ISMS STANDARDS UPDATE

February 2012

A summary of recent publications of relevance to the health informatics standards community. Content covers general NHS and social care developments, international activity, standards and journal articles.

NHS CONNECTING FOR HEALTH Shifting power to the local NHS - a new way for NHS IT ............................................................................................1

NHS IT From patient records to NHS SBS: the challenges ahead for GP IT ............................................................................1

NHS DATA Your chance to shape future of England's biggest mental health dataset .................................................................1 Improving accuracy of GP lists saves NHS £6.1 million a year ...................................................................................1 Three more GP clinical systems suppliers sign up for GPES .......................................................................................2

INFORMATION GOVERNANCE Dame Fiona Caldicott to lead confidentiality review .................................................................................................2 Guidance: social interaction – good practice .............................................................................................................2

CLINICAL AUDIT HQIP consultation on principles of quality in national clinical audit ..........................................................................2

NHS TECHNOLOGY Clinical information system – contract award notice .................................................................................................3 Medical software package – contract notice .............................................................................................................3 Northern Devon trust pilots remote devices for community nurses .........................................................................3

HEALTH AND SOCIAL CARE BILL Ten reasons why we need a Bill to make these reforms work ...................................................................................3

HEALTH SELECT COMMITTEE Social care: fourteenth report of session 2010-12 .....................................................................................................4

PUBLIC ADMINISTRATION CloudStore opens for business ...................................................................................................................................4 Government anticipates £5 billion in cash savings this year ......................................................................................5 New approach to leadership of major public projects ...............................................................................................5

INFORMATION POLICY Cabinet Office calls on IT Community to engage in Open Standards consultation ....................................................5 Introducing the beta of GOV.UK ................................................................................................................................5 New site to take you inside government ...................................................................................................................6

DATA PROTECTION Commission proposes a comprehensive reform of the data protection rules ..........................................................6

DEPARTMENT OF HEALTH New DG appointments announced ............................................................................................................................6

NHS NHS Constitution ........................................................................................................................................................7 How the NHS measures up to other health systems ..................................................................................................7 Introducing a single operating model ........................................................................................................................7 First estimates of funding in new health structure ....................................................................................................7

NHS COMMISSIONING BOARD National Director of Finance appointed .....................................................................................................................8 Commissioning intelligence report ............................................................................................................................8

HEALTH AND WELLBEING BOARDS A short guide to health and wellbeing boards ...........................................................................................................8

CARE QUALITY COMMISSION Performance and capability review of the Care Quality Commission ........................................................................9 Cynthia Bower announces resignation .......................................................................................................................9

MONITOR New pricing analysis highlights opportunities to improve patient care .....................................................................9

NATIONAL INSTITUTE FOR HEALTH RESEARCH NIHR appoints National Director for Public Participation and Engagement in Research ...........................................9

NHS INFORMATION CENTRE The NHS Information Centre announces key appointment to support GPES ..........................................................10

PUBLIC HEALTH Guidance for local public health teams and clinical commissioning groups ............................................................10 Government publishes response to health committee report on public health .....................................................10 Health inequalities widen within most areas of England .........................................................................................11

DENTAL SERVICES NHS dental service - live pilot practices and pilot types ..........................................................................................11

HOSPITALS Outpatient survey 2011 ............................................................................................................................................11 Does competition improve public hospitals' efficiency? ..........................................................................................11

URGENT AND EMERGENCY CARE GPs fine hospitals over failure to meet A&E waiting time targets ...........................................................................12

END OF LIFE CARE Deprivation and death: variation in place and cause of death ................................................................................12

CANCER CCG publishes report supporting the critical role of cancer networks in improving patients’ care ........................12

LONG TERM CONDITIONS Long-term conditions and mental health: the cost of co-morbidities .....................................................................13 Personal health budgets and NHS Continuing Healthcare .......................................................................................13

MENTAL HEALTH £22 million for ground-breaking children’s mental health programme ..................................................................13 Introducing the national dementia CQIN .................................................................................................................13

QUALITY ACCOUNTS Quality accounts reporting requirements for 2011-12 and planned changes for 2012-13 .....................................14

PATIENTS A framework for NHS patient experience ................................................................................................................14 Patient experience in adult NHS services: improving the experience of care ..........................................................14

PAYMENT BY RESULTS Confirmation of Payment by Results arrangements for 2012-13 ............................................................................15 Maternity pathway payment system in 2012-13 .....................................................................................................15

NHS PROCUREMENT Variations to the NHS Standard Contracts ...............................................................................................................15

EUROPE European Commission establishes new eHealth Stakeholder Group ......................................................................16 European Medicines Agency to publish information on ongoing medicine evaluations .........................................16 European Medicines Agency counts down to introduction of new pharmacovigilance legislation ........................16

GERMANY Notification of infectious diseases - Electronic data transmission trial successful ..................................................16

CANADA The value of electronic health records extends far beyond patient care ................................................................16 Primary health care EMR reporting system gets green light to grow ......................................................................17

UNITED STATES We can't wait: Obama administration calls for a consumer privacy bill of rights for the digital age ......................17 HHS Secretary Kathleen Sebelius announces major progress in doctors, hospital use of health information technology ................................................................................................................................................................17 HHS announces intent to delay ICD-10 compliance date .........................................................................................17 SHARP Area 4: secondary use of EHR data - annual progress report 2011 ..............................................................17

STANDARDS EHRs for clinical research .........................................................................................................................................18 Global Traveler’s EHR template (TrEHRT) ................................................................................................................18

RECENTLY PUBLISHED STANDARDS ISO/IEC guide upgrades safety aspects in medical device standards .......................................................................18 ISO/IEC 29167-1:2012 - Information technology - Automatic identification and data capture techniques -Part 1: Air interface for security services and file management for RFID architecture .......................................................19 ISO/IEC TR 29149:2012 - Information technology - Security techniques - Best practices for the provision and use of time-stamping services ........................................................................................................................................19 ISO/IEC 17020:2012 - Conformity assessment - Requirements for the operation of various types of bodies performing inspection ..............................................................................................................................................19

ARTICLES Abstraction of complex concepts with a refined partial-area taxonomy of SNOMED .............................................20 Adoption of telemedicine: from pilot stage to routine delivery ..............................................................................20 Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation ..........................................................................................................................................................21 Auditing complex concepts of SNOMED using a refined hierarchical abstraction network ....................................21 Benefits and risks of structuring and/or coding the presenting patient history in the electronic health record ....22 De-identification methods for open health data: the case of the Heritage Health Prize claims dataset ................22 Developing a summary hospital mortality index: retrospective analysis in English hospitals over five years .........22 The distribution of lung cancer across sectors of society in the United Kingdom: a study using national primary care data ...................................................................................................................................................................23 Electronic health record-based messages to primary care providers: valuable information or just noise? ............23 The health informatics cohort enhancement project (HICE): Using routinely collected primary care data to identify people with a lifetime diagnosis of psychotic disorder ...............................................................................24 Incorporating personalized gene sequence variants, molecular genetics knowledge, and health knowledge into an EHR prototype based on the Continuity of Care Record standard ......................................................................24 The many faces of the computer: an analysis of clinical software in the primary care consultation ......................25 Miscoding, misclassification and misdiagnosis of diabetes in primary care ............................................................25 Multidimensional evaluation of a radio frequency identification wi-fi location tracking system in an acute-care hospital setting .........................................................................................................................................................26 Opening up the "black box" of the electronic patient record: a linguistic ethnographic study in general practice 26

Organizational framework for health information technology ................................................................................27 Perspectives of Australian adults about protecting the privacy of their health information in statistical databases ..................................................................................................................................................................................27 Portability of an algorithm to identify rheumatoid arthritis in electronic health records .......................................27 Postmarketing surveillance of medical devices - filling in the gaps .........................................................................28 Reform and the National Health Service ..................................................................................................................28 Semantic mappings and locality of nursing diagnostic concepts in UMLS ...............................................................28 Standardized nursing diagnoses in an electronic health record: nursing survey results .........................................29 Use of name recognition software, census data and multiple imputation to predict missing data on ethnicity: application to cancer registry records ......................................................................................................................30 Validity of electronic health record-derived quality measurement for performance monitoring ...........................30 'Wading through treacle': quality improvement lessons from the frontline ...........................................................31 Weekend hospitalization and additional risk of death: An analysis of inpatient data .............................................31

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NHS CONNECTING FOR HEALTH Shifting power to the local NHS - a new way for NHS IT A profound shift of decision-making to the local NHS means that clinicians lead change in information technology, ensuring its freedom to innovate, the Health Secretary has said. Speaking at the launch of the Chief Clinical Information Officers network, he confirmed that the government has secured agreement to over a billion pounds reduction in its contract with CSC and he made clear that this money will be released back into the NHS. Following years of waste and delay in introducing electronic care records to hospitals, he emphasised that this agreement signals an enormous breakthrough that will free up clinicians in the NHS to exercise control and flexibility. Alongside focusing on clinical involvement to drive change, the Health Secretary reiterated the need for clinical systems across the country to talk to each other, exchanging information safely in the interests of patients. The NHS Commissioning Board will lead on championing the national standards that are required to underpin local innovation and choice Connecting for Health will no longer exist in April 2013. A new, leaner delivery organisation will manage existing national applications and services such as the Spine, Choose and Book, digital X-rays, the Electronic Prescription Service, the Summary Care Record and a secure broadband network. All of these are necessary to how the NHS runs on a daily basis and will continue, but any new national initiatives will only happen when there is a clear need across the NHS. (DH, 08 Mar 12)

x Press release NHS IT From patient records to NHS SBS: the challenges ahead for GP IT Dr Chaand Nagpaul of the British Medical Association's IT committee highlights some of the key issues facing the profession's IT. (Guardian Professional, 06 Feb 12)

x Full text NHS DATA Your chance to shape future of England's biggest mental health dataset The Information Centre is consulting on what measures and breakdowns should be provided in regular statistics and data extracts from the Mental Health Minimum Dataset. (NHS IC, 01 Mar 12)

x Press release Improving accuracy of GP lists saves NHS £6.1 million a year The Audit Commission has released results of its latest National Duplicate Registration Initiative (NDRI), which looks for anomalies in general practice patient lists across England and Wales. Ninety-five thousand records were identified and removed following NDRI 2009/10. As each patient's registration is worth £64.59 a year on average, these deleted records have saved £6.1 million in one year alone.

