ehealth COMPETENCY FRAMEWORK BCS RESPONSE (v8 dated 21 April 2011)

Transcription

1 ehealth COMPETENCY FRAMEWORK BCS RESPONSE (v8 dated 21 April 2011) 1

2 BCS High Level Comments We believe that this is a good and welcome opportunity to get health informatics within the medical training agenda from the on-set. This should be used to inform training opportunities and support education of doctors who operate in an information intensive environment. This section of our response contains high level statements that refer to the document as a whole. Detailed comments are provided in each section. Observations on parallel and related activities: Was the Skills for the Information Age SFIA and in particular SFIAplus ( used for the development of practitioner skills and the ECDL ( used for development or user skills? It would appear that the overarching objective is to get up and coming medical practitioners, really promoting, advocating and leading the ehealth agenda, as such we feel something like SFIAplus or ECDL could help with this objective. There are other frameworks around in this area (such as NHS HI Career Framework, UKCHIP, IHRIM Records Management standards, eice - Learning to Manage Health Information: a Clinical Theme in England) and whereas this may be attempting to fulfil a niche area it would be helpful to show that it has considered such work and to refer or to position itself in relation to these other efforts. The document does not acknowledge previous work, e.g. ECDL Health Module (developed in England as 'NHS Health') for clinical end users; Professional Awards in Health Informatics (developed in England though no longer used for policy reasons, but being refurbished and deployed in Northern Ireland) for informaticians. There is no reference to the International Medical Informatics Association recommendations on education. Some of our members expected such a document to contain a bibliography (other than current policy documents) and they were not clear on whether a literature search had been conducted and that the content was evidence-based where possible, Comments about the method of competency definition, skills and behaviours within the document: The document meshes a number of purposes as one - doctors as end users (in daily personal practice); clinical leaders (e.g. in encouraging effective use); and doctors in informatics (messaging standards, procurement processes). Although the document is a checklist for all of these purposes and more, help may be required to assist doctors understanding of what is most relevant for the key purposes they are engaged in informatics for. The general tone and tenor is a promotion of health informatics. While it is right to promote good use of health informatics, this should be informed and balanced, and include risks, responsibilities, and drawbacks. For example, in both clinical decision support systems, and telemedicine, clinicians must use these technologies informedly and with awareness of the risks. Until e-health is 2

3 deployed as a responsible health science, with risk control, it will not be accepted or respected as it should be. We are not sure how the acquisition of the skills by the medical trainees will be assessed and graded, presumably this will be evidenced with quantifiable and demonstrable data as part of a portfolio of evidence the trainee needs to submit for appraisal, revalidation and other evaluation processes. Observations on missing content: There is little reference to risk and its management. Yet there is a strong bibliography of adverse effects, including death, of health informatics. The NHS generally must become more safety conscious and promote a safety culture, and health informatics is no exception. There are a number of topics that were thought to be missing in the document such as Risk, Governance, Responsible use (such as avoiding open screens, proper use of passwords, etc), and reference to Care Record Guarantee. Care is inter-professional and inter-disciplinary, but there is little mention of topics such as shared records, unambiguous meaning, etc. Observations on terminology: Please consider the use of the term health informatics instead of IT and ehealth throughout the document, as this broader term encompasses all the areas in the framework and equally relates to information handling and not just the technology. Please review Understand references and consider rewording to Demonstrate understanding where appropriate. A number of terms used, such as 'Know' were felt to be unspecific, with little indication of what should be known. As a result there was concern that this would not form a strong enough basis for either a syllabus or personal assessment. There is a good opportunity to draw upon educational experience. 3

4 CONTENTS PREFACE...5 CONTRIBUTORS TO FRAMEWORK DEVELOPMENT...6 INTRODUCTION...8 Assessment for ehealth Competency Framework...10 CLINICAL LEADERSHIP AND MANAGEMENT...11 Clinical Leadership and Team working...12 Managing Services and Performance...13 Improving Services...15 Healthcare planning and delivery...16 Setting direction...18 IT HEALTHCARE PROJECTS...20 Project Leadership...21 Sourcing, developing and implementing healthcare IT systems and applications.22 Maintenance and support of healthcare IT systems...24 WORKING WITH INFORMATION...26 Collection and storage of health information...27 Safe care of clinical information...29 Using and Sharing health information...31 CLINICAL CARE RECORDS...33 Health Records...34 Patient access to health information...36 CLINICAL IT SYSTEMS AND TECHNOLOGIES...40 Integrated Healthcare...41 Clinical IT systems...42 Electronic test requesting and results reporting...45 Medicines Management...47 Infrastructure and Technologies...50 Telemedicine...52 KNOWLEDGE MANAGEMENT...54 Decision Support...55 elearning...57 CLINICAL AND HEALTH IT STANDARDS...58 Clinical Coding and Terminologies...59 Standards...60 GLOSSARY OF TERMS...63 LINKS TO INFORMATION...68 ACKNOWLEDGEMENTS

