Holistic Approach
By Fanny Klett (IEEE Fellow)

Building Virtual Collaborative Research Community Using Knowledge Management Approach
By Ju-Ling Shih, Jussi Nuutinen, Gwo-Jen Hwang, Nian-Shing Chen

Situational Language Teaching in Ubiquitous Learning Environments
By Angus F.M. Huang, Stephen J.H. Yang, Gwo-Jen Hwang, Chin-Chung Tsai

Understanding Retailers' Acceptance of Virtual Stores
By Irene Y.L. Chen

Call for Papers:

Maggie M. Wang (magwang at hku.hk)
Stephen Yang (jhyang at csie.ncu.edu.tw)

Knowledge Management & E-Learning: An International Journal (KM&EL)

My source: GANM (Global Alliance for Nursing and Midwifery) list

Sunday, June 27, 2010

Nursing attitudes [towards patients ( and self { and ? } ) ]

In the past half-year there have been two discussions, that concern the nurse's attitude towards patients.

One was held on the nursing philosophy list in February:


"The patient is always right"

The other in May was on the mental health in higher education list:

"Insufferable' or 'Suffering' - a response"

Both provoked a similar response and debate. I have just reprised my post in February on the MHHE list and have copied it - with some revision - below:

Patients are always a challenge in that they come in lots of 'varieties'.

This is why we recognise the need for individualised, person-centred care. One variety is trauma laden to which the full-complement of the multidisciplinary team must respond. These patients and *their* crises bring out the best in us in terms of the skills and knowledge, team work they force us to exercise.

Among the plethora of other varieties there are those who are viewed as 'problems'. Like the Pepsi ad of decades ago they are variously and pejoratively described as multiple attending, attention seeking, patience sapping, heart-sinking, time wasting, symptom preoccupied .... patients.

If I receive referral information, or heads up information on diagnosis that suggests the above what do I do?
  • Brace myself for impact?
  • Become task focused?
  • Share collective anecdotes in the staff room as a way to cope, unstress, inject some humour?
OR -
  • Avoid labelling them or use these labels in a re-constructive way?
  • Refuse to make gross assumptions
  • Look at the individual non-judgmentally, holistically, educationally, behaviourally
  • Believe I can make a difference (change is always possible [inevitable] )
  • Side-step being tripped by foibles, behaviours and blatant displays of -ve obstructive ... attitudes that offend 'me'
  • Enter their space and do my utmost to find room for manoeuvre?
  • As a nurse do go and seek out strengths and opportunities in the same way that Capt Kirk et al. go and seek New Life, New Civilizations..?
You may have an impossible lock to pick. In its most severe form this is (pejoratively) known as 'personality disorder', but the nursing challenge is there in all its personal and professional glory.

So. Listen.
Attend to this personal
/ under-the-skin \
Listen and Learn.

Be aware of the pit that continues to trap many people. The life chances - the health career - that they may have missed, took for granted, spurned and much more you (we) will never know about.

Do your job: nurse.

Friday, June 25, 2010

Drupal musings 5: Jump start for a new blog / site

Last month I had a great offer from the Drupal North West UK user group members at Manchester's - MadLab.

The proposal is using a central Manchester venue with wifi for a day engage some volunteers and create a new version of this blog in Drupal. This has woken me up! Putting a request out MDDA - Manchester Digital Development Agency have kindly offered to help out in terms of the venue.

At this months meeting I explained where things are up to and it was clear I still had some sorting to do.

As Chris and the others asked: What can Drupal do that Blogger cannot deliver?

Recently Blogger have extended their template design and functionality. So, now I should be able to find a new (and clean) template and re-introduce comments. In 2006 when I started the blog there were problems with spam.

So... it looks best to leave the blog as a going concern and focus on a new site for Hodges' model and the specific content and functionality requirements there.

I have my ticket for Drupalcon Copenhagen, for me this is 3rd time lucky, last chance saloon. This would be great timing and with the darkening nights too. ...

A phantom outline (currently an example of the 'living-dead') has been known for a while:

  • Archive
  • Case Studies (content types)
  • Glossary
  • Introduction - beginners guide to the health career model
  • ...
If in one day a group of Drupalers can help me jump start this project that would be - awesome! First though I have to get an idea of numbers and a poll to gauge which day is the best for people - looking ahead to October - November. Before then I have some work to do...