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The NDRI compares GPs' patient lists with those of other GPs, and with other lists, to find matches. Not every match will result in a removal, as local areas will carry out further checks to confirm the match is the result of duplication. The report highlights a number of areas that have rigorously followed up matches. In Manchester, for example, 200 patient registrations were removed following checks to confirm whether patients were still alive. However, the report also says that in some areas matches have not been followed up effectively, preventing records being removed and savings made. The report gives examples of good practice in following up NDRI matches and recommends that PCTs, and the organisations that carry out checks on their behalf, maximise the benefits of NDRI. (Audit Commission, 23 Feb 12)

x Press release Three more GP clinical systems suppliers sign up for GPES The NHS Information Centre has agreed arrangements with Microtest, iSoft and In Practice for the extraction and delivery of general practice data from GP practices supported by these system suppliers. Discussions are ongoing with TPP as the only GP systems supplier yet to sign up. (NHS IC, 08 Feb 12)

x Press release INFORMATION GOVERNANCE Dame Fiona Caldicott to lead confidentiality review The Department of Health has announced an independent review of the protection of patient information. To be lead by Dame Fiona Caldicott, the review will consider the balance between protecting patient information and it's sharing to improve patient care, in line with the Future Forum’s recommendations.

Dame Fiona will be calling on an expert panel made up of clinical, social care, research and other professionals, as well as patients and service users. The panel will determine the detailed scope and priorities for the review. (DH, 23 Feb 12)

x Press release Guidance: social interaction – good practice This information governance guidance, issued by the DH Informatics Directorate, provides NHS organisations and their staff with general awareness of the information risks and good practices associated with the protection of sensitive information in social media and other social interaction scenarios. The guidance replaces Blogging & Social Networking published in December 2009. (DHID, 24 Feb 12)

x NHS CFH website > IG > News CLINICAL AUDIT HQIP consultation on principles of quality in national clinical audit The Healthcare Quality Improvement Partnership (HQIP) has launched a consultation on its Principles of Quality in National Clinical Audit guidance.

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It is envisaged that the resulting set of principles will enable any national clinical audit to be compared against a standard, perhaps within an accreditation scheme. This will set ground rules for judgement of what is good, and effective, or not. (HQIP, 08 Feb 12)

x Press release NHS TECHNOLOGY Clinical information system – contract award notice NHS Shared Business Services (NHS SBS) has announced the successful bidders for a framework contract for clinical information systems set up on behalf of some eight trusts in the North West of England. Four contracts have been awarded to Ascribe, Civica, CSE and Strand Technology. (European Union, 03 Mar 12)

x Contract Award Notice Medical software package – contract notice NHS Supply Chain is leading a procurement on behalf of various trusts for picture archiving and communications systems (PACS) and radiology information systems (RIS). The four-year framework agreement will be worth between £171m and £363m, according to the notice published in the Official Journal of the European Union – Supplement. Where hardware and software options are procured through the framework, the provision of associated professional services may be included, according to the notice. Suppliers chosen for certain lots may also be expected to provide a managed service. (European Union, 29 Feb 12)

x Contract Notice Northern Devon trust pilots remote devices for community nurses Northern Devon Healthcare NHS Trust is piloting mobile devices for its community care nurses and therapists to enable them to access files, capture data and update back office systems remotely. The pilot will see about 60 staff equipped with smartphones and tablets using Vodafone's 3G network. They will have access to policy and other documents held on the trust's database and, using an in-house app based on NDL software, will be able to update information about their visits in real time. The app will help the trust comply with the Department of Health's requirement to provide the Community Information Data Set - which includes information on patients' demographics, care and referrals - from April, without its community nurses, occupational therapists, physiotherapists and others having to return to an office. (Guardian Professional, 07 Feb 12)

x Full text HEALTH AND SOCIAL CARE BILL Ten reasons why we need a Bill to make these reforms work Health Minister Simon Burns explains why the Health and Social Care Bill is needed to make the changes that are being proposed for the NHS. (DH, 15 Feb 12)

x DH > Policy News

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HEALTH SELECT COMMITTEE Social care: fourteenth report of session 2010-12 This report from the Health Select Committee claims that older people are being let down by fragmented care services. It concludes that joined up services are the key to securing better outcomes for older people and other vulnerable groups, and to delivering the required efficiency savings. The central recommendation is the introduction of "joined up" commissioning. The Committee recommends that the Government should place a duty on the new clinical commissioning groups and local councils to create a single commissioning process, with a single accounting officer, and a single outcomes framework for older people’s health, care and housing services in their area. (House of Commons, 08 Feb 12)

x Committee - news PUBLIC ADMINISTRATION Cabinet Office and DWP procure digital services for Universal Credit The Cabinet Office and the Department of Work and Pensions (DWP) have joined forces to formally seek the services of specialist identity providers who will deliver safe and secure access to DWP services. DWP will be the first to use the new Identity Assurance (IDA) digital services to support its flagship Universal Credit programme and the Personal Independence Payment, which from 2013 will replace the current complex and outdated benefit system. The Government’s IDA programme is designed to ensure that all users of digital public services are able to assert their identities safely, securely and simply. The contract will be in line with the Cabinet Office’s overall efficiency programme using smarter procurement and the move to put more services online through the Government Digital Service (GDS). (Cabinet Office, 01 Mar 12)

x Press release CloudStore opens for business The Cabinet Office has announced the launch of CloudStore, an online appstore of the Government’s G-Cloud framework for cloud-based ICT services. CloudStore offers the public sector a cheaper, quicker and more transparent way to procure the services they need, including email, word processing, system hosting, enterprise resource planning, electronic records management, customer relationship management or office productivity applications. The G-Cloud framework is set to revolutionise the purchasing, management and delivery of public sector IT services and the way suppliers work with government. Public sector organisations will be able to purchase off-the-shelf IT services from CloudStore on a pay-as-you-go basis rather than having to develop their own systems. This model means the government can use what it wants, when it wants it, and save money by avoiding duplication of services that cannot be shared. (Cabinet Office, 19 Feb 12)

x Press release

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Government anticipates £5 billion in cash savings this year The Cabinet Office has announced that the government is firmly on track to make around £5 billion cash savings this year. Last year’s tough controls in property, procurement, ICT and staffing delivered £3.75 billion savings in just one year. The figures have been corroborated by key independent auditors, including the National Audit Office. This year the government, in just eight months, has secured £3.25 billion in savings from efficiency measures. This will help departments live within their tighter budgets set at the Spending Review. On top of this, work carried out to uncover waste in areas such as fraud, error and debt mean that projected savings for the full financial year are anticipated to be around £5 billion. (Cabinet Office, 16 Feb 12)

x Press release New approach to leadership of major public projects The Cabinet Office has unveiled plans for a new Major Projects Leadership Academy, which will be created and delivered in partnership with Oxford's Saïd Business School. The new academy will build the skills of senior project leaders across government to deliver complex projects, reducing the over-reliance on expensive external consultancy further and building expertise within the Civil Service. In future no one will be able to lead a major government project without completing the Academy. (Cabinet Office, 07 Feb 12)

x Press release INFORMATION POLICY Cabinet Office calls on IT Community to engage in Open Standards consultation The government has launched a consultation on the use of open standards for software interoperability, data and document formats in government IT. The results of the consultation will inform:

x The definition of open standards in the context of government IT. x The meaning of mandation and the effects compulsory standards may have on government

departments, delivery partners and supply chains. x International alignment and cross-border interoperability.

