从今天开始陆续贴一些从英国带回来的资料
Pathways to Professionalism in Health Informatics
A Discussion Document
July 2002
1. What do we mean by “Health Informatics” and Who are the Professionals?
There are many definitions of “health informatics”. Some are more inclusive than others. The following is one generally agreed to sum up the scope of the discipline:
“The knowledge, skills and tools which enable information to be collected, managed, used and shared to support the delivery of healthcare and promote health”
This means, then, the following groups of staff might be included under the umbrella of “health informatics professional”:
• Medical records
• Coding
• Audit
• Libraries and knowledge management
• Information systems development and support
• Information and communications technology
• Help desk
• Data analysts
• Clinical/medical informaticians
Each of these may well be broken down into small sub-disciplines; and some might consider health informatics to be a secondary profession (eg clinical informaticians).
The breadth of the discipline offers particular challenges. Any solution/pathway to the establishment of health informatics as a recognised and respected national profession must be inclusive (not exclusive) and serve the needs and aspirations of all working within the field, whatever their background, level of qualification or salary level.
2. Current State of Health Informatics Organisation in the NHS
There is a growing number of professional bodies, associations and interest groups representing health informatics staff and the discipline in which they work. For example:
• British Computer Society (BCS)
• ASSIST
• British Medical Informatics Society (BMIS)
• Institute of Health and Records and Information Management (IHRIM)
• Communications Managers’ Association (CMA)
• Charted Institute of Librarians and Information Professionals (CILIP)
• Worshipful Company of Information Technologists
• UK Institute for Health Informatics
• Nursing professions information group (NPIG)
• Clinical professions information advisory group (CPIAG)
• Academy of Medical Royal Colleges Information Group (ACIG)
• Medical Informatics Group (MIG)
Specialists may, however, also be members of other professional bodies as well as or instead of any of the above, for example:
• Institute of Health and Care Management (IHM)
• British Association of Medical Managers (BAMM)
• Medical Royal Colleges
• Other Clinical Professional Bodies and Trades Unions
Whilst some collaboration is now taking place between some of the above groups and bodies this tends to be on the basis of personal contact or around specific events.
The health informatics professional community is currently fragmented. We speak with many voices. Closer working and collaboration would give weight to the argument that this is an emergent profession. Collaboration would also be required for a number of the following options to be selected.
Collaboration must, however, also allow for individual professional bodies and groups to retain their identity.
There is general consensus within the community that:
• The profile of health informatics in general is low
• General over-emphasis of the “T” in IM&T (health informatics)
• This leads to pre-conceptions about the function that need to be dispelled, for example that health informatics is only about the IT kit
• People do not understand what health informatics is, or the importance of it as a discipline in the achievement of national modernisation objectives
• This applies at all levels within the Service, including at very senior levels
• There are pay and grading disparities across the NHS
• Many health informatics staff – particularly ICT staff - leave the NHS because of lack of career and personal development opportunity
• Working conditions also lead to low morale and high turnover – this is in part due to the low profile and lack of understanding of the importance of the function
• This in turn leads to recruitment and retention difficulties in certain disciplines and areas of the country.
• Under involvement of HI professionals in strategic thinking/planning within the NHS
3. National Context
If the national modernisation agenda is to realise its objectives, the Service requires sufficient skilled, knowledgeable, proactive specialists in all areas of health informatics.
This can only be achieved by addressing some of the issues highlighted above, eg improving the employment package (through access to education, training and development and improved working conditions); making health informatics staffing issues mainstream (eg better workforce planning, links with other professional groups, and inclusion in human resource planning and development at national level).
The NHS Information Authority has “the establishment of health informatics as a recognised and respected national profession” as one of the four strands of the vision for its activity over the next few years.
The recent publication of “Delivering 21st Century IT Support for the NHS” indicates that the government is serious about using ICT to modernise the NHS. It also recognises that there is an urgent need to address issues of capacity and capability with the NHS if the agenda is to be successful.
To support the development of health informatics specialists, a national HR Strategy for HI specialists is being developed, with a view to a launch in autumn 2002. The move towards professionalism and support for the health informatics specialist community are likely to be central to this strategy.