Monday, June 21, 2010

Philosophy of information empowers philosophy of care

The moral and ethical dimensions of nursing quickly become apparent to individual practitioners and professional associations. Philosophy in nursing boasts specific courses, journals and groups, for example:

International Philosophy of Nursing Society (IPONS)

Here on W2tQ, in papers and on the (former) website I have stressed the importance of the health career model as a framework that can utilise information as a fundamental and potentially unifying concept.

Expanding on the post last week about the philosophers' magazine [tpm50] let's look at Floridi's piece on the philosophy of information (PI). The 50 ideas featured are each only granted two pages, but this has a definite philosophical equivalent twitter-styled appeal. On page 42 (- 43) Floridi notes that:

... PI possesses one of the most powerful conceptual vocabularies ever devised in philosophy. This is because one can rely on informational concepts whenever a complete understanding of some series of events is unavailable or unnecessary for providing an explanation. Virtually any issue can be rephrased informationally. Such semantic power is a great advantage of PI, understood as a methodology. ...

It shows that we a dealing with an influential paradigm. But it may also be a disadvantage, because a metaphorically pan informational approach can lead to a dangerous equivocation, namely, thinking that since any x can be described in (more or less metaphorically) informational terms, then the nature of any x is genuinely informational. (Luciano Floridi, 2010).
Admittedly Floridi's context is the position and status of PI as an emerging discipline within philosophy. As he notes the vocabulary while powerful lies in the discipline of philosophy.

Given my preoccupation with information, Floridi's observation above is a timely warning for me and the many nurses who in the past saw a concomitant risk that in adopting the nursing process, patients (and carers) would be processed. Ironically, this processing concerned information. The workflow - form and layout of the documentation - was prescribed. This is an old tale, with the nursing process being subsumed within the routine work of nursing. Perhaps though this also demonstrates a need for a new debate?

My interest in information is as a trope to explain the significance of the care (knowledge) domains that underpin Hodges' model. Crucially, though these can stand on their own as nursing philosophy issues. Joining the efforts of the nursing philosophers above, this can bring information and philosophy out of the academic realm to include a more practical and grounded variety of topics:

FROM: personal identity,
definitions and ownership of computer based records,
utility versus security of information (summary care record ...),
definitions of information (data, knowledge) - through
TO: patient information and patient informatics, ...
where is collective informatics# heading?

Taking Floridi's lead - which of the above .... are core nursing (health) information concepts (and not just freeloading info-masqueraders along for the ride)? Well, that is a question for a new community of scholars to decide?

Philosophy resources: Interpersonal care domain

#Collective informatics = all the claimed informatics disciplines combined?

Saturday, June 19, 2010

Care ecology

Webster’s dictionary defines ecology as:

".. the totality or pattern of relations between organisms and their environment."
In health and social care there are several environments:
  • cognitive
  • social
  • physical
  • political
  • [and spiritual]
In this sense then Hodges' model provides a much needed care ecology:

An ecology not only for* care (disposition?)

- but an ecology to* care (direction?).

That is as something to protect given its inherent inclusiveness, balance and holism - an ecology within which we can also check on the health of our values.

In being focused on life - as an ecology - the model can also encompass the end of life.

*Michael Serres writes on the role of prepositions:

Conner, S. (2008) Wherever: The Ecstasies of Michel Serres, Accessed 19 June 2010.

Michael Serres: messengers - a Blog

Thursday, June 17, 2010

tpm50: the philosophers' magazine

tpm50 The best ideas of the 21st century

A 50th issue special (3rd quarter 2010) is on news stands. Possibly very useful insights for those managing or contemplating information projects - at No. 13:

Philosophy of information
Luciano Floridi

It looks as if there is an ironic subtext for ICT professionals here as the first idea featured is -

Conscious machines,
Igor Aleksander

And while the Floridi's Philosophy of information had me running to the till - it is followed by:

Non-critical thinking,
Nick Fotion

This is a 128 page little gem at £5.99 $US 9.99. More to follow me thinks. ...

Tuesday, June 15, 2010

Drupal musings 4: Modules and the nursing masquerade

Periodically I go through the list of available modules for Drupal both the current version and that in development - at present that is versions 6 and 7.

Reading the descriptions and reflecting on a module's functionality it is surprising where they can take you. Some of the modules stand out, prompting thoughts of potential applications. This is not just a case of descriptions fulfilling their role. Some of them shout out just by virtue of their name.

