Benita Cox

Cost of skin cancer in England

This paper estimates the financial cost of skin cancer in England. National Health Service (NHS) costs were calculated by combining published data on health service use by patients with skin cancer with published data on the unit cost of services. Indirect costs arising from individuals’ inability to function in their usual role as a result of skin cancer were estimated from incapacity benefit claims and numbers of registered deaths due to skin cancer. The total costs of skin cancer were around £240 million. Costs to the NHS represented 42% of the total.

Facilitating stroke care planning through simulation modelling

Stroke is a leading cause of death and long-term severe disability. A major difficulty facing stroke care provision in the UK is the lack of service integration between the many authorities, professionals and stakeholders involved in the process. The objective of this article is to describe a prototype model to support integrative planning for local stroke care services.The model maps the flow of care in the acute and community segments of the care pathway for stroke patients and allows exploring alternatives for care provision. Simulation modelling can help to develop an understanding of the systemic impact of service change and improve the design and targeting of future services.

Evaluation of the impact of a PACS system on an intensive care unit.

Describes part of a wider evaluation exercise undertaken to assess the impact of the introduction of a picture-archiving and communication system (PACS) on the adult intensive care unit (AICU) at the Royal Brompton NHS Trust in London. The objectives of this research were to evaluate the perceptions of PACS of the medical and ancillary staff working within AICU as well as to undertake a preliminary assessment of its impact on the workload of radiographers. Questionnaires, interviews and a process analysis were undertaken. The research findings indicate that the overall perception of staff towards the introduction of the PACS was positive. The impact of the system on the workload of radiographers was significant, reducing the time taken to obtain an image from 90 to 60 minutes. However, lessons to be learned for future PACS implementations include the need to ensure compatibility with existing IT systems, adequate IT support and initiatives to ensure that the benefits of PACS are communicated to the hospital at large.

The I-Space: a framework for analyzing the evolution of social computing

Abstract Advances in the design of computer architectures and networks have led to new ways of representing, creating, manipulating and distributing knowledge. This paper takes a sociotechnical view of computing and considers the impact of computer architectures which are based on connectionist principles and the growth in computer networks on the representation of the learning process and strategies for dealing with complexity. It calls for a new economic view of knowledge and intellectual property rights more appropriate for the analysis of information flows in networks. Finally, the Information Space (I-Space) is presented as a framework for the analysis and evaluation of information flows.

The factors that influence attitudes toward organ donation for transplantation among UK university students of Indian and Pakistani descent

The shortage of organs donated for transplantation is particularly severe among ethnic minorities. Previous work has often studied ethnic minorities in broad groups, failing to differentiate by age or country of education. We investigated the younger generation of UK‐educated ethnically Indian and Pakistani students to determine their attitudes toward organ donation.

Strategic use of EDI in the public sector: the HMSO case study

Abstract There has been widespread academic discussion in recent years on the potential of information systems to provide organisations with a strategic advantage. To this debate has recently been added a further controversy, i.e. the extent to which information systems (EDI in particular) and the concept of business network redesign are compatible. The aim of this paper is to contribute to these debates, by arguing that the implementation of EDI may still provide strategic advantage to an organisation, but is dependent upon the industry sector in which the organisation is operating, its position within that sector, the dynamics of the market place, its ability to build on its existing stregths and its ability to exploit the available technology innovatively. Support for these arguments is provided by documenting the case of Her Majestys Stationery Office (HMSO), where the implementation of EDI has resulted in financial gains estimated at between £5 million and £10 million per annum since 1993. This has been achieved through the integration of EDI with the corporate strategy and results from a process re-design programme reflection the changing environment of the British public sector. The paper also explores how the traditional role of EDI as a document exchange system has been extended to that of systemss integrator and corporate change agent, thus facilitating future business and technical change requirements.

The impact of electronic patient records on workflow in general practice.

The Patient Access to Electronic Healthcare Records System (PAERS) allows patients to register their arrival at a GPs surgery and to view their healthcare record electronically whilst in the waiting area. The research reported in this short article was carried out to identify potential changes in clinical and administrative workflow resulting from the introduction of the system. The study considers workflow pre and post the implementation of PAERS. It also makes comparisons between two UK London-based surgeries, one with PAERS (Wells Park Practice) and one without such a system (South Lewisham Group Practice). The impact of PAERS on workflow and the potential benefits for GPs, administrative staff and patients are highlighted.

