CHAPTER 6: INFORMATION
SYSTEMS - NECESSARY SUPPORT|
Information systems should provide opportunities
to improve current infectious disease control. Surveillance can
be enhanced by developing integrated information systems across
all relevant Government departments and agencies in order to facilitate
collation and analysis of information. Information Technology
can be used to provide automated rapid feedback to health professionals.
Surveillance information and electronic resources of information
about best practice and current events relating to infectious
disease inform clinical practice.
Resources are needed to improve information systems
and work needs to be undertaken to ensure that there are links
between relevant databases to allow rapid exchange of information.
We warn that IT must be used to ensure that people can work more
effectively rather than adding a further burden onto already high
workloads. This demands adequate supply of IT, training of staff
and provision of sufficient technical support staff.
"Information technology is not used to its full
potentialvarious parts of the service cannot transfer information
to other parts quickly and securely" [Bradford MDC, I p34].
6.1 We heard that implementing and supporting information
technology was a key priority for action and was needed to improve
services [Assoc Brit Pharma Industry, I p6; Assoc Clin Microb,
I p15; Leeds City Council, I p99; Paton, Q621; PHLS Q277]. Advances
in information technology in recent years provide opportunities
to collate, analyse and disseminate information from a wide variety
of sources in much larger volumes and at far greater speed than
ever before. For example, IT has been used to share and disseminate
information relating to the SARS outbreak across the world [AcMedSci,
6.2 We heard that information systems across different
organisations, and sometimes within the same organisation, are
incompatible. Thus priority should be given to making information
transfer possible between different systems. This might be a "huge
resource intensive issue" and requiring careful attention
to the laws on data protection and human rights [Bradford MDC,
I p34; PHLS, II p135; Spittle Q621].
6.3 The Government have announced a significant increase
in spend on IT in the NHS in England, which will constitute an
additional £400 million in 2003-04, £700 million in
2004-05 and £1,200 million in 2005-06 to the baseline spend
in IT of £850-£1,050 million [Pattison, II, p271]. We
heard that this, along with other advances, such as developing
the integrated care record, should help to counter some concerns
[Pattison, Catchpole Q637].
6.4 We take heed of the National Audit Office's caution
that there are "continuing delays in the implementation of
NHS national IT initiatives and networks" [II p378]. Furthermore,
we are concerned that infection disease control should be recognised
when developing IT in relation to health and should be integrated
into any improved system.
6.5 We discuss below the main concerns relating to
IT and make recommendations.
reporting: electronic submission of information
6.6 One of the challenges facing surveillance activity
is that relevant information needs to be gathered and transferred
to appropriate authorities [PHLS, II p139]. Providing surveillance
information is time consuming and often paper based. If it does
use electronic systems, it is often necessary to enter information
manually on more than one occasion because of different, incompatible
IT systems [Assoc
Med Microb I, p71; Kelsey, II p42].
6.7 The Association of Medical Microbiologists points
out that transferring information should be "simple and automatic"
[I p71, see also PHLS Q277]. Providing surveillance information
should not be something separate to, but part of, every-day working
practices. Dr Catchpole summed up the views of many when he stated:
"It should not be that we do surveillance as
well as looking after patients, but that in looking after patients
we are undertaking surveillance" [Q629].
6.8 We recommend that the Department of Health
should ensure that procedures for collecting and reporting information
electronically are integrated where possible into everyday working
practices and are less burdensome than at present.
6.9 One of the concerns about surveillance is that
advances in forecasting techniques are not being exploited by
the infectious disease community [Borriello II p218, Q515; Seminar,
p378-81]. Such techniques often require sophisticated hardware
and software which is not routinely available.
6.10 We also heard that there is no common agreement
over the terms and coding systems used in databases [PHLS, II
p139]. We are concerned that this makes extracting comparable
information from different databases extremely difficult and time
consuming, which would be an obstacle to responding quickly in
an emergency [Nicoll Q277]. The SARS outbreak indicated how important
it was to be possible to share information internationally.