'Organic groups' will change to 'Group' in Drupal 7. If there is one thing about groups in nursing they are organic - whether that's disciplinary groups, groups held by nurses. Groups are a basic part of the structure and content of Hodges' model, and so it may be well worth factoring in the Group module from the outset.

As I read about the Masquerade module:

The masquerade module is designed as a tool for site designers and site administrators. It allows a user with the right permissions to switch users. While masquerading, a field is set on the $user object, and a menu item appears allowing the user to switch back. Watchdog entries are made any time a user masquerades or stops masquerading.

I thought of the tribes and camps within nursing and health care in general. Have we moved on? Well OK, let's see how holistic, integrated, multidisciplinary nursing is these days: picture then the nurse in medicine, surgical, operating theatre acting as a mental health nurse, learning disability nurse and vice versa?

Can we spot the imposter? One suspects (surely) that given a technical case study, care scenario then the game would be up very quickly. As to basic nursing care situations, there might be an interesting party there?

Original image source: http://www.mchooksinc.com/catalog/index.php

Thursday, June 10, 2010

Carer's support evidence / measures and end of life care

The following e-mail was received this week from (Prof.) George Kernohan and includes correspondence with Mary A. Waldron, Research Assistant, University of Ulster (thanks to Mary for confirming the reference).

My responses to George's points are right justified, italicised.


I am beginning to find examples of Hodges’ model every day now.

Once you adopt the model as a framework George it does tend to frame everything,
so I am not surprised at your finding. Maybe there is a paper there too...

Today we had a second research meeting to consider a (more) rigorous attempt to evaluate the provision of ‘support’ to carers of people undergoing palliative or End-of-Life Care (EOLC). An area of care with a dearth of evidence. So we looked at one review from Grande et al. (2009). They say that:

There has already been considerable research identifying carers’ needs in EOLC. These include psychological support, information, help with personal, nursing and medical care of the patient, out of hours and night support, respite, domestic and financial help.9,10,16–21 There is also a large body of research into adverse effects of care-giving, such as anxiety, depression, stress, strain, fatigue and mortality.22–24
Given this strong evidence base, any further investigation into the prevalence of needs and adverse effects should mainly focus on under-researched groups to ensure that future interventions are sensitive to their specific concerns. This includes carers of patients with conditions other than cancer, including neurodegenerative disorders,25 respiratory26 and cardiovascular diseases,27 to help us understand how differences in disease trajectories, awareness of the terminal nature of the disease and available support28 translate into different carer experiences. Although carers of patients with dementia have been extensively researched, little is known about their needs during patients’ final phase of life.9 p.340.
(The numbers refer to references by Grande et al., I have extended the quote used here).

Thanks for this paper George (and Mary) which I will read in full.
I extended your quote to encompass some additional interesting ideas.

To move toward a plan for a more rigorous evaluation, I would like to use a simple framework: here we go!

I think I will be suggesting Hodges’ Health Career as a possible model.

:-) ! If I can support you in this George I am pleased to help.

This could provide a framework for all carer-focused interventions in a broad way. As always, it would imply that carers need to have their needs addressed in terms of science, sociology, politics and interpersonal needs. As I see it, the first step would be to ‘map’ the carers’ needs onto that framework (from publications, if necessary from carers themselves). The basic idea (I think) is that care should address the four quadrants:
  • Science: (carer’s physical needs, information, instruction)
  • Political: (policy that enables care for carer, finance, allowance)
  • Sociology: (recognising that people need people, networks and “sharing” groups, story telling/hearing)
  • Interpersonal: (psychological support, prevention of anxiety & depression)
Have you any thoughts or guidance on this “mapping exercise”?

Goodness, that's quite a question!

Plenty of thoughts George but not sure how meaningful ....
Basically, since a community mental health project in 1990s
I have always considered (as per standard approach of course) that a toolkit of measures are needed. Even when we start from that most basic of distinctions between demand and supply.

As per your approach if h2cm is considered as a circle, a spectrum -
(sometimes we must circle the square)
then (if holstic) the adopted measures should cover all the domains:

Political: (outcomes, carer, patient satisfaction, financial assessment (means testing), respite care frequencies, reviews)
Interpersonal: (mood, coping ability, anxiety, depression, sleep, HoNOS)
Sciences: (pain, general health scales, care complexity (measures?))
Sociology: (dedicated carer assessment tools, sociability - social network size, psychosocial measures... there are many out there)

George, I realise the above is a ragbag collection but - like yours - these are dimensions which can (must) be reduced. Now there is also emphasis on this area post Darzi and the 'new' quality agenda.