Requirements of a new communication technology for handover and the escalation of patient care: a multi‐stakeholder analysis

RATIONALE, AIMS AND OBJECTIVES In order to enable safe and efficient information transfer between health care professionals during clinical handover and escalation of care, existing communication technologies must be updated. This study aimed to provide a user-informed guide for the development of an application-based communication system (ABCS), tailored for use in patient handover and escalation of care. METHODS Current methods of inter-professional communication in health care along with information system needs for communication technology were identified through literature review. A focus group study was then conducted according to a topic guide developed by health innovation and safety researchers. Fifteen doctors and 11 nurses from three London hospitals participated in a mixture of homogeneous and heterogeneous sessions. The sessions were recorded and transcribed verbatim before being subjected to thematic analysis. RESULTS Seventeen information system needs were identified from the literature review. Participants identified six themes detailing user perceptions of current communication technology, attitudes to smartphone technology and anticipated requirements of an application produced for handover and escalation of care. Participants were in favour of an ABCS over current methods and expressed enthusiasm for a system with integrated patient information and group-messaging functions. CONCLUSION Despite concerns regarding confidentiality and information governance a robust guide for development and implementation of an ABCS was produced, taking input from multiple stakeholders into account. Handover and escalation of care are vital processes for patient safety and communication within these must be optimized. An ABCS for health care professionals would be a welcome innovation and may lead to improvements in patient safety.

The impact of the Internet on the doctor-patient relationship

This paper presents the results of a study of 300 randomly selected obstetricians and gynaecologists in the United Kingdom to assess their perception of the effect of Internet usage by patients on the doctor-patient relationship. It also considers their perception of the extent of patients’ Internet usage, the quality of the information on the Internet and the need for Internet access and training in hospitals. Results showed that respondents accepted that the Internet might lead to patients being better informed than themselves with 40 per cent feeling that this may damage the doctor-patient relationship. Despite this 90 per cent believed that providing more and better information to patients was good. Respondents were aware that patients used the Internet for medical information but felt that their own patients’ usage was low and that the quality of information was variable. Use of the Internet was thought to be beneficial for patients but could confuse them, leading to unrealistic expectations and increased medical litigation. Most respondents think all doctors should be Internet trained, but only a minority had training programmes in their hospitals. Respondents want Internet training to be more widely available.

Modelling and performance analysis of clinical pathways using the stochastic process algebra PEPA

BackgroundHospitals nowadays have to serve numerous patients with limited medical staff and equipment while maintaining healthcare quality. Clinical pathway informatics is regarded as an efficient way to solve a series of hospital challenges. To date, conventional research lacks a mathematical model to describe clinical pathways. Existing vague descriptions cannot fully capture the complexities accurately in clinical pathways and hinders the effective management and further optimization of clinical pathways.MethodGiven this motivation, this paper presents a clinical pathway management platform, the Imperial Clinical Pathway Analyzer (ICPA). By extending the stochastic model performance evaluation process algebra (PEPA), ICPA introduces a clinical-pathway-specific model: clinical pathway PEPA (CPP). ICPA can simulate stochastic behaviours of a clinical pathway by extracting information from public clinical databases and other related documents using CPP. Thus, the performance of this clinical pathway, including its throughput, resource utilisation and passage time can be quantitatively analysed.ResultsA typical clinical pathway on stroke extracted from a UK hospital is used to illustrate the effectiveness of ICPA. Three application scenarios are tested using ICPA: 1) redundant resources are identified and removed, thus the number of patients being served is maintained with less cost; 2) the patient passage time is estimated, providing the likelihood that patients can leave hospital within a specific period; 3) the maximum number of input patients are found, helping hospitals to decide whether they can serve more patients with the existing resource allocation.ConclusionsICPA is an effective platform for clinical pathway management: 1) ICPA can describe a variety of components (state, activity, resource and constraints) in a clinical pathway, thus facilitating the proper understanding of complexities involved in it; 2) ICPA supports the performance analysis of clinical pathway, thereby assisting hospitals to effectively manage time and resources in clinical pathway.