1. In defence of single clinical record systems

    28 Oct 2011

    Last month, the Department of Health confirmed that it was ditching its plans for a single clinical record system for England. Instead, IT policy will be devolved to local NHS organisations. On the face of it, this new emphasis on local flexibility may sound appealing but we should not forget the potential hazards that come with fragmented IT.

    The original plan would in essence have created a single set of medical records for all patients, to which patients could grant access to clinicians working in any part of the NHS. The alternative we are now facing will be a separate, partial...

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  2. Open to suggestions: can the National Programme for IT be saved by open source software?

    11 Sep 2011
    Comments: 9

    Last month, the Commons’ public accounts committee published a pretty damning report on the NHS National Programme for IT in England, Connecting for Health.  The committee’s analysis looked specifically at the development of a single care record.  This is a set of electronic notes for each patient that can – with the patient’s permission – be accessed by clinicians working in different parts of...

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  3. PARR++ is dead: long live predictive modelling

    11 Aug 2011
    Comments: 3

    Earlier this year, the Journal of General Internal Medicine published new research, which showed that neither doctors, nurses nor case managers were able to predict which patients were at highest risk of readmission to hospital. 

    This finding is important because if we are to tackle the health problems that manifest as unplanned hospital admissions then we need to be able to predict and prevent these events at the individual level. Unplanned admissions cost the NHS an ...

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  4. Integration in Scotland: a litmus test for the NHS in England?

    24 Jun 2011
    Comments: 2

    I was in Glasgow earlier this month speaking at a British Geriatrics Society (Scotland) symposium about community services for older people.  Two things struck me: first, how refreshing it was to be at a conference where England’s Health and Social Care Bill was barely mentioned; and secondly the abundance of practical examples of health care integration from across Scotland.

    One of the major criticisms of the Health and Social Care Bill was that its emphasis on promoting...

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  5. Data integration for emergency care: Scotland leads the way

    15 Apr 2011

    This week, the summary care record is back in the news.  At the moment, if you become critically unwell and are taken unconscious to an A&E department, the doctors and nurses looking after you will typically have no idea of your past medical history, your allergies or what medicines you are taking. This is because they usually have no way of accessing your GP clinical record....

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  6. Portuguese lessons: don’t forget the chronic diseases with high planned costs

    1 Dec 2010

    I was in Lisbon last week to speak at a chronic disease workshop run by the National School of Public Health.  Both the English and the Portuguese health services currently face a significant funding squeeze, and policymakers in the two countries see chronic diseases as an area ripe for potential cost savings.  However, in Portugal the focus is on different chronic diseases from those on which we concentrate in this country. Moreover, the emphasis in Portugal is on reducing the expected costs of these chronic diseases, whereas in the UK we tend to focus on preventing the...

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  7. Toronto Virtual Ward: useful lessons for NHS hospitals?

    11 Oct 2010
    Comments: 11

    Starting in April 2011, NHS hospitals in England will not be paid for “avoidable” readmissions occurring within 30 days of discharge.  As Trust finance officers begin steeling themselves for this change, they may be interested in a Canadian project designed to predict and avoid such readmissions. 

    Known as the Toronto Post-Discharge Virtual Ward, the project borrows a concept first developed...

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  8. Open-source software: could this be the glue that holds the NHS together?

    5 Oct 2010

    Good news stories don’t come around that often for Connecting for Health, the beleaguered national IT programme for the National Health Service in England.  But I think I might have found one in the making.  This month marks the mid-way point in a two-year project to build an “open-source community” for the NHS. 

    For the uninitiated, open-source software is different from the “closed source” software that...

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  9. Broccoli branding, 23-hour clinics, and the bone phone: new lessons from Kaiser Permanente

    1 Aug 2010
    Comments: 1

    On 22 July, The Nuffield Trust held the first in our series of seminars focussing on ‘High Value Health Care’, in partnership with the Royal College of Physicians and the Cambridge Health Network.

    Before the seminar began I heard a few mutterings from audience members about how comparisons between Kaiser Permanente and the NHS are so well known that they’re becoming a bit trite. 
    However, by the end of Bernard Tyson and Jed Weissberg’s presentations, nobody could be in doubt that the NHS still has...

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