5 PREFACE The ehealth Competency Framework has been jointly developed by the Academy of Medical Royal Colleges and Scottish Government. The Framework includes generic competences required by all doctors, such as the safe and secure management of health information, as well as those competences required by doctors involved in the planning, delivery or transformation of clinical services using healthcare information and technology at a local, regional or national level. The Framework has been circulated widely for comment during its development. The Academy of Medical Royal Colleges will continue to review and update the Framework on a regular basis in the future. I would like to thank everyone who has contributed to the development of this Framework, and my steering group colleagues for their help and support. I would particularly like to thank Scottish Government for their continued support for the development of this Framework, from initial concept to completion, and for providing the funding to make this possible. My sincere thanks also goes to the Academy of Medical Royal Colleges for recognising that clinical influence and leadership are essential in ensuring healthcare information technology can be used to support high quality clinical care. Dr Catherine Kelly Chair, ehealth Competency Framework Steering Group Clinical ehealth Lead, Scottish Government 5

6 CONTRIBUTORS TO FRAMEWORK DEVELOPMENT The framework is designed to include content and processes suitable for all registered doctors. The ehealth Competences Framework Steering Group was established in 2010 under the Chairmanship of Dr Catherine Kelly. It was project managed by Ms Lesley Hagger. The Framework was approved by the Academy of Medical Royal Colleges ehealth Working Group. ehealth Competency Framework Steering Group Dr Catherine Kelly (Chair) National Clinical ehealth Lead Scottish Government Dr Jamie Coleman Senior Lecturer in Clinical Pharmacology University Hospitals Birmingham Dr Charles Gutteridge National Clinical Lead for Informatics Department of Health, England Dr Roy Harper Consultant Physician and Endocrinologist The Ulster Hospital, Belfast Dr Mike Jones Chair of Specialty Training Committee Academy of Medical Royal Colleges Dr Robin Mann Head of Clinical Design NHS Wales Informatics Service Professor Andrew Morris Director of ehealth, NHS Tayside Director of Biomedical Research Unit, University of Dundee Mr Daniel Ray Director of Informatics University Hospitals Birmingham Additional contributors to development of the framework were : Dr Nick Booth Director for Clinical Data Standards Connecting for Health Ms Kim Kingan Information Governance Lead Scottish Government 6

7 Academy of Medical Royal Colleges ehealth Working Group Dr Tony Shannon College of Emergency Medicine Dr Ian Curran Conference of Postgraduate Medical Deaneries/Committee of General Practice Education Directors Dr James Brown Faculty of Sports and Exercise Medicine Dr Mike Jones Joint Royal College of Physicians Training Board Mr Neil Formstone Patient Representative Dr Richard Marks Royal College of Anaesthetists Dr Ben Riley Royal College of General Practitioners Mr Jim Innes Royal College of Ophthalmologists Dr David Low Royal College of Paediatrics and Child Health Dr Jem Rebass Royal College of Pathologists Dr Mike Jones Royal College of Physicians (Edinburgh) Dr Justin Marley Royal College of Psychiatrists Dr Mark Cowling Royal College of Radiologists Mr Chris OIiver Royal College of Surgeons (Edinburgh) Dr Muj Hussein Trainee Representative 7