This will serve (and is serving) to emphasize the distinctions between measures:

Objective - Subjective
Quantity - Quality
Staff administered - Self (Patient, Carer) administered
Global/general - condition specific
Service centered: Primary care - Secondary care

While it is easy to spin dichotomies,
the NHS must (constantly) focus on this area whatever the policy emphasis:

NHS Information Centre: Measuring for Quality Improvement

NHS Information Center: What is happening on indicators for...?

NHS Inst. for Innovation and Improvement: Quality and Service Improvement Tools

Earlier this year I contacted the NHS-IC [enquiries at ic.nhs.uk] regards additional measures of quality suggesting that the health career model bears due consideration (research).

Mental health services (and others?) have recognised how the measures they use can be a chaotic, personally selected, preferred, legacy-mix of assessment tools. Dictated by Senior Nurses, Consultants, Senior Management and not the evidence base. Now these are assured (are they?) with purposed selection (a task worthy of an 'away day') and then supported with regular in-house training.

Last month Anne-Marie Osbourne-Fitzgerald, Clinical Development Nurse, with (her) Clinical Manager, Denise Banks (Cygnet Hospitals), met Michael Doyle (Univ. of Manchester & Edenfield Unit, Prestwich Hospital) and I one evening at the Trafford Center in Manchester. Our two hour+ discussion covered the health career model, documentation, approaches to formal assessment and future plans (aspirations!). In the time available we obviously only scratched the surface, but Mike and Anne-Marie brought along examples of their paperwork.

Mike demonstrated how the health career model can be used implicitly or explicitly. At the Edenfield Unit the domains are being used individually to make up what is a standard A4 portrait form. The model informs their existing documentation; rather than the explicit form of the h2cm with the 2 x 2 matrix.
(I have a MS Word version of the latter and must update this to other formats).
Legally, as we know if it is not written down, recorded then it did not happen.
Educationally however, the objective is also to get students - practitioners - to think - before they do.

Anne Marie's documentation example at Cygnet Hospital included The Recovery Star:


As you consider the star's points against the domains of the health career model - where in the model are you?

Can this provide another means to define 'care pathway'? A way that is not masked, hiding behind political, policy rhetoric (and really service-centered)? There are without question some excellent tools available, so care needs to be taken not to re-invent the wheel - hence your literature search. In some tools the effort and engagement of patients, carers and the public is exemplary. It seems what is needed is a hybrid solution. There is no single measure.

It may not sound scientific, but the complexities of care mean that academics, clinicians and managers must resort to a pick'n'mix approach. There is a battery of evidenced tools each with their history, application context and issues log (Why not? Lack of the latter might denote that such tools are no longer in development / review). As a clinician also involved in training, managers need to listen and make some tough operational decisions. The comms 'traffic' between clinicians, their managers, and senior managers needs to improve even more. Since, just using the above as an example, the STAR approach may find us on a ramble in the humanistic domains, the constraints of the mechanistic domain prompts the clinician's to ask:

"If you want me to use this assessment tool, what other thing do you want me to put down?"

As we are all aware: There is only so much time in a day, week, month, quarter. ...

In follow up emails I directed Anne-Marie to -


If you scroll down there is some discussion and graphics I did quite a while ago. This deserves revision as per the rest of the website, but the ideas are there I believe which can inform your project George?

Back then - and here on W2tQ I have been trying to demonstrate the wide range of contexts to which the health career model can be applied. In our meeting that evening the well established Tidal Model was also noted. This has of course benefitted from specific development, as per research that has produced audit and evaluation tools (Stevenson, et al. 2002).

It might make a useful reflective article – or at least a conference presentation. Ideally it would lead us to a measurement or observation approach ...

I would relish the prospect of a paper George, or a conference presentation. Not just contributing as a co-author/presenter, but supporting and enthusing new authors. The 21st century belongs to our students. Hodges' model can act as 'stellar' nursery not just here in the UK and EU, but globally. And not just in our respective disciplines (mental health, palliative - end of life care, forensic nursing care), but in informatics - conjoining and championing the need for socio-technical perspectives.

In addition to the above and thinking before they do, all health and social care practitioners must be able to reflect after.

As one of the original purposes for the model in my initial interviews with Brian Hodges (1997-98), research work addressing these are much needed.