In addition to issues impacting directly upon the health informatics professional domain, there are a number of national developments which also underpin discussions around “Pathways to Professionalism”, for example:
• National human resource strategic initiatives eg “Improving Working Lives” and “Working Together, Learning Together” which have led to work around developing national occupational standards for ICT staff in the NHS
• The creation of a new Health Professions Council for the NHS – a body to manage the statutory registration of certain clinical and scientific groups in the NHS
• The response to the Bristol Enquiry by the Institute of Health and Care Management (IHM) who have recommended registration ands regulation for health care managers to “protect” patients and the public by ensuring standards of professional practice are maintained and enforced.
Although some of the above relate only to the position in England, the other home countries also need to be involved in any pathways to professionalism in the interests of staff mobility, etc
4. Discussions and Progress to Date
A number of informal discussions and more formal workshops with stakeholders have taken place to consider:
a. Do we need health informatics professionals?
b. Should we be proactive in establishing a “profession”?
c. Is there the willingness to collaborate towards an agreed pathway?
d. How does one recognise professionalism?
e. What do we need to do?
f. Are there any models we can use/experiences of others we can learn from?
g. What already exists that might help make the journey smoother/easier?
The consensus to date indicates positive responses to the first of the four questions above. It is in that context that this discussion paper has been prepared.
5. What is Professionalism?
Professions are characterised by the following:
• Some form of self-regulatory body, which holds a Register of individual members/organisations based on agreed criteria
• National standards of education and competence
• National codes of practice, conduct and/or ethics, which are enforced through the process of registration, ie someone can be removed from the register for breach of a Code (and may - but not necessarily – lose the right to practise)
• A complaints procedure (for use by the public/customers)
• A disciplinary procedure
• A requirement for professional updating/CPD
• There may be professional indemnity insurance
Registration and regulation may be statutory or voluntary.
5.1 Statutory Regulation
Statutory regulation is mostly used to register clinicians and others, ie the right to practise in the NHS is generally dependent on being registered with the appropriate national body. This in turn is only open to individuals who have qualified through an approved route (usually formal qualification and work-based experience). Retention on the register is dependent upon adherence with codes of conduct and demonstrable continuous professional development.
Groups who are registered by statute include physiotherapists, radiographers, nurses, doctors and healthcare scientists.
The Health Professions Council is the new umbrella regulatory body for some of these and other groups – who may be non-clinical – yet to be subject to statutory regulation. Whilst the scope of the Council includes the identification of “new” groups for regulation, the reality is that few new groups will enter the Council, at least in the short-medium term.
The acid test for the Council is whether the professional group seeking regulation can demonstrate:
• a direct impact upon patient care
• a need to promote accountability and
• the need to protect the public against “incompetence and malpractice”.
In summary, the role of the Health Professions Council is to: establish from time to time, standards of education, training and conduct and performance of the relevant professions; and establish and maintain a register of members of the relevant professions. Professional Advisory Panels will be set up to work with the various sub-committees.
5.2 Voluntary Regulation
Voluntary regulation is generally seen as a an essential step on the way to statutory regulation.
In effect any professional group whether or not seeking subsequent statutory regulation needs to have in place:
a) A clear rationale for regulation based on the need of patients and the public
b) A definition of the profession, with agreed established roles, areas of practise
c) Agreed standards of professional competence
d) National qualifications and delivery mechanisms
e) A means of validating courses leading to qualification and the institutions delivery such courses/programmes
f) A code of conduct/practice adhered to
g) A voluntary register
h) A disciplinary procedure
i) An understanding of how they fit into Government care priorities
The rationale for regulation is the starting point in any agreed process.
6. Rationale for Establishment of Regulation for Health Informatics Professionals In the NHS
The rationale for the establishment of regulation for Health Informatics Professionals in the NHS rests on the basis of benefits for patients and the public, organisations and communities, and individual members of the professional community.
6.1 Benefits to Patients & the Public
If, as we contend, Health Informatics is core to the achievement of national government modernisation targets, its impact on the delivery of patient care has to be a given. Whilst most health informatics professionals will rarely have hands on contact with patients and the public, the services they deliver can have direct impact, for example:
• Result in improved communication between clinical professionals
• Improve security and the confidentiality required for patient/client records
• Speed up access to records, sources of knowledge and diagnostic support, requests for tests, and booking of appointments
• Reduce duplication – of records, data items and, through on-line delivery of test results, reduce the need for repeated tests
• Save resource through all of the above
Consider the impact of the following on patient care:
• Pharmacy system fails and no drugs can be ordered by wards for several hours
• The cervical cytology screening system that failed to detect malignant diagnoses as a result of the Y2K issue
• The decision support system that provides the wrong patient care information to a clinician
• A laboratory system that goes down and fails to deliver an urgent test result within the required time?
