NHS Connecting for Health Evaluation Programme (NHS CFHEP) Advisory Group Meeting Thursday 4 th October 2007, 13.00-16.00 Lecture Room 2, Professional Development Unit, Medical School, The University of Birmingham Present: Prof Mike Pringle Chair Uni of Nottingham Prof. Richard Lilford Programme Director Uni of Birmingham Mrs Jo Foster Academic Manager NHS CFHEP Dr Phil Candy Director of Education, Training and Development NHS CFH Mave Smith NHS CFH Mr Robin Arnold NME Development Director NHS CFH Mr Justin Riordan-Jones R & D Information Manager Department Of Health Prof. Jeremy Wyatt Professor of Health Informatics Uni of Dundee Prof. Nick Barber Prof. of Practice Pharmacy School of Pharmacy Dr Claudia Pagliari Chair ehealth IDG Uni of Edinburgh Prof Aziz Sheikh Prof. of Primary Care R &D Uni of Edinburgh Miss Nathalie Maillard NHS CFHEP Uni of Birmingham In attendance: Chris Ranger NPSA / NHS CFH (On behalf of Maureen Baker) Renata Villoro-Valdes Research Associate Uni of Birmingham Apologies: Mr Richard Jeavons Director of IT Service NHS CFH Implementation Sir Muir Gray Ms Beki Ruban Head of Nursing Development NHS CFH Dr Nick Goodwin Senior Lecturer Kings Fund Marlene Winfield OBE Head of Public Engagement NHS CFH Mr Tosh Mondal Chief Technology Officer NPSA Mrs Gillian Stonham Head of Service Implementation NHS CFH North East Dr Chris Watkins Board Programme Manager MRC Mr Matthew Stiles Southern Cluster Architecture Team NHS CFH Ms Jana Dale Head of Service NHS CFH Implementation Southern Mrs Paramjit Oberoi Patient and Public Representative Dr Maureen Baker National Clinical Safety Officer NHS CFH 1. Welcome and Introductions: [Mike Pringle] Mike Pringle thanked all for coming and invited members of the group to introduce themselves. Mave Smith, NHS CFH, is new to this group and will take on the desk officer role to liase between NHS CFHEP and NHS CFH. Page 1 of 7
2. Minutes from last meeting (1 st May 2007): [Mike Pringle & Jo Foster] The minutes were agreed to be correct by the group. Each action point form the 1 st May 2007 meeting were discussed in turn. All action points have been addressed / completed since this meeting. 3. Matters arising: [Mike Pringle] 3a) Membership of PAG and 3b) Communication strategy The PAG NHS CFH membership needs to be addressed and should consist of people able to give a steer to current / emerging projects. NB. Nick Goodwin has moved from SDO to Kings Fund and has been invited to continue to be a part of this group as a representative from the Kings Fund. A new representative from SDO will be approached. Action 3a / b 1: NHS CFH to liaise with NHS CFHEP to discuss PAG membership and communication strategy. Action 3 a / b 2: NHS CFHEP to contact Pamela Baker at SDO for representative. 3c) Standard Operating Procedures (SOPs) Action 3c: NHS CFHEP to add The group reports into what was the Service Implementation Board, now the joint Board for SI, OCCO, Comms and Stakeholder Engagement to SOPS and post on website. NB: University of Birmingham undergoing a website re-branding. A new NHS CFHEP website is being developed and will go-live by end of 2007. 3d) Executive summary of Naomi Fulop s SDO study The PAG considered the research recommendations outlined in Naomi Fulops executive summary and would like the following comments to be fed back to the team: a) the group recommended that the team clearly state the specific research questions with testable hypotheses in the report to clarify the precise nature, objectives and priorities of the research. b) although well written, the group thought that the executive summary is not as clearly structured as it could be. The group suggested that a specific description of the context from which each of the research questions were derived might improve the structure. This ideally should include the economic context and particular conditions faced by individual stakeholders (GP s, Trusts, Hospitals, etc). c) the group suggested that the executive summary would benefit from a deeper level of detail regarding the description of the different types of systems and settings that have been encountered in the research. It was highlighted that a higher granularity would contribute to a better understanding of the level of complexity dealt with in the research. d) it was suggested that the methodology section would benefit from a clear statement of quantitative and qualitative outcomes elicited in the evaluation. e) the group highlighted that an economic analyses within the current NHS CFHEP research priorities would be desirable as it would help shed further light on the relative merits of each programme. However, the group noted the difficulty involved in this task, due to the scarcity of data on costs and outcomes. The group suggested that the Future Research Agenda section Page 2 of 7