This conceptual framework can offer much in case formulation, evaluation, clinical supervision, patient, carer and public (health) engagement.

[In short -] Can we measure Hodges' model?

George K. (Prof.)

You started with a big question George and similarly here at the end.
We have to be able to do this. In the first instance taking apart your question - there are clearly several questions here:


Above you noted that:

This could provide a framework for all carer-focused interventions in a broad way. As always, it would imply that carers need to have their needs addressed in terms of science, sociology, politics and interpersonal needs. As I see it, the first step would be to ‘map’ the carers’ needs onto that framework (from publications, if necessary from carers themselves).

It would be interesting to consider the formal process and practice of dementia care mapping against Hodges' model. Perhaps the approach you seek is something similar? If carer's make use of self-assessments these e-documents might act as an input for text analysis tools? If appropriate you could also weight certain items according to the priorities of carers? This would build on other carer research adding validity to your 'final' objectives.

Carers and clients (patients, service users) can with due explanation, appreciate the health career model. The model has a role to play in health education. I can well imagine a proforma similar to the Recovery Star example above, but purposed for carers and underpinned with the health career model. We also need to remember the spiritual domain, which is collective.

Ultimately George, your question concerns our ability to measure holistic, integrated, person-centred, multidisciplinary care and to state the obvious: there is no single measure to do this. Several tools and approaches gathered within a conceptual framework might however provide an environment favourable for a hybrid measure to emerge - literally a cycle?


In the paper you referred to George - Grande. et al. (2009) state:

In parallel with the lack of empirical evidence, there has been a lack of theoretical and conceptual models for when and how support provision in EOLC should improve carer outcomes. To guide further research, palliative care may here benefit from drawing on models within other fields, such as gerontology, sociology or psychology. p.341.

I am biased, but reading the paper the potential of the health career model as a high level tool is convincing just from a 'disciplinary cross-match'. Intra-, interdisciplinary, metadisciplinary and transdisciplinary perspectives could be a focus. This in addition to the specific knowledge and practical domains of sociology and psychology and as the authors note models therein. I forget the reference at the moment (and will check), but I recall carers / family units being framed in terms of strengths and weaknesses. That is, events, characteristics and relationships impact on a family with either additive, subtractive or neutral effects. This would seem applicable here?

While Grande et al. (2009) note that the (informal) carer's role is hidden (and is routinely described in this way) I wonder if in palliative care there are other dimensions that accentuate this 'hidden, covert' role?

The politics of potential death and actual dying may be another factor the health career model can help illuminate in a constructive, enabling way? Health care, patiency, sick roles, caring are always mediated by 'politics'. Hence the need for a political domain in any conceptual framework that Grande, et al. may consider. On a negative front, the model might also illustrate alienation and related concepts?

In conclusion!

Thank you so much George and Mary for my being able to share your initial thoughts here and respond with some of my own. I hope this helps you take your work further? There may be a few points to follow, which I will add and as you have noted above there is much that could be done to take this further.
Peter J.

From: Waldron Mary [mailto:MA.Waldron at ulster.ac.uk]
Sent: 06 June 2010 17:49
To: wg.kernohan at ulster.ac.uk
Subject: Carers Support Evidence


Jury's still out on the effectiveness of support interventions and programmes which support carers in palliative care. Not enough research. Lack of evaluation, lack of rigour, no conclusive research, but lots of policy advocacy of carers support and addressing of needs. Sample of lit attached.

Mary A Waldron,
Research Assistant,
School of Nursing,
University of Ulster.

Many thanks George and Mary for your ongoing interest, and to Anne-Marie, Denise and Mike.


Grande, G. et al. (2009) Supporting lay carers in end of life care: current gaps and future priorities
, Palliative Medicine, 23: pp. 339-344. DOI: 10.1177/0269216309104875

Stevenson C, Barker P and Fletcher E (2002) Judgement days: developing an evaluation for an innovative nursing model. J Psychiatric and Mental Health Nursing, 9(3), 271-276.

Stellar nursery image
My source: http://media-2.web.britannica.com/eb-media/60/21260-004-3C62CA58.jpg

Special appeal: for former (current) users of Hodges' model - Isle of Man

It appears there have been two visitors to W2tQ from the Isle of Man. Over the years there have been many such hits on the website. Nursing staff on the Isle of Man did use the Hodges' model many years ago. A former colleague and manager worked there for a time, and there were students who attended the then Manchester Polytechnic and were taught the model on nursing courses - CPN Cert in Community Psychiatric Nursing.