The ICT Futures team in the Cabinet Office is responsible for this consultation, which closes on 01 May 2012. (Cabinet Office, 09 Feb 12)

x Press release x Open Standards Consultation website

Introducing the beta of GOV.UK The Government Digital Service (GDS) has released the first phase of the beta test of GOV.UK. This will be the single domain for the public facing side of central government. (GDS, 31 Jan 12)

x GDS News x Beta site

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New site to take you inside government The Government Digital Service has released, on a trial basis, the Inside government section of the gov.uk website. This is aimed at specialists seeking a behind the scenes look at what government is doing, as opposed to the public-facing service. The beta will run for a 6-week period with the initial participation of 10 government departments, including the Department of Health. (DH, 29 Feb 12)

x DH > Consultations x Inside government

DATA PROTECTION Commission proposes a comprehensive reform of the data protection rules The European Commission has proposed a comprehensive reform of the EU's 1995 data protection rules to strengthen online privacy rights and boost Europe's digital economy. Among issues being addressed is the processing of personal health data, to ensure on the one hand privacy for patients while still enabling the EU to meet the other legitimate objectives in the Treaties such as a high level of health protection. (European Commission, 25 Jan 12)

x Press release HEALTH STATUS Update on the ONS Measuring National Well-being programme The Office for National Statistics (ONS) has published an update on national well-being. Between October 2011 and January 2012, ONS ran a public consultation about initial proposals of domains and headline measures of national well-being. Nearly 1,800 people or organisations responded to the consultation, and initial findings have been published. The consultation has shown that there is broad support for the domains and headline measures of national well-being initially proposed, with several common themes for additions and changes. At the same time, the ONS has published experimental estimates of subjective well-being from the Annual Population Survey (APS), with results from questions asked during Apr-Sept 2011 reaching over 80,000 adults across the UK. Of the four UK countries, Northern Ireland has the highest score for life satisfaction; Northern Ireland also had the highest scores for the ‘worthwhile’ and ‘happiness yesterday’ questions. The overall life satisfaction rating for England was 7.4 out of 10. Most English regions did not differ very much from this. However, London and the West Midlands had the lowest average ratings (7.2 out of 10) and the South East and South West had the highest ratings (7.5 out of 10). (ONS, 28 Feb 12)

x Press release DEPARTMENT OF HEALTH New DG appointments announced The DH has announced three new appointments to its senior team. Dr Felicity Harvey CBE, currently Director of the Implementation Unit in the Cabinet Office, will take up the post of Director General for Public Health. She will lead the Department’s public health teams and will work closely with Public Health England, the NHS Commissioning Board and local government.

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Charlie Massey, currently Director for Ageing Society and State Pensions at the Department of Work and Pensions (DWP), will take up the post of Director General for External Relations. He will be responsible for the Department’s relations and communications with external stakeholders, from members of the public, to health unions, to Parliament. Karen Wheeler CBE, currently Director for the Department of Health’s transition programme, will take up the post of Director General for Group Operations and Assurance. She will be responsible for delivering change within the Department itself, human resources, corporate services and managing the overall performance and capability of arm’s length bodies. (DH, 29 Feb 12)

x Press release NHS NHS Constitution An updated NHS Constitution has been published, with an increased emphasis on the importance of whistleblowing in the NHS. The new version replaces the previous version of the Constitution published in 2010. There is also an updated handbook to accompany it. Health Secretary, Andrew Lansley, has also announced the formation of an NHS Future Forum Working Group, to be chaired by Professor Steve Field, to contribute to a government report on the NHS Constitution. (DH, 08 Mar 12)

x DH > Policy News x Press release – Working Group

How the NHS measures up to other health systems The government’s plans for reorganising the NHS have sparked heated discussions about the performance of the UK health system in comparison with that of other countries. Politicians favouring reform have emphasised real and perceived shortcomings of the NHS, while opponents have lauded its successes. Objective data have been sadly lacking in much of this debate. Arbitrary examples of good or bad performance from the UK and various other countries have been thrown back and forth, often using totally incommensurable data. Two new publications from the Commonwealth Fund, a New York based health policy institute, shed some much needed light on these questions. This commentary analyses the data and then proceeds to discuss the strengths and weaknesses of the NHS in the light of current proposals for reform. (BMJ, 22 Feb 12)

x Full text (Athens login required) or available on request x Guardian, 23 Feb 12

Introducing a single operating model Between February and May 2012, SHA clusters will be introducing a single operating model to support and assure NHS trusts through their Foundation Trust applications. The Department of Health has published documents outlining this new operating model. (DH, 23 Feb 12)

x DH > Policy News First estimates of funding in new health structure The Department of Health has estimated that Clinical Commissioning Groups (CCGs) could control almost £65 billion of NHS funding. In addition, around £5.2 billion would be spent on public health services. Of

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this, at least £2.2 billion will go direct to Local Authorities. The NHS Commissioning Board will be responsible for around £21 billion of commissioning expenditure. These figures will help to plan for the distribution of resources in the new system in a way that meets the needs of local populations. They will also support local organisations to plan for the transfer of public health responsibilities to Local Authorities and of commissioning to CCGs. The Advisory Committee on Resource Allocation will, in due course, publish their formulae for allocating resources to clinical commissioning groups and to local authorities for their new public health responsibilities. (DH, 07 Feb 12)

x Press release NHS COMMISSIONING BOARD National Director of Finance appointed The NHS Commissioning Board Authority has announced the appointment of Paul Baumann as the National Director of Finance. Paul, currently Director of Finance at NHS London, is the seventh of nine National Directors to be appointed to the Board. The two remaining posts of Chief Nursing Officer and National Director of Patient and Public Engagement, Insight and Informatics are expected to be appointed in the coming months. (NHSCB, 27 Feb 12)

x Press release Commissioning intelligence report A draft report and associated model has been published which provides feedback on the results of a large-scale engagement exercise to understand the information and intelligence requirements of emerging clinical commissioning groups (CCGs). The requirements have been presented in the form of a Commissioning Intelligence Model, which has been developed to facilitate discussions between local PCT clusters, emerging CCGs, Public Health and emerging Clinical Support Organisations (CSOs). It is intended to raise awareness of the broad range of commissioning questions that need to be answered and to show how commissioning intelligence can provide insights into local population health needs and the efficiency of health service provision. The report builds upon the commissioning requirements discussion document published in August 2011. Both report and model remain as draft subject to the passage of the Health and Social Care Bill. (NHSCB, 03 Feb 12)

x NHSCB > Publications HEALTH AND WELLBEING BOARDS A short guide to health and wellbeing boards The Department of Health has published a short guide to the role and purpose of health and wellbeing boards. (DH, 28 Feb 12)

x DH > HWB Guide

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CARE QUALITY COMMISSION Performance and capability review of the Care Quality Commission The Department of Health has published the report of its Performance and Capability Review of the Care Quality Commission (CQC). The review ran from October 2011 to February 2012, and was led by a panel of senior departmental officials and external reviewers, chaired by the Permanent Secretary. The review gathered evidence from a range of external stakeholders and CQC staff. It also considered findings of the recent reports from the Health Select Committee and the National Audit Office.

The review sets out recommendations to challenge CQC and support its continuing improvement by providing clearer strategic direction, strengthening the CQC board and developing and delivering the regulatory model. These recommendations will be important to ensure that CQC builds and sustains its capability for the future. The review also recognises that the Department has more to do as a sponsor and work is underway to strengthen accountability arrangements across all the Department’s arms length bodies. (DH, 23 Feb 12)

x Access to review and associated documents

Cynthia Bower announces resignation The chief executive of the Care Quality Commission has resigned. Cynthia Bower will however remain in post until autumn 2012 to allow for an appropriate handover. (CQC, 23 Feb 12)

x Press release MONITOR New pricing analysis highlights opportunities to improve patient care The government has proposed that Monitor takes on responsibility for pricing, working closely with the NHS Commissioning Board. It is important for Monitor and the NHS Commissioning Board to understand the strengths and weaknesses of the current reimbursement systems in the NHS and how these compare to best practice in other healthcare systems around the world and in other sectors. Monitor appointed PwC to undertake an in-depth, independent and extensive evaluation of the reimbursement system in the NHS in England. The findings have now been published and will be used to help establish the evidence for Monitor to use to develop new ways of using pricing to deliver benefits for patients. The report highlights the vital importance of good quality information which accurately identifies the true costs of providing care. (Monitor, 23 Feb 12)

x Press release NATIONAL INSTITUTE FOR HEALTH RESEARCH NIHR appoints National Director for Public Participation and Engagement in Research The National Institute for Health Research (NIHR) has asked Simon Denegri, Chair of INVOLVE, to take on the additional role of National Director for Public Participation and Engagement in Research. The new role will provide strategic direction and leadership to initiatives aimed at encouraging more people to take part in research. (NIHR, 07 Feb 12)

x Press release

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NHS INFORMATION CENTRE The NHS Information Centre announces key appointment to support GPES The NHS Information Centre has announced the appointment of Neil Serougi as the inaugural interim chair of the Independent Advisory Group (IAG) set up to review requests for data via the General Practice Extraction Service (GPES). Neil, who was recommended for the position by Chair of the National Information Governance Board Dame Fiona Caldicott, was previously Director of Informatics and Communications Technology at Solihull Primary Care Trust and Solihull Care Trust, and also Director of the NHS Connecting for Health programme for East Birmingham and Solihull. He is a member of the Economic and Social Research Council and the Digital Birmingham Board. (NHS IC, 28 Feb 12)

x Press release PUBLIC HEALTH Guidance for local public health teams and clinical commissioning groups The Department of Health has issued draft guidance on the public health advice that is aimed at helping commissioners with local planning in this transition year. Subject to the Health and Social Care Bill, from 2013-14, clinical commissioning groups will have access to public health advice, information and expertise in relation to the healthcare services that they commission, provided by local public health teams based in local authorities. The intention is to make it a mandatory requirement for local authorities, from April 2013, to provide this service to clinical commissioning groups, but the detail of the arrangements will need to be planned locally. The draft guidance has been sent to Directors of Public Health and Clinical Commissioning Group leads, together with a request for comments to be received by 30 March to help refine the guidance. (DH, 22 Feb 12)

x Access to draft guidance and Dear Colleague letter Government publishes response to health committee report on public health The government has published its response to the Health Select Committee’s report on public health, welcoming its endorsement of the intention to give greater prominence and priority to public health policy. The response notes that in the new system the Secretary of State for Health will retain his duty to promote a comprehensive health service (including public health services) and will remain accountable for them. He will provide national leadership, resources and the legislative infrastructure for public health. He will also give direction to the system through publishing a Public Health Outcomes Framework. Local authorities will be accountable first and foremost to their local populations for delivery of their new public health functions, and improvements will be driven by transparency and local scrutiny and accountability. Public Health England will publish data that will make it clear how local authorities are performing against the outcomes in the Public Health Outcomes Framework, and council overview and scrutiny functions will track performance. To support local authorities, Public Health England will offer expertise and assistance and, where necessary, constructive challenge. (DH, 07 Feb 12)

x DH > Policy News x Download document (Cm 8290) (PDF, 32 pages, 501Kb)