could state that future evaluations should include some level of modelling that is, an analysis of costs and consequences under different broadly defined scenarios, especially when a sound economic analysis of a new programme proves difficult. f) in addition, the group suggested that the report could include a recommendation for the systematic collection of routine data in new technology adopter sites in the future. Action 3d: NHS CFHEP (Richard Lilford to write letter) to feedback implications for future research to Naomi Fulop and colleagues. 4. NHS CFH update: [Robin Arnold / Mave Smith] NHS CFH has undergone restructuring with staff being transferred to geographically relevant Strategic Health Authorities within South, London and North, Midlands and East. Matthew Swindells from Department of Health is completing a review of informatics to: a) better support the information needs of Department of Health and NHS; b) ensure the NHS maximises the benefits from NHS NPfIT and; c) create an information system and management structure for delivery. In addition, several other developments such as, departure of Richard Granger from organisation, the review being conducted by Sir Ara Darzi, the UKCRC report on the NPfIT and Justin Keens SDO study, are likely to have an impact on NHS CFH activities. 5. Update from NHS CFHEP: [Jo Foster] An update of projects NHS CFHEP 001-004 was provided to the group. Recent developments include: NHS CFHEP 003 - Evaluation of the pilot implementation of an IT specification for a blood tracking systems The research team has been selected and is under contract. It is envisaged that the research will commence early 2008. NHS CFH would like to include 2 additional sites / trusts in the implementation of an IT specification for blood tracking. This process is under negotiation and NHS CFHEP has made additional funds available for the successful team to include a comparative evaluation in the study. NHS CFHEP 004 - Evaluation of the Electronic Prescription Service in Primary Care The research team has been selected and is under contract. It is envisaged that the research will commence January 2008. 6. Research Priorities: [Jo Foster and ALL] Before this meeting, the PAG received presentations from investigators involved in the NHS CFHEP 001 and NHS CFHEP 002 projects. Findings / interim findings were presented to inform the decisionmaking around possible extension to these projects. 6a1) Extension to NHS CFHEP 001 Systematic review of IT Strand 1: Database of systematic reviews/randomised controlled trials on IT and healthcare The group agreed that the database developed by the team would be a valuable international resource that should be maintained, even after the end of NHS CFHEP in 2010. The group would like further clarification on the following: Page 3 of 7
a) that the project team had secured or could demonstrate the source of funding for the sustainability of the database beyond the end of the NHS CFH Evaluation Programme. b) clarification of the ownership, access to and marketing of this database. c) demonstration that the team are co-ordinating with other groups working on similar IT databases, such as the European Federation of Medical Informatics (EFMI). d) would like some idea to what extent this strand contributes to the overall cost. Strand 2: Updating systematic review The group agreed that this was an important strand of work, but suggest that the team should emphasis their role in critiquing and synthesising the literature. Strand 3: Broadening the review to include novel application of IT-based information sharing/decision support, remote care and consumer information The group agreed that this was an important strand of work, but would like further clarification that the update would focus on NHS CFH priorities e.g. RFID and barcoding. Strand 4: Compiling a database of experts Strand 5: Acting as a response mode resource for NHS CFHEP Strand 6: Identifying future research priorities for NHS CFHEP The group suggested that strands 4, 5 and 6 were not high priority for NHS CFHEP in particular 5 and 6 as the budget will be nearly spent by April 2008. New Strand: Collaborative working The group felt that an additional strand: to work more collaboratively with academics and researchers in this field, in order to share learning and maximise the potential content of the database, would be beneficial. In addition, the group had some more general comments on the proposal overall and would like team to provide further detail on the following: a) further clarification of the benefit of working across two academic institutions. b) demonstrate that the current steering committee contains the relevant expertise for the extension of this work. c) the cost of extending the project was fairly substantial and questions arose over whether this would represent value for money. The group suggested that the cost-savings could be made if a librarian was employed to undergo searchers / maintain database and perhaps if the project team was reduced in size to focus on synthesis and critique. Action 6a1.1: NHS CFHEP to liaise with Department of Health to confirm if a single tender action is justified for this project. Action 6a1.2: NHS CFHEP to provide feedback to project team and invite them to submit full proposal. 6a2) Extension to NHS CFHEP 002 Evaluation of early adopters of Summary Care Record a) the group agreed that the key research questions identified within the presentation were appropriate and would like further detail on how your would approach this work. b) the group suggested that the project team liaises with NHS CFH to ensure all relevant research questions from their perspective are included in the proposal. Page 4 of 7