If anyone there (or any other Isle - worldwide) is reading this - please get in touch; it would be great to hear from you of your experience, and possibly feature your thoughts and insights here.

Thanks and best regards,
Peter J.
h2cmng @ yahoo.co.uk

To follow - enquiries about end of life care and carer support.

Monday, June 07, 2010

Clinical Informatics in the North West – the start of a new era!

Thursday, 1st July 2010, 6.15pm light buffet, 7pm talk
Clinical Informatics in the North West – the start of a new era!
Speakers: Dr Andrew Coley, Dr Asad Sadiq, Mr Bibhas Roy, Dr Sydney Schneidman, Dr Rhidian Bramley, Dr Amir Hannan
Organiser: BCS Health Northern
Venue: Manchester Conference Centre, Sackville Street, M1 3BB

HICAT - a new approach by NHS Northwest – is this the start of a new era for Clinical Informatics in the region?

The HICAT are the Health Informatics Clinical Advisory Team at NHS North-West:

  • Dr Andrew Coley is the Senior Clinical Officer.
  • Dr Asad Sadiq is a consultant psychiatrist and Mental Health IT lead.
  • Mr Bibhas Roy is an orthopaedic surgeon and Secondary Care IT lead.
  • Dr Schneidman is an A&E consultant and Lorenzo clinical IT lead.
  • Dr Bramley is a consultant radiologist and Diagnostics IT lead.
  • Dr Hannan is a GP and the Primary Care IT lead.
We will describe the HICAT Mission Statement and the principles used to help deliver the next generation healthcare using IT to help deliver care. We will describe what we are doing for Clinical Informatics across the board in the North West and what impact we expect from the initiatives and efforts to have on clinical practice in the region, both short term and long. We will explain how our work will benefit patients. The speakers will be happy to discuss our plans and expectations with a knowledgeable audience and to take note of helpful feedback.

This talk should appeal to all with an interest in the use of Informatics by clinicians and the impact that can have on the quality and safety of patient care and the efficiency of services provided through the NHS.


If you have any queries on anything BCS related then please do not hesitate to contact me. Also, if you know of any IT events that would be of interest to fellow members, then please let me know.

Andrew Mohan,
BCS Manchester Branch
The Branch's website has details on all of its events and links to the other BCS groups that operate in the Greater Manchester area.


Sunday, June 06, 2010

EHR Software Market Share Analysis & UK residential care / nursing home sector musings

Last month (20th May 2010) Chris Thorman, who blogs about EMR systems at Software Advice, e-mailed me (copied below). Could I mention his recent EHR post on my blog?

Well thanks Chris! It is very encouraging to learn that W2tQ is seen by others as an infocare centre and valuable media avenue. It is very difficult for me to comment on this USA based analysis ...

- but here are some thoughts. ... This is a great piece of work-in-progress which acknowledges the problem of being 100% comprehensive and coherent given the task, plus the market's spread and dynamics.

My perspective is UK and my full-time work as a nurse gives me a limited outlook on health IT markets as a whole. Nonetheless I value efforts to capture such data in order to better understand the health informatics industry and grasp the bigger picture. As Chris notes this project is challenging, the post is also an appeal for help. While a great proportion of surveys are commercial in motivation, the e-community and e-media can now add value by pointing out the gaps and other data sources. The comments that conclude Chris's post ably demonstrate this.

I would very much like to read something similar for the UK, including the use of information systems in the residential and nursing home sector (any suggestions welcome). It still amazes me how many care homes - including those that are part of large business groups - do not use a 'resident' information system.

Perhaps the new - post-election - health ICT market in England will see new opportunities?
(See post re. 1 July 2010 NW England BCS - British Computer Society meeting).

In ICT terms the care / nursing home sector to me seems passive; it is content to be waited-upon by primary care and the hospital based systems. If they are not engaged on this level can they (and others, e.g. commissioners) argue that they are integrated? I think not.

Care homes need to realize that a dedicated information system could pay dividends in terms of assessment; continuity of care (transfer of care); quality of care; client, family and staff engagement, reporting to inform commissioning, inspection and marketing. When we talk of a patient's viability, there is also the question of the future viability of this market sector amid competition, economics, standards and costs ... ?

[Previously ..] Buyer sought for Loyd’s Nursing Homes Group’s 64 care homes
Catherine Boyle, Times Online, 21 May 2010.