8 INTRODUCTION ehealth describes the use of information and communication technologies to support healthcare practices which benefit patients, healthcare professionals, healthcare providers and policy makers. This clinical field has developed rapidly over the last decade as advances in technology have influenced changes in clinical service delivery. This document aims to provide a framework for training and education of doctors with an interest in this emerging specialty. The higher performing organisations across the world have recognised that investment in healthcare IT is critical to achieving better quality of clinical care in the most cost efficient manner. These organisations also recognise the role that clinicians play in ensuring achievement of these objectives. ehealth has not traditionally been an area that has attracted a great deal of attention from the medical profession but there is increasing recognition that clinical influence into development of ehealth strategy, and use of technology in the healthcare setting, is critical to ensuring that maximum benefits are achieved from investment. In times of limited resource it has become even more essential that funding for IT is targeted at those areas which will deliver maximum benefit to patient care, improving safety and efficiency of service delivery. Doctors need to use healthcare information to enable transformation of care processes and quality improvement. The ehealth Competency Framework has been designed as a reference document for doctors who are actively involved with planning, delivery or transformation of services using any form of healthcare IT technology and healthcare information. The competency framework covers a broad range of skills and knowledge and it is not anticipated that all doctors in training would be able to demonstrate achievement of each competence but would allow doctors to focus on different areas of expertise, as necessary. There are, however, competences such as those relating to safe and secure management of healthcare information that are applicable to all healthcare professionals, irrespective of their area of specialist interest. For this reason individual competences relevant to all postgraduate medical trainees have been highlighted in each section of the framework. It is anticipated that some of these generic competences may be included in other specialty training curricula in the future. The ehealth competency framework will also help those doctors in continuing clinical practice demonstrate the competences required to undertake organisational ehealth roles, whether on a local, regional or national basis. It will lay the foundation for establishing a better working relationship between doctors and other members of the healthcare IT professional team. The framework will provide doctors with a broad range of competences required to work outside the traditional clinical area but is not intended to suggest that doctors will have in depth knowledge of all domains covered. It will equip them with enough knowledge to help them perform their role well and to be able to identify where additional sources of expertise can be found, as required. The ehealth framework covers a range of areas where competency documents have already been produced and published. Where applicable, existing published competences have been incorporated into this framework with the respective 8

9 authors consent, to ensure consistency of approach. It is recommended that these documents are read in association with this competency framework. These include: Common Competences Framework for Doctors Academy of Medical Royal Colleges Information Governance in NHS Scotland: A Competency Framework (2008) NHS Education for Scotland and NHS National Services Scotland Learning to Manage Health Information: a theme for clinical education NHS Connecting for Health ulum Medical Leadership Competency Framework Academy of Medical Royal Colleges and NHS Institute for Innovation and Improvement y_framework_-_homepage.html 9

10 Assessment for ehealth Competency Framework Acquisition of competences must be assured during any training programme. Trainees from all the disparate specialties will have experience of both formative and summative processes that are designed, and have been validated, to determine whether defined competences have been obtained. The most common workplace based assessments are designed for use within the clinical setting that the trainee is primarily working within and are unlikely therefore to be immediately transferable for use with the ehealth framework. Similarly summative assessments including the Medical Royal Colleges examinations are designed to test the competences defined within the relevant specialty curricula. The framework has defined the competences that should be acquired during an e- health training period but it is not within the remit of this framework to design new assessment tools. It is suggested, however, that a two-pronged approach could be adopted to ensure adequate assessment of trainees competence acquisition. Firstly, as with the medical leadership framework, certain of the existing workplace based assessments could be modified to facilitate review of competence acquisition in ehealth. For example, the acute care assessment tool has been modified to test certain leadership skills and assessments such as case based discussion could be similarly modified for use in e-health training. Secondarily, centres using the framework, in collaboration with local educational centres may develop a formal summative assessment based on the competences defined within this framework. For the latter assessment this may be associated with the formal award of a diploma and thus may be the formal assessment of knowledge acquisition whereas the use of workplace based assessment would better assess the application of skills and the relevant attitudes. We believe that the chunking of the framework into knowledge-skills-attitudes is innovative and most appropriate. We observed that one stakeholder group that is not noted as benefiting from ehealth practice is carers/parents/guardians. We would recommend reference be made that doctors do not work in isolation and form part of a multidisciplinary team that care for the patient and their significant others. 10

11 CLINICAL LEADERSHIP AND MANAGEMENT The competences in this section describe the management and leadership skills required by doctors working in ehealth. They must develop self awareness, recognising their own values, principles and assumptions, be able to manage themselves and others, take account of the needs and priorities of others and always act with integrity. Doctors showing effective leadership are focused on the success of the organisation in which they work, manage resources efficiently, motivate and provide direction to others and support activities that monitor and improve performance. They must play a leadership role in promoting use of technology that encourages improvement and innovation and facilitates transformation while continuing to ensure patient safety. Clinicians contributing to ehealth at a local or national level need to be aware of the organisational, economic and political context. This requires an understanding of health service delivery, both local and national, and how ehealth initiatives support the strategic direction of travel and contribute towards improving business processes. We believe that it would be appropriate to note the patient as part of the group of stakeholders. We recommend that reference to clinical safety and the role of ICT should be placed in this section. We recommend identifying that Clinicians need to lead by example to create a longterm cultural shift with the use of ehealth. 11