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Health inequalities widen within most areas of England Following the two-year anniversary of the release of the Marmot Review, newly updated figures on health inequalities show that while life expectancy improved for most of the 150 local authority areas in England that will take over responsibility for public health in April 2013, inequalities within these areas also increased. (UCL Institute of Health Equity, 15 Feb 12)

x Press release DENTAL SERVICES NHS dental service - live pilot practices and pilot types The latest list of dental practices participating in the dental contract pilot scheme, indicating their primary care trust and pilot type, is available. Seventy pilot sites are now live around England, each trialling a different model. The list contains live pilot practices and pilot types information. (DH, 08 Feb 12)

x DH > Publications HOSPITALS Outpatient survey 2011 The Care Quality Commission (CQC) carries out periodic surveys of the views of patients' experiences. The latest survey asked more than 72,000 outpatients for their feedback in relation to waiting times, hospital facilities, seeing a doctor or other members of staff, tests and treatments and prescribed medications. Results show that more patients are treated with respect and dignity but the way they are given information about treatments and results needs to improve. The feedback will be used by NHS trusts to improve their performance and by CQC for regulatory, compliance and monitoring activities. (CQC, 14 Feb 12)

x Press release Does competition improve public hospitals' efficiency? This paper uses a difference-in-difference style estimation strategy to test separately the impact of competition from public sector and private sector hospitals on the efficiency of public hospitals. In this study, the authors measure efficiency using average length of stay (LOS) for patients undergoing elective surgery, broken down into its two key components: the time from admission until surgery and the time from surgery until discharge. Results suggest that competition between public providers prompted public hospitals to improve productivity by decreasing pre-surgery, overall and post-surgery LOS. In contrast, competition from private hospitals did not spur public providers to improve their performance and instead left incumbent public providers with a more costly case mix of patients and led to increases in post-surgical LOS. (London School of Economics, Centre for Economic Performance, Feb 12)

x Access to full text

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URGENT AND EMERGENCY CARE GPs fine hospitals over failure to meet A&E waiting time targets Clinical commissioning groups have started to impose fines on hospitals that are failing to meet A&E waiting time targets, in a sign of the growing willingness of GP commissioners to tackle underperforming acute trusts. Three CCGs in Worcestershire, under delegated powers from the PCT, have withheld a total of £1.2m in payments to Worcestershire Acute Hospitals NHS Trust over the last three months. In Northamptonshire, two CCGs plan to withhold up to £56,000 from Kettering General Hospital – equating to 10% of their monthly funding - after it failed to meet operational targets in every quarter in the past year. (Pulse, 13 Feb 12)

x Full text (registration required) END OF LIFE CARE Deprivation and death: variation in place and cause of death This report looks at patterns of death by socioeconomic deprivation. It examines the interaction between deprivation, sex and age group, and place and underlying cause of death. All data are from Office for National Statistics (ONS) mortality files for deaths registered in England between 2007 and 2009. Findings suggest that people who live in deprived areas are more likely to die in hospital than those living in affluent areas. (NHS National End of Life Care Programme, 08 Feb 12)

x Access to document CANCER CCG publishes report supporting the critical role of cancer networks in improving patients’ care The Cancer Campaigning Group (CCG) has published a report, Developing excellence in cancer networks, which calls for the NHS Commissioning Board to establish cancer networks as Strategic Clinical Networks. It sets out three recommendations: 1. The Board should develop a model contract based on the themes and quality markers set out in this

report: x Acting as an ‘honest broker’. x Analysing and collating data. x Supporting commissioning. x Engaging stakeholders in the delivery of national strategies. x Ensuring the provision of quality care and services.

2. The Board should set out measures against which performance in each of these areas can be measured. 3. Cancer networks should report annually on their performance in these areas. The CCG hopes that this will be a useful contribution to the ongoing Department of Health work looking at the role and responsibilities of clinical networks. (CCG, 28 Feb 12)

x Press release

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LONG TERM CONDITIONS Long-term conditions and mental health: the cost of co-morbidities This paper suggests that developing more integrated support for people with mental and physical health problems could improve outcomes and play an important part in helping the NHS meet the quality, innovation, productivity and prevention challenge. It concludes that the prevailing approach to supporting people with long-term conditions is at risk of failing unless the role of emotional and mental health problems in reducing people’s ability and motivation to manage their physical health is recognised. (The King's Fund, 09 Feb 12)

x The King's Fund - publications Personal health budgets and NHS Continuing Healthcare The Department of Health has published guidance setting out the potential use of personal health budgets for people receiving NHS Continuing Healthcare. Personal health budgets are currently being piloted in the NHS in England, with over 2,700 participants across 20 sites. A number of sites are piloting personal health budgets with people eligible for NHS Continuing Healthcare. In October 2011, the Secretary of State for Health announced that, subject to the evaluation, by April 2014 everyone in receipt of NHS Continuing Healthcare will have a right to ask for a personal health budget, including a direct payment. This will form part of a broader rollout of personal health budgets to people with long term health conditions. (DH, 27 Jan 12)

x Access to document MENTAL HEALTH £22 million for ground-breaking children’s mental health programme The government has announced a £22m investment in the Children and Young People’s Improving Access to Psychological Therapies (IAPT) project over the next three years to enable more treatment outside of traditional health settings, such as in schools or youth groups. One in ten children aged 5-16 years has a clinically diagnosable mental health problem and, of adults with long-term mental health problems, half will have experienced their first symptoms before the age of 14. Failure to treat mental health disorders in children can have a devastating impact on their future, resulting in reduced job and life expectations. (DH, 29 Feb 12)

x DH > Policy News Introducing the national dementia CQIN In a video blog Professor Alistair Burns, National Clinical Director for Dementia, introduces the national commissioning for quality and innovation (CQIN) plan. The CQIN will be introduced in April with the aim of improving areas of dementia care in hospitals. (DH, 21 Feb 12)

x DH > Policy News Guidance for commissioners The Royal College of Psychiatrists (RCPsych) has published four guides to help current and future commissioners plan and deliver high quality mental health services. The guides focus on primary mental health care services, child and adolescent mental health service transitions, dementia services and acute

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liaison services. They describe what good quality, modern mental health services should look like and bring together scientific evidence, patient and carer experience and viewpoints, as well as examples of best practice. (RCPsych, 06 Feb 12)

x Press release QUALITY ACCOUNTS Quality accounts reporting requirements for 2011-12 and planned changes for 2012-13 The Department of Health (Sir Bruce Keogh) and Monitor (Dr David Bennett) have jointly written to all NHS trusts to provide advance notice of likely changes to quality account reporting requirements for the 2012/13 round of quality accounts, following consideration by the National Quality Board. The letter also flags up that NHS acute and mental health trusts will be formally required to have their quality accounts externally audited from this year, 2011/12. (DH, 16 Feb 12)

x Download document (PDF, 15 pages, 183Kb) PATIENTS Online patient feedback linked to hospital performance A team of researchers from Imperial College, London, has studied the correlation of patients' unsolicited ratings on the NHS Choices website with objective measures of performance at hospitals. The team examined more than 10,000 ratings of all NHS acute hospital trusts submitted on NHS Choices in 2009 and 2010. The research found that better-rated hospitals tend to have lower death rates and lower readmission rates. Hospitals rated as cleaner by patients have also been found to have lower MRSA rates. The team concludes that the ratings do provide "useful and relevant" information for patients. (DH, 15 Feb 12)

x DH > Policy News x Imperial College press release x Original source – Archives of Internal Medicine, 13 Feb 12 / Felix Greaves et al (Athens login

required) A framework for NHS patient experience The Department of Health has published the NHS Patient Experience Framework which outlines the areas most important to patients’ experience of NHS services. The framework provides a common evidence-based list of what matters to patients, and can be used to direct efforts to improve services. For example it can be used to help define what questions to ask patients in surveys and in real time feedback. The framework, agreed by the National Quality Board, is based on a modified version of the Picker Institute Principles of Patient-Centred Care. (DH, 21 Feb 12)

x DH > Policy News Patient experience in adult NHS services: improving the experience of care NICE has published guidance and a quality standard on patient experience in NHS adult services. This clinical guidance and quality standard has been produced by the National Clinical Guideline Centre hosted at the Royal College of Physicians. The focus of the guidance is on core areas affecting patient experience such as staff–patient interaction. Recommendations are made in the following areas: knowing the patient

