Embedding biohealth informatics within university, health care and industry settings

1
Embedding bio-health informatics within
university, health care and industry settings

• David Ingram
• UCL Centre for Health Informatics and and
  Multi-Professional Education

NIBHI Launch June 6th, 2005
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Some reflections on ten years of CHIME at UCL

• Origins and development of CHIME
• Examples connecting health informatics with
  health care, internationally
• Looking to the future

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Co-evolving informatics and health care focus
Health information utility
Pervasiveness
Consumer bioinformatics
Genomic medicine, patient self- management
Health informatics
Quality accountability
Medical informatics
Primary care public health
Medical computing
Health care management
Clinical specialism
1960
1970
1980
1990
2000
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UK Audit Commission Survey of Acute Hospitals
(1995)

• 15 of hospital resources are spent gathering
  information
• Up to 25 of doctors and nurses time is spent
  collecting and using information
• Professional collaboration requires access to
  some common basic information

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Historically, a low priority
Wanless Report, 2000
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Links with medical education - when was this
written?
The use of computers in education and
assessment inevitably will be linked to their
uses in medical information systems. Such
linkages will allow, if not force, the formation
of new relationships between segments of the
medical education and assessment continuum,
through accumulation of large data bases on
student characteristics and performance, on
physician and institutional performance in
patient care, and on patient outcomes following
treatment. These databases could serve as the
thread of continuity between portions of the
continuum. They could provide more objective and
quantitative feedback mechanisms from active
practice to education and assessment.
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Computer Technology in Medical Education and
Assessment, Office of Technology Assessment,
Congress of the USA, 1979
Currently, the best measures of competence in
learning do not necessarily predict good
performance in practice. Patient care assessments
depend on comparison with peers using standards
(processes that should be followed) or
empirically determined norms (the average care
provided). Computer technology could be used to
improve the linkage between medical education
and patient care through the provision and
maintenance of more specific and objective
databases for diseases and treatments. In
addition to providing better data for generation
of standards, computer data bases could allow
better comparison of standards and norms of care
with actual patient outcomes. These data also
could permit the development of computer
consultant systems. Feedback from medical
information and health data systems could provide
continuous updating of the data bases Written
by a predominantly clinical team from AAMC and
Government health agencies, summarising 20 years
of innovation in the field, up to that time!
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Origins and development of CHIME

• CHIME origins
• CHIME must participate in diverse academic,
  professional, health care, industrial and
  governmental communities
• It is expected to justify its presence in each of
  these a challenging expectation, hard to meet
• It has succeeded in some important integrative
  roles across UCL
• This has earned vital leeway for grounding the
  Centres academic work in practical innovations
• CHIME ten years on

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Looking to the future
CHIME greatly appreciates its longstanding
collaborations with colleagues in Manchester It
looks forward to many new working synergies with
NIBHI, in developing and specialising bio-health
informatics initiatives across the UK and Europe,
linking with industry and national initiatives
such as BioBank, UKCRN, and CfH, through the 5
LSP Regions
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Clinical engagement A recent National Audit
Office study of all Acute Health Care Trusts in
the NHS
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The Royal Marsden Hospital

• A local IMT strategy, driven by technical
  innovation, to capture and manage data
  consistently and coherently
• Continuous evolution - iterative and experimental
  approach
• Strong links with clinical research
• In-house development

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Some issues should give pause for thought

• Reflects experimental nature of transforming
  initiatives in the field over past 40 years
• Lack of health professional understanding and
  recognition of this profound achievement
• Wide recognition from practical implementers, who
  have lacked influence
• Low NHS profile, no commercial take-up

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Bio-Health Informatics An adventurous threefold
challenge

• Achieving excellence
• Demonstrating relevance
• Being recognised as a successful catalyst of
  change

Understanding the past, Challenging the
present, Shaping the future is a dangerous
business
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Understanding the past, challenging the present

• Four cycles of health care IT since the 1960s
• The mainframe (IBM), mini-computer (DEC),
  Microcomputer (Microsoft) and Web (Open-source)
  manifestos
• Four major health care policy shifts have driven
  change
• Clinical specialism, health care management,
  primary care, patient choice
• Now bioinformatics, genetics and the GRID
  alongside CfH

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Shaping the future

• Building bio-health informatics discipline
• Building the evidence base
• Embracing continuous co-evolution of science and
  services - aligning eScience and CfH innovation
  through an academically-led, regionally-organised
  Health Grid
• New challenges, changing expectations seeking
  cooperative investments at national and
  international levels
• Building capacity - education and training