12 Clinical Leadership and Team working This section omits any mention of forming a common goal set or vision for the team/ department/ organisational levels such that each stakeholder group, whilst operating separately, will contribute to the overall aims of the project. a. Common goals are a particular problem in complex areas such as health b. The language used by different stakeholders (clinical, managerial, policy setting, applications and IT infrastructure) is sufficiently different to result in different/conflicting interpretations c. There is a common danger of fragmentation, which appropriate common vision/goals and understanding will lessen. Objectives To acknowledge that effective leaders need to demonstrate personal skills and qualities which allow them to develop and motivate their team, influence others and deal with conflict Effective communication is a key skill for healthcare professionals and for an ehealth leader. We would recommend this be considered as more appropriate than ability to deal with conflict. Current statement is more about being a significant/dominant stakeholder than creating a leadership approach or vision BCS suggested amendments: Knowledge Recognise the skills, qualities and personal behaviours that make a good leader in ehealth including emotional intelligence setting the context and developing relationships Understand the need to build networks with stakeholder groups and others and to build and maintain relationships with them and professional colleagues Skills Contribute a clinical or managerial perspective to team, department, system and organisational developments while listening to others and recognising different perspectives Facilitate and gain consensus from a wide range of stakeholder groups Gain and maintain the respect, trust and support of colleagues Develop communication networks to ensure different clinical communities are aware of progress, changes and future plans in relation to ehealth initiatives Set clear goals and objectives and communicate these to other healthcare and IT professionals Manage time efficiently and complete work within required deadlines Negotiate responsibilities and commitments and meet these commitments once agreed Employ strategies to manage conflict of interests and differences of opinion Formatted: Font color: Red Deleted: decisions Deleted: clinical stakeholders Deleted: Be reliable in meeting 12

13 Keep up to date with ehealth related issues relevant to delivery of future services Identify good practice and communicate this to a wider audience e.g. speaking at meetings/conferences, publishing articles and guidelines Behaviours Recognise and articulate own values and principles, understanding how these may differ from those of other individuals or groups Recognise and articulate others values and principles, when representing them in project boards, steering groups and stakeholder forums Adopt a team approach, acknowledging and appreciating efforts, contributions and compromises Recognise your own communication and presentation style and when this needs to be adapted to influence the target audience Take responsibility for exploring difficult issues and resolving conflicts Recognise the need to be adaptable and respond to requests within short and long term timescales Adopt a positive attitude to problem solving and decision making Consider the resource implications of decisions and potential impact on other services Deleted: tackling Deleted: financial Managing Services and Performance This section appears to refer only to targets-based quality management systems. We believe that it ought to refer to other forms of quality control including balanced scorecard and alert systems. There is reference to the need to be aware of external organisations with responsibility for assuring quality. It would be good to also refer to the need to understand (and perhaps help establish) internal arrangements for quality assurance. There is no reference in this section (or much throughout the document) on the role of transparency and publication of information in quality assurance and accountability. Indeed there is no reference to the role of publication of information in informing patients either. We would like to highlight this as an important gap in the document. We couldn t find any explicit reference to the use of data in individual appraisal/ revalidation. This could be regarded as falling under using information to challenge existing practices but that might be seen as a rather negative interpretation of appraisal. We recommend that this topic requires specific mention. We feel that it is right to have separate sections on performance management and improving services, but it may be worth recognising that the two should be closely integrated. 13

14 Objectives Recognise that information is required for healthcare planning, commissioning of services and allocation of resource Understand the need to critically appraise information provided and to ensure that data is accurate and up to date Understand how IT systems provide information to measure performance against local and national targets The third bullet point suggests that an ehealth leader must understand how IT systems provide information. We believe it would be important for a leader to know the way IT systems SHOULD provide information and recommend this word insertion. Knowledge Awareness of tools available for generating performance reports. Recognise the advantages and disadvantages of these reporting tools for generating regular or ad hoc clinical and management reports Awareness of how to analyse information from a range of sources to monitor performance Awareness of performance reports required by national regulatory bodies and how information contained in these reports is captured and validated Awareness of the source and limitations of data and information used for performance reports Awareness of the difference between activity and outcomes in performance measurement and monitoring Skills Be able to critically evaluate performance reports and challenge information presented, if appropriate Use information to challenge existing practices and processes Participate in and contribute to organisational decision making processes Take action when resources are not being used efficiently and effectively Behaviours Recognise the need to quality assure healthcare to identify areas of concern, deliver sustained improvement and facilitate transformation Undertake activities to promote and monitor quality improvement It may be useful to consider behavioural heuristics in performance. e.g. Local/short timescale targets will tend to have a more powerful effect, which can if not consciously managed, have a significantly negative overall effect on outcome even though the measures will appear to be positive at every stage. 14