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as an individual; essential requirements of care; tailoring healthcare services for each patient; continuity of care and relationships; enabling patients to actively participate in their care. (NICE, Feb 12)

x Access to guidance and quality standard PAYMENT BY RESULTS Confirmation of Payment by Results arrangements for 2012-13 Details of the arrangements for Payment by Results (PbR) in 2012-13 are now available. The road test of the draft 2012-13 guidance concluded on 20 January 2012 and a number of changes have been made as a result of this feedback. (DH, 16 Feb 12)

x DH > Policy News Maternity pathway payment system in 2012-13 Background information on the PbR maternity pathway system has been published. It includes the structure of the system, how prices have been produced, data templates, business rules and frequently asked questions. (DH, 16 Feb 12)

x DH > Policy News NHS PROCUREMENT Variations to the NHS Standard Contracts The variations to the NHS Standard Contracts for 2010/11 and 2011/12 are now available. The NHS Standard Contract should be used by commissioners when commissioning acute, mental health and learning disability, community or ambulance Services. The variations bring contracts in line with the requirements of the 2012/13 NHS Operating Framework. (DH, 21 Feb 12)

x Access to standard contracts and 2012-13 variations

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EUROPE European Commission establishes new eHealth Stakeholder Group Following the recent call for expressions of interest, the European Commission has selected 29 members to participate in its new eHealth Stakeholder Group. Members of the group, appointed for a period of three years, are expert representatives of European umbrella organisations active in the eHealth sector. A complete list is available online. (European Commission, 29 Feb 12)

x EC > eHealth Stakeholder Group European Medicines Agency to publish information on ongoing medicine evaluations From 01 March 2012, the European Medicines Agency (EMA) will start to publish information on applications for centralised marketing authorisation for human medicines that it has received for evaluation. The Agency will publish the international non-proprietary names (INN) and therapeutic areas for all new innovative medicines under evaluation by the Committee for Medicinal Products for Human Use (CHMP). This initiative forms part of the drive towards increased transparency on its activities by the Agency and other European regulatory authorities. (EMA, 17 Feb 12)

x Press release European Medicines Agency counts down to introduction of new pharmacovigilance legislation The European Medicines Agency, together with the European Member States and the European Commission, is preparing for the introduction of new pharmacovigilance legislation in July this year, which will bring the biggest change to the legal framework since the establishment of the Agency in 1995. Over the next months, the Agency will finalise its preparations for the inaugural meeting of the new Pharmacovigilance Risk Assessment Committee (PRAC), planned for 19 July 2012. (EMA, 02 Feb 12)

x Press release GERMANY Notification of infectious diseases - Electronic data transmission trial successful This briefing reports on the process for the reporting of infectious diseases to the responsible federal authority, the Robert Koch Institute (RKI) in Berlin. The notification process is expected to be simplified following the successful implementation of a pilot project for the electronic submission of data to the local health department, which in turn ensures that the RKI is timely informed via federal state authorities. (ePractice, 14 Feb 12)

x Full text CANADA The value of electronic health records extends far beyond patient care The Information and Privacy Commissioner of Ontario has joined forces with Canada Health Infoway to produce a paper which sets out how patient privacy can be built into electronic health record (EHR) systems. The paper argues that the current practice of using health information for a range of authorised purposes should continue in the EHR environment, but that this must be done in a way that respects individual rights to privacy while benefitting the health system for all Canadians (Infoway, 02 Mar 12)

x Press release

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Primary health care EMR reporting system gets green light to grow Following a successful pilot, the board of the Canadian Institute for Health Information has approved an extension of its Primary Health Care Voluntary Reporting System. The three-year pilot project has shown that primary health care providers are willing to voluntarily contribute data from their electronic patient record systems to the reporting system (in a privacy-sensitive manner), in return for reports on their patient population to support planning and outcome analysis, as well as comparative results for other patient groups. (Canadian Institute for Health Information, Feb 12)

x Full text UNITED STATES We can't wait: Obama administration calls for a consumer privacy bill of rights for the digital age The US government has outlined new data privacy principles that US organisations should introduce to give consumers means to control how their personal data is collected and used. The White House said the measure, which was announced as part of a new Consumer Privacy Bill of Rights (CPBoR), would help those companies build up "trust" in their relationship with consumers. The CPBoR sets out a basic framework of rules that companies should observe in order to respect consumer privacy. The US government wants law-makers in Congress to draft new privacy legislation that sets out the framework in greater detail. It has also called on industry stakeholders to draw up new "legally enforceable" self-regulatory voluntary codes giving companies the chance to sign-up to industry-specific rules that comply with the CPBoR framework. (White House, 24 Feb 12)

x Press release HHS Secretary Kathleen Sebelius announces major progress in doctors, hospital use of health information technology The Department of Health and Human Services (HHS) has announced that the number of hospitals using health information technology (IT) has more than doubled in the last two years. New data show nearly 2,000 hospitals and more than 41,000 doctors have received $3.1 billion in incentive payments for ensuring meaningful use of health IT, particularly certified Electronic Health Records. (HHS, 17 Feb 12)

x Press release HHS announces intent to delay ICD-10 compliance date As part of President Obama’s commitment to reducing regulatory burden, the Department of Health and Human Services (HHS) has announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10). (HHS, 16 Feb 12)

x Press release SHARP Area 4: secondary use of EHR data - annual progress report 2011 The Mayo Clinic contributes to the Strategic Health IT Advanced Research Project (SHARP) program. Part of the Office of the National Coordinator for Health Information Technology (ONC), the program is focused on improving quality, safety and efficiency of health care through information technology.

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The Mayo Clinic’s specific project seeks to enhance patient safety and improve patient medical outcomes through the use of an electronic health record. Traditionally, a patient’s medical information, such as medical history, exam data, hospital visits and physician notes, are stored inconsistently and in multiple locations, both electronically and non-electronically. This program proposes to generate a framework of open-source services that can be dynamically configured to transform EHR data into standards-conforming, comparable information suitable for large-scale analyses, inferencing, and integration of disparate health data. This document provides a progress report on the six projects that make up the program. The six projects are strongly intertwined, mutually dependent projects, including: 1) semantic and syntactic normalisation 2) natural language processing (nlp) 3) phenotype applications 4) performance optimisation 5) data quality metrics and 6) evaluation frameworks. (Mayo Clinic on behalf of the ONC, Jan 12)

x Download document (PDF, 278 pages, 757Kb) x SHARP4 website

STANDARDS EHRs for clinical research This briefing provides an overview of how standards and processes are being used to enable system vendors to ensure that electronic health record data can be used to conduct clinical research. (The Standards Standard, Winter 11-12)

x Full text Global Traveler’s EHR template (TrEHRT) Informaticians associated through the International Medical Informatics Association have collaborated to publish a template and create an associated open code source cell phone application to support timely access globally to minimum dataset fields of medical information. This template standard is of potential use for travellers where there is minimal internet access, or as a default for sharing personal health information with clinical personnel worldwide on a need-to-know basis. Data security technologies are incorporated in the design and International Classification of Diseases (ICD) and Anatomical Therapeutic Chemical (ATC) codes are used to enhance understanding of the information regardless of location. (The Standards Standard, Winter 11-12)

x Full text RECENTLY PUBLISHED STANDARDS ISO/IEC guide upgrades safety aspects in medical device standards The International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC) have published a guide to help standards writers address safety aspects in medical device standards. ISO/IEC Guide 63:2012, Guide to the development and inclusion of safety aspects in International Standards for medical devices, improves on and replaces a 1999 edition. In addition, it responds to the risk-based framework set out in ISO 14971: 2007, Medical devices – Application of risk management to medical devices. (ISO, 28 Feb 12)

x Available on request – no cost

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ISO/IEC 29167-1:2012 - Information technology - Automatic identification and data capture techniques -Part 1: Air interface for security services and file management for RFID architecture This standard defines the architecture for security and file management for the ISO/IEC 18000 air interface standards for radio frequency identification (RFID) devices. It provides a common technical specification for security and file management for RFID devices that can be used by developers of RFID application standards. It defines various security features called security mechanisms that can be implemented by a tag depending on the application. A tag can support one, a subset, or all of the specified security mechanisms. For an interrogator it is possible to get information about the security mechanisms that are actually implemented and supported by a tag. Moreover, it has been considered that adding new security mechanisms remains possible. Besides signalling the presence of certain security services, further details of the mechanisms such as utilized encryption algorithm and key length also need to be specified and accessible. (ISO, 05 Mar 12)

x Available on request – no cost ISO/IEC TR 29149:2012 - Information technology - Security techniques - Best practices for the provision and use of time-stamping services This technical report explains how to provide and use time-stamping services so that time-stamp tokens are effective when used to provide timeliness, data integrity, and non-repudiation services in conjunction with other mechanisms. (ISO, 05 Mar 12)

x Available on request – no cost ISO/IEC 17020:2012 - Conformity assessment - Requirements for the operation of various types of bodies performing inspection This standard specifies requirements for the competence of bodies performing inspection and for the impartiality and consistency of their inspection activities. It revises ISO/IEC 17020:1998. (ISO, 27 Feb 12)