6.11 We recommend that the HPA should standardise
information entry across all surveillance systems. This should
be undertaken in consultation with representatives of all those
involved in the collation and transfer of information for infectious
6.12 Information technology provides some exciting
opportunities to facilitate collation and analysis of information
from widely different and innovative sources [Catchpole, Q629].
Witnesses suggest that combining information systems about animal,
human and food-borne infection would provide an immensely powerful
tool for surveillance [PHLS, II p135]. Recent developments, such
as the integrated care record, have potential for enabling access
to a greater breadth and depth of patient information for surveillance
purposes than at present [Catchpole, Q637].
"The worst thing that could happen is to build
new, modern systems as islands of automation and not link them
together. I would urge everybody to build a very robust infrastructure,
that you can hang systems from and interchange data with. That
is going to be the key here" [Spittle, Q631].
6.13 We note that in order for the integrated care
record to provide maximum benefit to infectious disease services
it is necessary to consult bodies which lie outside the immediate
jurisdiction of the NHS Information Authority, such as the HPA
[Catchpole, Q637]. If such consultation does not happen, we heard
that significant opportunities to incorporate public health needs
with immediate clinical needs could be wasted [Spittle, Q631].
The HPA and others could contribute to discussion as to what information
is needed and in what format it should be presented.
6.14 There should be coordinated activity within
the Department of Health and its agencies and across different
Government Departments and agencies to ensure that all organisations
involved in surveillance, prevention and treatment of infectious
disease can share relevant information [Pattison, Q643]. In particular,
the Department of Health should develop a system which allows
interchange with other systems.
6.15 We recommend that the Government should develop
a fully compatible electronic system of disease surveillance information
across all relevant departments and agencies.
information to health care professionals
6.16 We heard that one of the reasons for underreporting
by clinicians is that they lack ownership in the surveillance
process; if they do send in information it seems to disappear
[Brit Infection Soc, I p38; Catchpole, Q639; Friedland, I p67;
Little, Q401]. There have been some recent initiatives to increase
feedback through world-wide-web technologies. Professor Duerden
of the PHLS told us that there are web-based systems which allow
health professionals both to report and to compare infectious
disease events in their local area with the regional and national
pattern [Q284; also see Inf Control Nurses Assoc, II p176, Q380].
6.17 Professor Finch told us that IT provides opportunities
to enable health professions and public to gain access to information
about best practice in relation to infectious disease such as
via the recent initiatives of the National electronic Library
for Communicable Disease or NHS Direct Online [p55; Q92; Haworth,
6.18 Both of the above areas of disseminating information
should be further developed and we expect the Department of Health
and the HPA to draw on the structures and projects that are already
in place and provide appropriate funding. However, we also have
some concern about email overload. Bombarding busy health professionals
with emails about potential outbreaks could mean that many are
not read and encourage complacency.
6.19 We recommend that the HPA takes the lead
in further developing electronic methods for providing feedback
about surveillance and for targeting delivery of information about
infectious disease to healthcare professionals.
IT is not sufficient
6.20 Whilst the evidence pointed to the opportunities
offered by better use of IT, there were also quiet warnings throughout.
In particular, investing heavily in IT without due consideration
to the way that the infectious disease service operates would
be an ineffective way of using resources. Other issues which witnesses
said needed to be addressed in order to implement an effective
IT system, are outlined below.
(a) Patient Confidentiality: Patient confidentiality
and data protection could undermine opportunities to improve surveillance
activity [Leeds City Council, I p99; US, II p388]. One way of
overcoming this would be to provide information in anonymous form
[Hawker, II p116; Nicoll, Q278; Pattison, Q647; Spittle, Q646].
However this would not be useful in all cases. If IT were to enable
improved surveillance through exchange of information across organisations,
data protection issues could arise. We urge the Department of
Health to carefully consider ways in which this can be overcome.
(b) Training and human support services: Simply
investing in and implementing IT systems is not sufficient to
ensure that the most value can be obtained from those systems.
Consideration needs to be given to ensuring that staff are trained
in IT skills and the resource implications of that time needed
for training are considered. We point out that critical services
must continue to run whether or not the IT system is working,
which demands back-up facilities and IT support staff on call
around the clock [Catchpole, Q629].