Chris' focus is the EHR market, very much concentrated upon physician, medical and medical billing coding applications. This is reflected in the search facility on the Software Advice website. The search is constrained and directed, driven of course by the underlying database of companies, their applications and reviews. Markets are, however, defined by their boundaries and the way they change over time. Anticipation of that change is a gift indeed.

The personal health record (PHR) lies outside the scope of this Software Advice post, since as per WikiPedia:

It is important to note that PHRs are not the same as EHRs (electronic health records). The latter are software systems designed for use by health care providers. Like the data recorded in paper-based medical records, the data in EHRs are legally mandated notes on the care provided by clinicians to patients. There is no legal mandate that compels a consumer or patient to store her personal health information in a PHR.
This work by Chris and respondents helps to establish and define the boundaries. The EHRs in question are not purely institutional (e.g. hospital-based), the vendors cater for varying numbers of users, in different care settings as you can see on the site's 3-stage search. So while I cannot add anything as such, I wonder if there could (should) be scope for residential care in there?

Or perhaps the EHR market is not viable when it comes to older adult* residential care?

Heaven forbid that the transatlantic (and global) EHR market is ageist!

Thanks again Chris.

*Residential care is also needed for younger adults too.

From: Chris Thorman
To: " Peter,"
Sent: Thu, 20 May, 2010 18:57:41
Subject: Blog post idea for your blog

Hello Peter,

I hope you've had a good week. I just finished a blog post about market share in the EMR industry and I wanted to give you a heads up about it. Here is the link:


In the article, I broke down:

  • The size of the outpatient EMR market;
  • What EMR vendors have the most physicians using their system; and,
  • What EMR vendors have the most practices using their system.
As I'm sure you can imagine, it was a tough project to get accurate numbers on. I was hoping you could mention my article on your blog to get more eyes on it so we can clear up any discrepancies. Sort of a "crowd sourcing" project if you will. I'd also be interested to read your thoughts on our findings.

Would you mind mentioning my post?

Chris Thorman
Senior Marketing Manager
Software Advice

Friday, June 04, 2010

As one chapter closes another opens ...

Even if that chapter number is 15, 20 or even the penultimate - when it comes to older adults entering or residing in residential and nursing care facilities this is not just an excuse for a euphemism roll call:

'the end of the road',
'Club Medicated',


'the final chapter', ...

Residents and their families all too frequently find that care needs are not static. The book is far from complete and ready for review. Their health (and we had better add well-being) status changes constantly. A care home's ability to cope and meet an individual resident's care needs adequately in safety without comprising other residents and staff must be continually evaluated. A person's condition may improve psychologically and yet their physical health calls for more nursing care that is physically driven; or vice versa. Trying to anticipate care needs what can be several years in advance is very difficult.

It is one of those intangible questions - as to how many care homes carry dual nursing registrations and so will be able to provide not only the current level of care, but future elderly mentally infirm care needs if required. The reasoning being that an internal move is far less traumatic than finding a new home? So, what is the state of care moves?

If we have no information about this
then we know nothing.

What might this tell us about an individual's health career and the health career - likely care trajectory - of conditions such as dementia?

Of course our assessments are, and can only be determined (a keyword if there ever was one) in the here and now. This is the priority, while also trying to anticipate the future if we possibly can.

There is undoubtedly a great need for research here. Research that spans the many care dimensions which residents, their families, care home staff and other multidisciplinary team members must balance. These include quality of life, physical, mental and spiritual care, economics, demand and supply and our very notions of care quality and holistic care.

Only then - for all unique individuals - can we write an epilogue that befits each of those preceding chapters.

Image: M.C. Escher crystal ball

Tuesday, June 01, 2010

Old man of the sea (or 'heroic informatics')

The seas have long been an information and communications channel ....

My source: AWADmail Issue 408 April 25, 2010

From: Steve Patterson
Lui Ko, ProteusSubject: Old Man of the Sea
Def: A tiresome burden, especially a person, difficult to free oneself from.

Outside of the Arabian tradition, the Greek mythology includes Proteus and Nereus, both titled old men of the sea, and shape-shifting gods, to boot. Heroes in search of secret information had to wrestle one of these gods, as the sea touches even the remotest shore, and the flow of rivers was always bringing more information to them.

Image source: Gallery Lui-Ko Proteus, 2003, oil, canvas, 60x80 http://www.unesco.kz/lui-ko/