15 Improving Services This section would benefit from reference to the key issues around measuring quality. The need to understand both activity and outcome measures is described. Please consider the terms process measures rather than activity (activity data being simply what happened process metrics are detailed measures of actions that relate to standards of care and against which targets/ benchmarks can be set). More importantly, we believe that you should refer to the need to understand both patient experience metrics and clinical outcomes. There should be reference to the need to understand the statistical issues around case-mix adjustment and fair comparisons. This should include a basic level of understanding of correlation, standardisation, confidence limits and process control techniques. The growing emphasis on outcomes will make these skills essential for any doctor working in e-health. There is no reference that we could find, to the role of local clinical audits. An entry on the need to recognise available national or regional data sources and the role of local data collection in creating quality metrics should be considered. Objectives Recognise that leaders in ehealth must be able to manage and improve services, facilitate change and transformation and support innovation Recognise how information technology and informatics can be used to support change and transformation, to benchmark performance and to promote a culture of excellence and achievement Aware of organisations responsible for quality assurance of healthcare BCS suggestion of an additional bullet point: Improvements need to demonstrate clear benefits such as in areas of quality, productivity, efficiency and effectiveness Knowledge Understand how IT can enable changes in clinical and business processes that drive quality improvement in healthcare settings Awareness of methods for mapping business processes Awareness of improvement and change methodologies which can support service improvement and innovation Understand how quality outcomes are developed, validated and benchmarked in practice Awareness of how quality metrics or outcomes can drive healthcare improvement through continuous performance monitoring Understand how dashboards can be constructed to allow for the visual representation of quality metrics 15

16 Recognise how quality improvement measures are used to improve both individual and business practice within the health service Recognise how benchmarking can improve quality across healthcare settings and systems Awareness of the organisations responsible for monitoring quality of healthcare in the four UK countries There is debate around whether IT should enable change or whether it should facilitate needed changes technology driven or needs led. Please consider understanding this tension to be part of this knowledge set. Skills Participate in the development and recording of quality metrics Be able to navigate within a clinical dashboard Obtain and act on service user feedback and experiences Identify healthcare improvements and develop creative solutions to transform services and care Use business process mapping techniques and participate in implementing change We believe a leader should have the skill to ENGAGE with as well as obtain and act on service user feedback. Behaviours Engage with quality improvement within clinical practice through the use of IT tools Engage with identifying best practice in IT enabled change elsewhere Engage with colleagues when involved with, or leading, change programmes Promote a culture of high achievement and excellence Promote ehealth to decision makers as an enabler for delivering improved quality of care Healthcare planning and delivery We feel that this section misses the very important point of understanding the positive and negative effects of models used outside of the UK, such that as the NHS attempts to improve, lessons can be learned from success and failures elsewhere. It would seem unwise for the NHS to repeat the mistakes made in other systems or lose the opportunity to learn from this. Objectives Develop an awareness of how healthcare is delivered, managed and governed in each country across the UK and recognise the benefits and risks associated with each model Knowledge Awareness of the organisations responsible for developing healthcare policy in all four UK administrations Understand the differences in models of healthcare delivery and service provision 16

17 across the UK Understand the differing relationships between healthcare providers in each UK health system Awareness of NHS governance structures Awareness of how central government health funding is allocated and subsequently used to deliver services across the UK Recognition of financial drivers and constraints affecting healthcare planning and delivery Skills Contribute to local or national healthcare policy and planning Behaviours Recognise diversity of healthcare delivery, funding and governance arrangements across different UK countries 17

18 Setting direction Objectives Understand the association between local and national ehealth strategy, stakeholder influence, and local and national teams responsible for delivery The objective should be expanded from understanding the association between local and national ehealth Strategy, to include an understanding of the factors that should be used to determine those elements of ehealth strategy that should be decided once, nationally, and that which should be left to local discretion, and why. Further, the components required, and characteristics of a viable, successful local and national ehealth Strategy should be understood. As for healthcare planning and delivery section we feel that this section misses the very important point of understanding the positive and negative effects of models used outside of the UK, such that as the NHS attempts to improve, lessons can be learned from success and failures elsewhere. It would seem unwise for the NHS to repeat the mistakes made in other systems or lose the opportunity to learn from this. Knowledge Awareness of the organisations responsible for developing and implementing national ehealth strategies across the UK Awareness of NHS national projects, initiatives and developments in the field of healthcare information technology Awareness of similarities and differences between national ehealth strategies in England, Scotland, Wales and Northern Ireland Awareness of stakeholders influencing development, funding and governance of national ehealth strategy in each country Awareness of ehealth strategies and developments in other international countries which many influence future UK strategies Recognise how national strategy influences local strategic direction and potential conflicts that may arise Understand how local ehealth strategy is developed and approved at an organisational level and the main stakeholder groups influencing this process Important knowledge-sets should be: "Understand the critical elements of local and national ehealth strategies, in the domains of Governance, Competence, Leadership and Technology." "Understand the success criteria for local and national ehealth strategies, in particular the interplay between technology, process, benefits realisation and clinical engagement." These may be embedded in some of the existing statements, but we feel that they should be explicitly stated. 18