x Available on request – no cost

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ARTICLES Abstraction of complex concepts with a refined partial-area taxonomy of SNOMED An algorithmically-derived abstraction network, called the partial-area taxonomy, for a SNOMED hierarchy has led to the identification of concepts considered complex. The designation "complex" is arrived at automatically on the basis of structural analyses of overlap among the constituent concept groups of the partial-area taxonomy. Such complex concepts, known as overlapping concepts, constitute a tangled portion of a hierarchy and can be obstacles to users trying to gain an understanding of the hierarchy’s content. This article presents a methodology for partitioning the entire collection of overlapping concepts into singly-rooted groups that are more manageable to work with and comprehend. Different kinds of overlapping concepts with varying degrees of complexity are identified. This leads to an abstract model of the overlapping concepts called the disjoint partial-area taxonomy, which serves as a vehicle for enhanced, high-level display. The methodology is demonstrated with an application to SNOMED’s Specimen hierarchy. Overall, the resulting disjoint partial-area taxonomy offers a refined view of the hierarchy’s structural organisation and conceptual content that can aid users, such as maintenance personnel, working with SNOMED. The utility of the disjoint partial-area taxonomy as the basis for a SNOMED auditing regimen is presented in a companion paper. Journal of Biomedical Informatics, Vol 45(1), Feb 12, 15-29 / Yue Wang et al

x Access to full text (no cost) Adoption of telemedicine: from pilot stage to routine delivery The objective of this paper is to achieve a better understanding of the adoption of telemedicine, to assist those trying to move applications from pilot stage to routine delivery. The authors have investigated the reasons why telemedicine has stalled by focusing on two, high-level topics: 1) the process of adoption of telemedicine in comparison with other technologies; and 2) the factors involved in the widespread adoption of telemedicine. They conclude that the widespread adoption of telemedicine is a major - and still underdeveloped - challenge that needs to be strengthened through new research directions. In particular, it is suggested that data about the adoption of telemedicine should be collected from applications implemented on a large-scale, to test the assumption that the adoption of telemedicine follows an S-shaped growth curve. This will lead to a better understanding of the process, which will in turn accelerate the adoption of new telemedicine applications. Research is also required to identify suitable financial and professional incentives for potential telemedicine users. BMC Medical Informatics and Decision Making, Available online 04 Jan 12 / Paolo Zanaboni, Richard Wootton

x Full text (open access)

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Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation Anticipatory care for frail older patients involves both case identification and proactive intervention to reduce hospitalisation. The aim of this study was to ascertain whether using primary and secondary care data can identify this population and then whether applying an anticipatory care plan (ACP) can help to reduce hospital admission rates. Using data from two Scottish general practices, the authors examined admission rate, occupied bed days and survival among an ACP cohort and a control cohort. They conclude that this approach produced statistically significant reductions in unplanned hospitalisation for a cohort of patients with multiple morbidities. It demonstrates the potential for providing better care for patients as well as better value for health and social care services. British Journal of General Practice, Vol 62(595), Feb 12, e113-e120 / Adrian Baker et al

x Access to full text (no cost) Auditing complex concepts of SNOMED using a refined hierarchical abstraction network Auditors of a large terminology, such as SNOMED CT, face a daunting challenge. To aid them in their efforts, it is essential to devise techniques that can automatically identify concepts warranting special attention. "Complex" concepts fall neatly into this category. A special kind of grouping, called a partial-area, is utilised in the characterization of complex concepts. In particular, the complex concepts that are the focus of this work are those appearing in intersections of multiple partial-areas and are thus referred to as overlapping concepts. In a companion paper, an automatic methodology for identifying and partitioning the entire collection of overlapping concepts into disjoint, singly-rooted groups, that are more manageable to work with and comprehend, has been presented. The partitioning methodology formed the foundation for the development of an abstraction network for the overlapping concepts called a disjoint partial-area taxonomy. This new disjoint partial-area taxonomy offers a collection of semantically uniform partial-areas and is exploited herein as the basis for a novel auditing methodology. The review of the overlapping concepts is done in a top-down order within semantically uniform groups. These groups are themselves reviewed in a top-down order, which proceeds from the less complex to the more complex overlapping concepts. The results of applying the methodology to SNOMED's Specimen hierarchy are presented. Hypotheses regarding error ratios for overlapping concepts and between different kinds of overlapping concepts are formulated. Two phases of auditing the Specimen hierarchy for two releases of SNOMED are reported on. With the use of the double bootstrap and Fisher's exact test (two-tailed), the auditing of concepts and especially roots of overlapping partial-areas is shown to yield a statistically significant higher proportion of errors. Journal of Biomedical Informatics, Vol 45(1), Feb 12, 1-14 / Yue Wang et al

x Access to full text (no cost)

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Benefits and risks of structuring and/or coding the presenting patient history in the electronic health record Patient histories in electronic health records exist mainly in free text format thereby limiting the possibility that decision support technology may contribute to the accuracy and timeliness of clinical diagnoses. Structuring and/or coding make patient histories potentially computable. A systematic review was undertaken of the benefits and risks of structuring and/or coding patient history by searching nine international databases for published and unpublished studies over the period 1990–2010. The focus was on the current patient history, defined as information reported by a patient or the patient's caregiver about the patient's present health situation and health status. Findings were synthesised through a theoretically based textural analysis. Of the 9207 potentially eligible papers identified, 10 studies satisfied the eligibility criteria. There was evidence of a modest number of benefits associated with structuring the current patient history, including obtaining more complete clinical histories, improved accuracy of patient self-documented histories, and better associated decision-making by professionals. However, no studies demonstrated any resulting improvements in patient care or outcomes. When more detailed records were obtained through the use of a structured format no attempt was made to confirm if this additional information was clinically useful. No studies investigated possible risks associated with structuring the patient history. No studies examined coding of the patient history. The authors conclude that there is an insufficient evidence base for sound policy making on the benefits and risks of structuring and/or coding patient history. The authors suggest this field of enquiry warrants further investigation given the interest in use of decision support technology to aid diagnoses. BMJ Quality & Safety, Available online 10 Feb 12 / Bernard Fernando, Dipak Kalra, Zoe Morrison, Emma Byrne, Aziz Sheikh

x Article available on request - cost De-identification methods for open health data: the case of the Heritage Health Prize claims dataset The authors describe a new methodology for creating a longitudinal public health dataset in the context of the Heritage Health Prize (HHP). The HHP is a global data mining competition to predict, by using claims data, the number of days patients will be hospitalized in a subsequent year. The winner will be the team or individual with the most accurate model past a threshold accuracy, and will receive a US $3 million cash prize. HHP began in April 2011 and ends on 03 April 2013. Journal of Medical Internet Research, Available online 27 Feb 12 / Khaled El Emam et al

x Full text (HTML - no cost)

Developing a summary hospital mortality index: retrospective analysis in English hospitals over five years The objective of this study was to develop a transparent and reproducible measure for hospitals that can indicate when deaths in hospital or within 30 days of discharge are high relative to other hospitals, given the characteristics of the patients in that hospital, and to investigate those factors that have the greatest effect in changing the rank of a hospital, whether interactions exist between those factors, and the stability of the measure over time.

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The predictors that were used in the final model comprised admission diagnosis, age, sex, type of admission, and comorbidity. The percentage of people admitted who died in hospital or within 30 days of discharge was 4.2% for males and 4.5% for females. Emergency admissions comprised 75% of all admissions and 5.5% died, in contrast to 0.8% who died after an elective admission. The percentage who died with a Charlson comorbidity score of 0 was 2% in contrast with 15% who died with a score greater than 5. Given these variables, the relative standardised mortality rates of the hospitals were not noticeably changed by adjusting for the area level deprivation and number of previous emergency visits to hospital. There was little evidence that including interaction terms changed the relative values by any great amount. Using these predictors the summary hospital mortality index (SHMI) was derived. For 2007/8 the model had a C statistic of 0.911 and accounted for 81% of the variability of between hospital mortality. A random effects funnel plot was used to identify outlying hospitals. The outliers from the SHMI over the period 2005-10 have previously been identified using other mortality indicators. The authors conclude that the SHMI is a relatively simple tool that can be used in conjunction with other information to identify hospitals that may need further investigation. British Medical Journal, Available online 01 Mar 12 / Michael J Campbell, Richard M Jacques, James Fotheringham, Ravi Maheswaran, Jon Nicholl

x Full text (PDF, 11 pages, 606Kb) (open access) The distribution of lung cancer across sectors of society in the United Kingdom: a study using national primary care data There is a pressing need to diagnose lung cancer earlier in the UK and it is likely that research using computerised general practice records will help this process. Linkage of these records to area-level geo-demographic classifications may also facilitate case ascertainment for public health programmes. However, there have as yet been no extensive studies of data validity for such purposes. To first address the need for validation, the author assessed the completeness and representativeness of lung cancer data from The Health Improvement Network (THIN) national primary care database by comparing incidence and survival between 2000 and 2009 with the UK National Cancer Registry and the National Lung Cancer Audit Database. The author then explored the potential of a geo-demographic social marketing tool to facilitate disease ascertainment by using Experian's Mosaic Public Sector ™ classification, to identify detailed profiles of the sectors of society where lung cancer incidence was highest. It is concluded that routine electronic data in THIN are a valid source of lung cancer information. Mosaic ™ identified greater incidence differentials than standard area-level measures and as such could be used as a tool for public health programmes to ascertain future cases more effectively. BMC Public Health, Available online 10 Nov 11 / Barbara Iyen-Omofoman

x Full text (open access) Electronic health record-based messages to primary care providers: valuable information or just noise? Communication between clinicians is critical to co-ordination of care and prevention of adverse outcomes in the outpatient setting. Increasing the adoption of electronic health records (EHRs) and medical home-based care models will greatly increase electronic communication between different members of the health care team. One method of clinician-to-clinician communication is note-based messaging through the