c) the group were concerned that the delayed deployment of SCRs to unscheduled care settings within the early adopter sites would delay the extension of this work. Following the presentation, the group were reassured that there would be further research avenues to explore e.g. evaluating the impact of SCR on workarounds, should a delay occur. The group would like the project team to provide further details of these research activities in their proposal. d) the group suggested that the project team includes detail on how they plan to carry forward and validate the quantifiable outcome measures of benefit and disbenefit developed in phase 1 of this work. e) the group would like details of the costs to extend the current project for 2 additional years, including work outlined above. Action 6a2.1: NHS CFHEP to provide feedback to the project team and invite them to submit full proposal. 6b1) NHS CFHEP 005 Evaluation of the adoption of the Electronic Health Record in secondary care. and 6b2) NHS CFHEP 006 - Evaluation of the effects of multiple IT deployments across many functions within healthcare organisations. The PAG suggested that both calls for proposals should be combined to look at the safety and organisational impact of Electronic Health Record within acute care setting, including the impact and interaction of other IT systems such as, E-prescribing, PACS, Choose & Book and Clinical decisionsupport. A Donabedian model (structure, process, outcome) with triangulation of data was suggested as a possible method to evaluate a complex intervention. The call for proposal should indicate that the project is 18 months, in the first instance, with potential extension of additional 18 months after presentation of interim / final findings and emphasise the importance of including a steering group with relevant expertise to advise on research activities. Ian Cawls was suggested as a possible central point of contact at NHS CFH for this call for proposals. In addition, Robin Arnold would provide a viewpoint from the North, Midlands and Eastern NHS CFH perspective. Action 6b1 / b2.1: NHS CFHEP to combine and refine call for proposals 005 and 006 and send to PEG for approval. Action 6b1 / b2.2: NHS CFHEP to liaise with NHS CFH (Ian Cawles and Robin Arnold) to ensure all research questions have been covered 6c1) NHS CFHEP 008 - Audit of clinical records to determine the affect on hospital ordering systems It was agreed that research questions around this issue could be incorporated into NHS CFHEP 005/006 call. Nick Barber to assist in the development of these research questions. Action 6c1: NHS CFHEP to liaise with Nick Baber and incorporate research questions around this issue into NHS CFHEP 005/006 call for proposals. Page 5 of 7
6c2) NHS CFHEP 009 Coding within the clinical record The PAG agreed this vignette included some interesting research questions. The vignette needs to be developed into a full call for proposals to include; the affect of technology (including SNOMED) on the content of the clinical record, questions around record linkage and the quality, accuracy, usability, completeness and utility of data to compare coding with free text. The group suggested Grant Kelly, SNOMED lead at NHS CFH and Alan Hasey, as points of contact at NHS CFH. Action 6c2.1: NHS CFHEP to develop full call for proposals and send to PEG for approval. Action 6c2.2: NHS CFHEP to liaise with NHS CFH (Grant Kelly and Alan Hasey) to ensure all research questions have been covered. 6d) NHS CFHEP 010 Evaluation of the impact of CFH systems overall on the health care consultation The PAG thought that this was a well written, well developed call for proposals, but that the scope should be widened to the look at the impact of systems on healthcare consultations. The research should include questions around the design of systems in terms of benefiting the patient/healthcare professional consultation. It was highlighted that this research question would need to be considered following decisions to extend NHS CFHEP 001 and 002 as they may limit the budget available for this work. Action 6d: NHS CFHEP to refine call for proposal and send to PEG for approval. 7. Budget [Jo Foster] Action 7: NHS CFHEP to amend budget sheet to reflect new research priorities discussed at this meeting. 8. Variation to contract for NHS CFHEP management Action 8: NHS CFHEP to meet with Mave Smith and Morton Philips (Department of Health) for annual budget meeting where potential variation to contract for management of NHS CFHEP will be discussed. 9. Core steering Committee The PAG agreed to the principle of a Core Steering Committee and were happy for NHS CFHEP to organise the first committee in March 2008. Action 9: NHS CFHEP to select venue and invite participants and relevant stakeholders 10. Future role of PAG This wasn t discussed at the meeting, due to time constraints and will therefore discussed at the next PEG meeting Action 10: NHS CFHEP to add the future role of the PAG to the next PEG meeting 11. AOB None Page 6 of 7
12. Date and time of next meeting This wasn t discussed at the end of the PAG meeting, but NHS CFHEP would organise another meeting for the beginning of 2008. Action 12: NHS CFHEP to organise another PAG meeting early 2008. Meeting Close Page 7 of 7