19 Additional knowledge-set should include: "Understand the mechanisms for successful ehealth innovation to be adopted into regular, mainstream use in the delivery of care, at national and local levels." This knowledge-set would address the typical issues that ehealth is seen as peripheral to core clinical activities, and seldom transitions from piloting. We also recommend consideration is given to noting BCS as a key stakeholder in ehealth as the appropriate professional body for informatics. Skills Articulate factors affecting healthcare delivery and healthcare organisations to those developing ehealth strategy Contribute to local or national organisational plans and strategy An important skill that clinicians must gain is to be able to evaluate and recognise a successful local or national strategy, and the implications for working practices, governance, competence and leadership of the technological changes involved. Often clinicians try to make this assessment, but based on incomplete understanding of the complexity involved, and with local optimums taking precedence over other factors. Behaviours Recognise the strengths and weaknesses of having different national ehealth strategies on information flow through the health service in the UK Anticipate emerging trends that will influence future strategy ehealth is about more than information flows; it encompasses collaboration across professional and organisation borders, and between professionals and patients / carers; and new processes for the delivery of prevention, care and public health. Clinicians should demonstrate behaviours that enforce the adoption of ehealth into the core delivery of care, prevention and public health. Further, a crucial behaviour change required by clinicians should be that they recognise and promote the use of standards-based ehealth solutions, rather than continuously inventing new solutions to already-answered problems, adopting innovation as readily as they innovate themselves. This is a frequent tension between national and local strategy - for instance, many local pilots trying to solve a problem that has already been solved somewhere in the country. 19

20 IT HEALTHCARE PROJECTS Doctors working in ehealth are required to communicate and work with colleagues from a range of professional backgrounds. They must demonstrate competence in building and maintaining relationships, developing networks, encouraging contributions from others and be able to work as part of a multi-professional team. This requires knowledge about the procurement process for IT systems or applications, processes and procedures required before, during and after their implementation and an understanding of how IT projects are managed so that clinical input can be focused appropriately and will be valued. 20

21 Project Leadership Objectives BCS suggested amendment: Understand support and use where applicable methodologies used for project management, associated terminologies and vocabularies and factors linked to successful project completion Recognise the role of clinicians as members of a project team and the skills and knowledge required to participate in a project effectively BCS suggestions amendments: Knowledge Awareness of the need for and the range of methodologies used for managing healthcare projects, such as PRINCE2 and Managing Successful Programmes Awareness of methodologies used for scrutinising healthcare change programmes, such as gateway reviews Understand the role and remit of different members of the project team e.g. project manager, project sponsor Understand how and why a project board is established, its constituent members and the role clinicians may have on a project board Recognise the need to identify and engage with key stakeholders Understand the role of the clinical reference or advisory group Develop an understanding of project documentation required at different stages of a project lifecycle, e.g. project initiation document, project status report, risk log Recognise that what governance and accountability arrangements are required for effective project management Recognise the factors linked to successful completion or failure of healthcare IT projects and the evaluation processes involved Awareness of when to consider Privacy Impact Assessment and Equality and Diversity Assessment We recommend inclusion of knowledge of the roles of iterative and/or agile development project methodologies, such as DSDM/RAD, Agile Development, RUP- SE and their interaction with IT project management. This is because the traditional PRINCE2/ MSP method tend to drive a single track waterfall process which is not agile and can drive project to be low in function and late, with little early value, which also results in reduced buy-in from users and slower uptake. Skills Work collaboratively and contribute to project planning, implementation, monitoring and evaluation Participate in project delivery as a member of a project board, clinical reference or clinical advisory group Communicate clearly and effectively with all members of the project team and 21