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EHR, where the recipient is requested to provide their "additional signature" to a message to attest that it was received. It was recently found that primary care providers (PCPs) receive a large number of EHR-based additional signature request (ASR) alerts and spend considerable time processing them. Large numbers of messages might also cause PCPs to miss certain higher-priority notifications. Whether ASR alerts and other types of electronic messaging (called "routing" in some systems) are relevant to patient care or just a medium for distributing legal risk is unclear. To determine the value of clinician-to-clinician messaging in the EHR, the authors developed and tested a new method to evaluate the content of electronic messages and determine whether they were essential to clinical care. Archives of Internal Medicine, Vol 172(3), 13 Feb 12, 283-285 / Daniel R Murphy et al

x Full text (Athens login required) The health informatics cohort enhancement project (HICE): Using routinely collected primary care data to identify people with a lifetime diagnosis of psychotic disorder The authors demonstrate how patients with psychotic disorders can be identified from primary care records for potential inclusion in a cohort study. They designed an algorithm with which patients with a lifetime diagnosis of psychotic disorders were identified within the Secure Anonymised Information Linkage (SAIL) database of routinely collected health data. The algorithm was validated against the "gold standard" of a well established operational criteria checklist for psychotic and affective illness (OPCRIT). Case notes of 100 patients from a community mental health team (CMHT) in Swansea were studied of whom 80 had matched GP records. The authors conclude that with certain limitations the algorithm can be used to search general practice data and reliably identify patients with psychotic disorders. BMC Research Notes, Available online 14 Feb 12 / Alexis Economou et al

x Full text (open access) Incorporating personalized gene sequence variants, molecular genetics knowledge, and health knowledge into an EHR prototype based on the Continuity of Care Record standard The current volume and complexity of genetic tests, and the molecular genetics knowledge and health knowledge related to interpretation of the results of those tests, are rapidly outstripping the ability of individual clinicians to recall, understand and convey to their patients information relevant to their care. The tailoring of molecular genetics knowledge and health knowledge in clinical settings is important both for the provision of personalised medicine and to reduce clinician information overload. In this paper the authors describe the incorporation, customisation and demonstration of molecular genetic data (mainly sequence variants), molecular genetics knowledge and health knowledge into an electronic health record (EHR) prototype based on the Continuity of Care Record standard, developed specifically for this study.

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They conclude that the research shows a feasible model for delivering patient sequence variants and presenting tailored molecular genetics knowledge and health knowledge via a standards-based EHR system prototype. This approach can form the basis for a personalised medicine framework, a more comprehensive standards-based EHR system and a potential platform for advancing translational research by both disseminating results and providing opportunities for new insights into phenotype-genotype relationships. Journal of Biomedical Informatics, Vol 45(1), Feb 12, 89-92 / Xia Jing, Stephen Kay, Thomas Marley, Nicholas Hardiker, James J Cimino

x Article available on request - cost The many faces of the computer: an analysis of clinical software in the primary care consultation Almost all general practitioners in Australia now use a computer for some part of the consultation, and mostly use one of eight clinical software applications. This paper draws on Goffman's notion of "face" to explore the way in which the actions, visual presentation, and interactions between general practitioners, patients and the computer can imbue the software with its own face in the consultation. This was carried out by an analysis of 141 consultations by 20 doctors (13 men, 7 women), who used one of four medical software applications commonly used in Australian general practice. Consultations were videotaped, tagged, analysed using a hermeneutic framework. All four software packages replicated constitutive elements of the paper health record, such as medical history, current medications, and the patient's social history, but also introduced other content not present in a paper system. This necessitated differing interactions between the software and the doctor. The differences in communicative work of each software package led to their different faces, along a gradient from a relatively passive mode that provided context dependent information in an unobtrusive way, to a relatively active mode that interrupted to provide information and to demand responses. The authors conclude that the more active the mode of presence of the computer in the consultation, the more patients and doctors may have to adapt their communicative styles in response. International Journal of Medical Informatics, Available online 10 Feb 12 / Christopher Pearce et al

x Article available on request - cost Miscoding, misclassification and misdiagnosis of diabetes in primary care

This audit of electronic primary care registries in the United Kingdom found a significant incidence of misdiagnosis of diabetes, with problems including both overdiagnosis and misclassification of the type of diabetes. The authors developed six searches to identify people with diabetes with potential classification errors. The search results were automatically ranked from most to least likely to have an underlying problem. Eight practices with a combined population of 72 000 and diabetes prevalence 2.9% (n = 2340) completed audit forms to verify whether additional information within the patients’ medical record confirmed or refuted the problems identified. Examples of misdiagnosis were found in all practices, misclassification in seven and miscoding in six. Approximately 40% of patients identified by computer searches (5.8% of people with diabetes) had errors.

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Misdiagnosis is commonest, misclassification may affect treatment options and miscoding leads to omission from disease registers, all leading to the potential for reduced quality of care. Diabetic Medicine, Vol 29(2), Feb 12, 181-189 / Simon de Lusignan et al

x Article available on request - cost Multidimensional evaluation of a radio frequency identification wi-fi location tracking system in an acute-care hospital setting Real-time locating systems (RTLs) have the potential to enhance healthcare systems through the live tracking of assets, patients and staff. This study evaluated a commercially available system deployed in a clinical setting, with three objectives: (1) assessment of the location accuracy of the technology in a clinical setting; (2) assessment of the value of asset tracking to staff; and (3) assessment of threshold monitoring applications developed for patient tracking and inventory control. Simulated daily activities were monitored by RTLS and compared with direct research team observations. Staff surveys and interviews concerning the system's effectiveness and accuracy were also conducted and analysed. The study showed only modest location accuracy, and mixed reactions in staff interviews. These findings suggest that the technology needs to be refined further for better specific location accuracy before full-scale implementation can be recommended. Journal of the American Medical Informatics Association, Available online 01 Feb 12 / Barbara Okoniewska et al, on behalf of the Ward of the 21st Century team

x Article available on request - cost Opening up the "black box" of the electronic patient record: a linguistic ethnographic study in general practice One of the most pervasive changes in general practice is the introduction of the electronic patient record (EPR). The EPR supports both immediate clinical and anticipatory care (e.g. management of risk factors). Incorporating the EPR into social interaction is a complex task which is achieved discursively, clinician and patient responding to interactional contingencies as the consultation unfolds. Clinicians are presented with a "dilemma of attention" as they seek to deal with the immediacy of the interpersonal interaction and the institutional demands of the EPR. The authors present data analysis which illuminates the EPR as an important presence in the clinic consultation context, one which places material and textual demands. Developing previous work on the triadic (three party) consultation, a novel multi-modal analysis of the EPR-in-use suggests there is value in considering the EPR as a collection of silent but consequential voices. Micro-analytic attention to the way in which these different voices are managed, combined with understandings drawn from ethnographic observation of the primary care context, reveals the EPR as exhibiting a previously under-explored kind of "agency" within the consultation. Communication and Medicine, Vol 8(1), 2011, 3-15 / Deborah Swinglehurst, Celia Roberts, Tricia Greenhalgh

x Article available on request - cost

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Organizational framework for health information technology The authors conducted a targeted literature review in an attempt to develop an organisational framework that provides a structure to organise and capture information on the implementation and use if health IT. They propose a framework based on five major facets: technology, use, environment, outcomes, and temporality. Each major facet is described in detail along with associated categories and measures. It is concluded that the proposed framework is an essential first step toward ensuring a more consistent and comprehensive understanding of health IT implementation and use and a more rigorous approach to data collection, measurement development, and theory building. International Journal of Medical Informatics, Available online 28 Feb 12 / Helga E Rippen et al

x Article available on request - cost Perspectives of Australian adults about protecting the privacy of their health information in statistical databases The aim of this study was to discover the public's attitude and views towards privacy in health care. This is a part of a larger project which aims to gain an insight into what kind of privacy is needed and develop technical measures to provide such privacy. The results of the study revealed both great support for medical research (98%), and concern about privacy of health information (66%). Participants prefer to be asked for their permission before their health information is used for any purpose other than medical treatment (92%), and they would like to know the organisation and details of the research before allowing the use of their health records (83%). The study showed that there are some particularly sensitive issues and there is a concern (42–60%) about any possibility of linking these kinds of data to the patient's name in a situation that is not related to medical treatment. Such issues include sexually transmitted diseases, abortions and infertility, family medical history/genetic disorders, mental illness, drug/alcohol related incidents, lists of previous operations/procedures/dates and current medications. Participants believe they should be asked for permission before their health information is used for any purpose other than medical treatment. However, consent and privacy concerns are not necessary related. Assuring individuals that their personal health information is de-identified reduces their concern about the necessity of consent for releasing health information for research purposes, but many people are not aware that removing their names and other direct identifiers from medical records does not guarantee full privacy protection for their health information. Privacy concerns decrease as extra security measures are introduced to protect privacy. International Journal of Medical Informatics, Vol 81(4), Apr 12, 279–289 / Tatiana King, Ljiljana Brankovic, Patricia Gillard

x Article available on request - cost Portability of an algorithm to identify rheumatoid arthritis in electronic health records Electronic health records (EHR) can allow for the generation of large cohorts of individuals with given diseases for clinical and genomic research. A rate-limiting step is the development of electronic phenotype