Bad Health Informatics can kill!
Consider also the practical benefits the profession through its effective support for the use of information and technology can bring:
• Provision of information and knowledge to support care diagnosis and treatment, reducing reliance on memory and access to paper-based journals and research reports
• Benefits in terms of prescribing safety thorough electronic prescribing systems
• Fast efficient test ordering and results transfer
• Facilitation of improved communication between professionals and organisations, etc
6.2 Benefits of Professionalism in Health Informatics for Organisations and Communities
Benefits should accrue from:
• Enhanced status and the knock-on effect on recruitment and retention and stabilisation of the workforce
• Increased understanding of the nature, scope and importance of the function
• Associated increased profile
• Increased involvement in strategic thinking/planning within the Service
6.3 Benefits to the Individual
Benefits to the individual would include:
• Recognition for their role
• Better understanding of their role
• Comparability in terms of professional education, etc with clinical and other groups
• Career pathways/frameworks and continuous professional development
• Greater opportunity within the NHS
7. Pathways to Professionalism in Health Informatics : Options for the Future
There are a number of options to be considered:
1. Do nothing
Take no further positive action.
2. Apply for Statutory Regulation now
Unlikely to succeed as embryonic Health Professions Council will be unable to process applications for at least a year (it would seem that it could also take 5 or 6 years to complete the process once started!). The advice from colleagues in the Human Resources Division of the Department of Health is that an application from a non-mainstream clinical group such as ours would not receive support as national policy is to reduce central control where possible and encourage as an alternative self-regulation. This would be reviewed if we could demonstrate a need for patients and the public to be protected from malpractice, etc
3. Agree to work incrementally towards voluntary regulation (and review the need/potential to apply for statutory regulation once the basic infrastructure is in place)
This would require us to put in place all the basic building blocks required for statutory regulation, and allow is time to decide whether or not to go for this in the longer-term. In the medium term we would, however, have a professional organisation akin to, say other groups of health service managers and others.
Specifically, we would, as a minimum, need to put in place the following incrementally:
• National (interim) regulatory/professional umbrella body
• Agreement on a descriptive statement for the profession
• Agreement on the list of disciplines to be included
• Identify, for each discipline, roles and core and other competencies
• Identify and agree educational qualifications and then “validate” delivery modes and centres
• Agree national codes – of conduct/practice/ethics
• Establish a complaints procedure/disciplinary procedure
• Establish and manage a national register of professionals having established criteria for acceptance onto the register
• Introduce and manage a continuous professional development scheme to support registration and career pathways.
This option would allow and support the establishment of additional professional bodies/colleges over time to meet the needs of specific groups of informaticians, as is being discussed in the medical domain. It would, however, provide a framework within which all such bodies could collaborate and reach agreement on the basic criteria for regulating staff and the standards and competencies required to support professionalism.
8. Recommendation
The recommendation is that option 3 above be accepted and that we start to work on a detailed business case for the creation of the infrastructure required to support voluntary regulation, on the basis that:
• Representatives of the different stakeholder groups generally support the development
• Work is already underway on the establishment of national (occupational) standards for ICT staff, on career pathways, continuous professional development and the creation of a register of professional competence within the NHS Information Authority’s Ways of Working with Information (education, training and development programme)
• There are other existing national standards, professional development and registration schemes and processes and codes of practice/conduct/ethics that could be built upon.
Acceptance of the recommendation would, however, have to be on the basis of agreement within and between the constituent bodies and associations to contribute to the resource required to make the vision a reality.
If this recommendation is accepted, the first step would be to establish a national umbrella organisation (council), comprising representatives of all key stakeholder groups and organisations to pan next steps. This “council” would form the embryonic national Health Informatics Professional Body, required for the purposes of regulation. |
发表于 2005-1-5 23:46:27
发表于 2005-1-6 09:49:30