22 external stakeholders Recognise the constraints and limitations of each project Ensure programme or project goals remain aligned to clinical objectives, where appropriate Recognise project risks and identify solutions to mitigate against these Identify when a project is not progressing to plan and recognise the clinical, organisational and financial benefits and risks associated with continuation or termination. Identify when early project termination may be necessary and understand contractual implications associated with this decision Behaviours Willing to value contribution from others and recognise their areas of expertise Have a clear sense of role, responsibilities and purpose within the team Be willing to identify project risks and voice concerns about failing projects Sourcing, developing and implementing healthcare IT systems and applications Objectives Recognise how IT systems and applications are procured and the processes associated with this Recognise the need to specify requirements and identify potential benefits prior to developing or sourcing a system or application Understand the processes involved with developing, configuring, testing and implementing new products Knowledge Understand sourcing options for IT products in the UK and the legal requirements relating to the procurement process Recognise the need to specify requirements, methods of achieving this (e.g. stakeholder workshops) and the need for refinement, prioritisation and ongoing management of these requirements Recognise the need to identify anticipated, measurable benefits of implementing a new system or application Awareness of the role of demonstrator projects to assess functionality, benefits and costs of systems or applications prior to decisions about procurement Understand how to evaluate and assess tender and procurement responses to identify product that meets requirements and will provide good return on investment (ROI) Have awareness of local and national teams involved with contract negotiation and management Recognise different design and development methodologies Appreciate the technical processes required to develop, configure and test new products prior to implementation 22

23 Recognise that implementation of new systems may require change to business processes or service redesign to maximise achievement of benefits The knowledge items of Recognising different design and development methods is insufficient for the significant effect this can have on the style, approach and outcomes from complex IT projects. Skills Communicate information about clinical and business requirements to suppliers and developers clearly and effectively Consider safety, usability and cost effectiveness when specifying requirements for clinical systems Assist in identification of measurable benefits of system implementation Critically appraise costs relating to procurement, development and implementation of new systems and be able to identify return on investment Contribute to writing and development of a business case for a new clinical IT system or application Work to develop systems that are safe and reliable, and prevent harm from occurring Undertake assessment of the impact of implementing new systems on people and services and articulate the need for any changes required to business processes Participate in procurement, development, configuration and user acceptance testing of new systems Able to design the implementation including scope of deployment, early adopter pilots and roll out Identify barriers to successful implementation and solutions to overcome these Manage expectations of clinical colleagues Behaviours Balance clinical aspirations against the need to procure and implement an affordable solution in a timely manner Promote the application of best procurement practice to ensure that value for money is achieved across all investments Encourage involvement of front line clinical staff with requirements definitions, system design and configuration and realisation of benefits Promote the need for good governance processes to ensure systems developed or procured are able to provide the functionality required to deliver the greatest benefits to the patient, end user and the organisation Identify solutions that assure data privacy, patient and user confidentiality, security and integrity Develop collaborative vendor-client relationship Facilitate the introduction of new systems or processes and support clinical colleagues during periods of change 23

24 Maintenance and support of healthcare IT systems Objectives Recognise the need for continuous monitoring of system safety and performance Understand procedures relating to identification and rectification of faults Understand procedures required for system patching or upgrades Understand what processes need to be put in place so that clinical care is not compromised if clinical IT systems are not available Knowledge Awareness of processes and methods to test and continuously evaluate the safety and efficacy of clinical systems Understand notification processes for system or application problems and the role of different individuals and facilities, including problem managers and service desks Awareness of processes for prioritisation and management of issues raised, including the Information Technology Infrastructure Library (ITIL) framework and escalation procedures Understand the need for Change Control procedures Understand application patching and upgrade processes and procedures, in particular those relating to system testing, system safety and business continuity arrangements Recognise the need to have information back up processes and disaster recovery procedures to ensure clinical care can continue to be delivered safely Awareness of processes to monitor system performance and capacity and how agreed standards are implemented, e.g. use of Service Level Agreements (SLAs) with suppliers Knowledge should include the necessity for patching or upgrading systems to maintain security in the face of changing threats, particularly given the sensitivity of patient data. We recommend the inclusion of an understanding of the difference and trade-offs between the following qualities of a system: i. Scalability ii. Performance iii. Resilience iv. Availability v. Maintainability vi. Flexibility vii. Recoverability viii. Business Continuity ix. Zero data loss This is to underline the limits of overemphasis on one quality at the expense of others e.g. maintainability requires the ability to run different parts of the systems at different software levels without having to bring the whole system down. 24