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selection algorithms to find such cohorts. This study evaluated the portability of a published phenotype algorithm to identify rheumatoid arthritis (RA) patients from EHR records at three institutions with different EHR systems. Physicians reviewed charts from the three institutions to identify patients with RA. Each institution compiled attributes from various sources in the EHR, including codified data and clinical narratives, which were searched using one of two natural language processing (NLP) systems. The performance of the published model was compared with locally retrained models. Applying the previously published model from Partners Healthcare to datasets from Northwestern and Vanderbilt Universities, the area under the receiver operating characteristic curve was found to be 92% for Northwestern and 95% for Vanderbilt, compared with 97% at Partners. Retraining the model improved the average sensitivity at a specificity of 97% to 72% from the original 65%. Both the original logistic regression models and locally retrained models were superior to simple billing code count thresholds. These results show that a previously published algorithm for RA is portable to two external hospitals using different EHR systems, different NLP systems, and different target NLP vocabularies. Retraining the algorithm primarily increased the sensitivity at each site. Journal of the American Medical Informatics Association, Available online 28 Feb 12 / Robert J Carroll et al

x Article available on request - cost Postmarketing surveillance of medical devices - filling in the gaps This article presents an overview of the safety surveillance regime for medical devices operated by the US Food and Drug Administration (FDA). It suggests that complementing existing event-reporting systems with enhanced prospective surveillance of high-quality registries will permit the FDA to efficiently monitor the safety of increasingly complex and widely used medical devices. New England Journal of Medicine, Available online 14 Feb 12 / Frederic S Resnic, Sharon-Lise T Normand

x Full text (no cost) Reform and the National Health Service The public can be forgiven for being bewildered about the latest round of plans to reform the National Health Service (NHS) in England. The set of proposals is large, many are highly technical, why they are needed is not clear and the protests from key respected groups are loud. What is going on? It is a story best told in two halves. First, there is a shortrun political story. Second, there is an analysis of the longer run development of the NHS. While the first grabs the headlines, the second is more important and interesting. The Political Quarterly, Vol 83(2), Apr–Jun 12, 143-152 / Jennifer Dixon

x Full text (PDF, 10 pages, 113Kb) (no cost) Semantic mappings and locality of nursing diagnostic concepts in UMLS One solution for enhancing the interoperability between nursing information systems, given the availability of multiple nursing terminologies, is to cross-map existing nursing concepts.

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The Unified Medical Language System (UMLS), developed and distributed by the National Library of Medicine (NLM), is a knowledge resource containing cross-mappings of various terminologies in a unified framework. While the knowledge resource has been available for the last two decades, little research on the representation of nursing terminologies in UMLS has been conducted. As a first step, UMLS semantic mappings and concept locality were examined for nursing diagnostic concepts or problems selected from three terminologies (i.e., CCC, ICNP, and NANDA-I1

) along with corresponding SNOMED CT concepts. The evaluation of UMLS semantic mappings was conducted by measuring the proportion of concordance between UMLS and human expert mappings. The semantic locality of nursing diagnostic concepts was assessed by examining the associations of select concepts and the placement of the nursing concepts on the Semantic Network and Group.

The study found that the UMLS mappings of CCC and NANDA-I concepts to SNOMED CT were highly concordant to expert mappings. The level of concordance in mappings of ICNP to SNOMED CT, CCC and NANDA-I within UMLS was relatively low, indicating the need for further research and development. Likewise, the semantic locality of ICNP concepts could be further improved. Various stakeholders need to collaborate to enhance the NLM knowledge resource and the interoperability of nursing data within the discipline as well as across health-related disciplines Journal of Biomedical Informatics, Vol 45(1), Feb 12, 93-100 / Tae Youn Kim, Amy Coenen, Nicholas Hardiker

x Article available on request - cost Standardized nursing diagnoses in an electronic health record: nursing survey results A survey was conducted to obtain feedback from registered nurses as end-users of standardised nursing terminology for care planning in an electronic health record. Revisions to the care plan terminology were completed as part of an evidence-based project by nurses at one facility. Nurses reported a more positive agreement with the changes at 6 months compared with baseline, which generally was found to be sustained in the 2-year survey. Overall, the standardised terminology provided the nurses greater ease in their selection of nursing diagnoses and interventions in planning patient care, yet their reported satisfaction did not change. The survey identified several problematic areas related to nurses and care planning. Nurses reported less agreement with the statement about the care plans offering them the ability to determine the status of their patient's nursing care needs. They noted less agreement with statements of the care plan offering information on assessment of patient outcomes of nursing care. The patient plan of care in the electronic record is expected to offer nurses the ability to communicate the needs of the patient and assess outcomes of care. The survey findings indicate weaknesses warranting further exploration to identify changes needed to improve care planning documentation. International Journal of Nursing Knowledge, Available online 20 Feb 12 / Nicolette A Estrada

x Article available on request - cost

1 Clinical Care Classification; International Classification of Nursing Practice; Nursing Diagnoses: Definitions and Classification

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Use of name recognition software, census data and multiple imputation to predict missing data on ethnicity: application to cancer registry records Information on ethnicity is commonly used by health services and researchers to plan services, ensure equality of access, and for epidemiological studies. In common with other important demographic and clinical data it is often incompletely recorded. This paper presents a method for imputing missing data on the ethnicity of cancer patients, developed for a regional cancer registry in the UK. Routine records from cancer screening services, name recognition software (Nam Pehchan and Onomap), census data, and multiple imputation were used to predict the ethnicity of the 23% of cases that were still missing following linkage with self-reported ethnicity from inpatient hospital records. The name recognition software were good predictors of ethnicity for South Asian cancer cases when compared with data on ethnicity derived from hospital inpatient records, especially when combined. Onomap was a poor predictor of ethnicity for other minority ethnic groups. Area-based data derived from the national census was also a poor predictor of non-White ethnicity. Currently, neither method for assigning individuals to an ethnic group (name recognition and ethnic distribution of area of residence) performs well across all ethnic groups. The authors recommend further development of name recognition applications and the identification of additional methods for predicting ethnicity to improve their precision and accuracy for comparisons of health outcomes. However, real improvements can only come from better recording of ethnicity by health services. BMC Medical Informatics and Decision Making, Available online 23 Jan 12 / Ronan Ryan, Sally Vernon, Gill Lawrence, Sue Wilson

x Access to full text (open access) Validity of electronic health record-derived quality measurement for performance monitoring Since 2007, New York City's primary care information project has assisted over 3000 providers to adopt and use a prevention-oriented electronic health record (EHR). Participating practices were taught to re-adjust their workflows to use the EHR built-in population health monitoring tools, including automated quality measures, patient registries and a clinical decision support system. This study aimed to determine the use and validity of the EHR-derived quality measures. Results show that workflow and documentation habits have a profound impact on EHR-derived quality measures. Compared with the manual review of electronic charts, EHR-derived measures can undercount practice performance, with a disproportionately negative impact on the number of patients captured as receiving a clinical preventive service or meeting a recommended treatment goal. The authors conclude that the results provide a cautionary note in using EHR-derived measurement for public reporting of provider performance or use for payment. Journal of the American Medical Informatics Association, Available online 09 Feb 12 / Amanda Parsons, Colleen McCullough, Jason Wang, Sarah Shih

x Full text (open access)

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'Wading through treacle': quality improvement lessons from the frontline In a time of financial uncertainty and structural reform, the NHS needs clinical leadership to help improve the quality of patient care. Increasingly, leadership development is being targeted at doctors in postgraduate training to help prepare them for their future leadership roles as consultants and general practitioners. However, there is a risk that an opportunity is being missed here by failing to recognise the role that doctors in training can play now, during their training. As frontline clinicians they have a unique view of the health service and the inefficiencies therein. The London Deanery has been running an educational programme called Beyond Audit to provide doctors in training with quality improvement skills. During this programme the authors have been given a unique insight into NHS systems as viewed by junior doctors. They have identified a wide range of small system problems that, when combined, result in large-scale inefficiency and prevent the delivery of high quality patient care. These problems have implications for cost, efficiency, patient safety, team-working and patient experience. Any attempt to improve the quality of care delivered in the NHS needs to look at the system from the point of view of those delivering the care, including doctors in postgraduate training. By empowering them to make improvements to the systems that they see, there is the potential to make significant improvement in the quality of patient care that they deliver. BMJ Quality & Safety, Available online 23 Dec 11/ Alice Roueche, Jocelyn Hewitt

x Article available on request – no cost Weekend hospitalization and additional risk of death: An analysis of inpatient data The aim of this study was to assess whether weekend admissions to hospital and/or already being an inpatient on weekend days were associated with any additional mortality risk. The authors conducted a retrospective observational survivorship study. They analysed all admissions to the NHS during the financial year 2009/10, following up all patients for 30 days after admission and accounting for risk of death associated with diagnosis, co-morbidities, admission history, age, sex, ethnicity, deprivation, seasonality, day of admission and hospital trust, including day of death as a time dependent covariate. The principal analysis was based on time to in-hospital death. Results show that admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays. However hospital stays on weekend days were associated with a lower risk of death than midweek days. Journal of the Royal Society of Medicine, Vol 105(2), Feb 12, 74-84 / N Freemantle et al

x Article available on request – no cost