25 Skills Develop and implement processes and methods to test and continuously evaluate the safety and efficacy of clinical systems Advise and work with system developers and other healthcare IT professionals in areas of good practice that enhance patient safety Participate in user acceptance testing of software prior to application upgrades Support the development of business resilience processes Communicate problems about clinical systems or applications clearly and concisely with technical staff and provide feedback to clinical colleagues where necessary Behaviours Question the safety and efficacy of clinical systems and be prepared to retire or reject those that have not been adequately evaluated Promote a safety culture within the service or organisation Promote application of continuous clinical and quality assurance processes Highlight the importance of business continuity arrangements for continuing to deliver safe care in the event of system or network problems Healthcare IT systems should be sourced and developed responsively and ethically staff should learn to maximise the IT assets that are already in the system first. This may be an additional behaviour to add. 25

26 WORKING WITH INFORMATION The competencies in this section relate to holding, obtaining, recording, using and sharing of healthcare related information to recognised ethical, legal, professional and quality standards. Information and communication technologies can be used to facilitate information recording, storage and retrieval. Patient s have a right to expect their information to be managed safely and securely, in accordance with ethical and legal requirements and to an approved standard. Information governance is about the structures, policies and practice necessary to ensure the confidentiality and security of information and the ethical use of that information for the benefit of the individual to whom it relates and for the broader public good. All doctors need to be aware of information governance principles and standards and adopt these into their clinical practice. Information is also necessary for supporting clinical audit, research, disease surveillance, service planning and resourcing and for optimising healthcare delivery through performance monitoring and quality improvement measures. Clinicians need to communicate with patients and other healthcare professionals using a range of technologies and may also need to share information with social care sectors or external agencies. They must be aware of the requirements for safe and secure data handling. Healthcare is increasingly an information-driven activity, therefore the quality of data is of critical importance, Clinicians need to be able to rely on the accuracy of information available and all healthcare organisations and staff have a responsibility to ensure the data they create and use is of the highest quality and fit for purpose. 26

27 Collection and storage of health information Objectives: Be able to obtain, record and hold information from patients and carers in accordance with recommended standards from professional bodies and in accordance with legal requirements Knowledge Understand the need to have a clear purpose for collection of any health information and to comply with data protection principles by only recording and storing information that is absolutely necessary Understand the advantages and disadvantages of narrative vs structured documentation in health records Understand the advantages and disadvantages of different electronic methods of obtaining and recording information in healthcare. Awareness of issues to consider when designing methods of recording structured information Understand Caldicott and Data Protection principles in relation to the relevance, quantity and quality of information obtained and stored Understand how to manage deceased patients information in accordance with the Access to Health Records Act 1990 Understand the terms patient- identifiable, sensitive and highly sensitive information Understand the need to inform patients about the collection and use of their information for the delivery of healthcare Understand the difference between implied and explicit consent Know the requirements for obtaining consent in cases of children, vulnerable adults or others where capacity is a issue Awareness of sources of information, advice and guidance in relation to maintaining patient confidentiality Understand the role of individuals and business responsibility and accountability for the control of records Awareness of different approaches to storing patient information, and the advantages and disadvantages of using different approaches e.g. databases document stores extensible markup language (XML) stores and related technologies 27

28 Skills Develop team, departmental or organisation policies, practice and capacity in relation to the safe and effective storage of confidential data Apply professional, ethical, legal and policy standards in the collection and storage of patient information Able to discuss and negotiate relevant approaches to storing of patient information Experience in the use of technologies designed to facilitate the storage and retrieval of clinical information Provide accurate and effective guidance to colleagues regarding patient confidentiality in relation to collection and recording of health information Store and destroy information in line with national guidance and local retention and destruction policies Advise patients where to seek further guidance in relation to queries about recording and storage of their personal information Communicate effectively to individuals to explain the purpose for which personal information will be used Use information with the highest regard for confidentiality, and encourage such behaviour in other members of the healthcare team Use and promote strategies to ensure confidentiality is maintained e.g. anonymisation of data Develop capacity of team, department or organisation for maintaining confidentiality through policy development, review of procedures and staff training Understand and interpret relevant legislation and accountability frameworks Behaviours Respect an individual s right to confidentiality and follow the guidance provided by the General Medical Council Recognise the need to manage clinical information securely and effectively Recognise when to seek early advice from information governance experts and professional bodies in relation to the collection and storage of personal information Maintain professional integrity by the adoption of best practice standards for collection and storage of health information Demonstrate ongoing awareness of information governance standards as part of appraisal and revalidation Understand the need to balance privacy of health information with improved healthcare delivery and health system management 28