1. e-Health The Royal College of Nursing Perspective Shařon Levy RCN Informatics adviser

2. With a membership of over a third of a million, the RCN is the largest professional association and union of nursing staff and students in the UK. The RCN promotes nursing interests on a wide range of issues by working closely with the Government, parliament, unions, professional bodies and voluntary organisations. The RCN campaigns on behalf of its members and the people they care for, and is a leading player in the development of nursing policy and practice, and standards of care. …the propaganda goes…

3. …but what is e-Health??? Internet/Intranet E-mail Mobile/ Hand-held devices ECDL Integrated Care Pathway Telehealth Decision Support EPR/EHR Computers Hardware/Software Operating System RAM/ROM Ergonomics Databases Spreadsheets Broad-Band Change Empowerment Self Care Effectiveness/Efficiency Security/confidentiality NHS24 Equity Best Practice

4. e-Health Definition “ eHealth encompasses much more than the deployment of computer technology. It conveys the message of electronics in support of health and stimulates thought and discussion about the broad range of issues and opportunities that technology offers in the health care setting to both healthcare professionals and patients” (NHSScotland 2004).

5. e-health covers all aspects of working with information and with information and communications technologies to improve outcomes and enhance people’s experience of healthcare. e-Health Definition

6. “e-Health … characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology…The distinct feature of e-health is that it is driven by non-professionals, namely patients” (Eysenbach, 2001).

7. The rational study of the way we think about patients, and the way that treatments and care are defined, selected and evolved. It is the study of how healthcare knowledge is created, shaped, shared and applied. (after Coiera 1998) Health Informatics Definition

8. The ‘e’ gaze: The victory over the machine is secured once Keanu Reeves is able to mentally detach himself from the false simulated reality and strip bare the Matrix into lines of machine generated numbers. It is this ‘Gaze’ that offered humanity hope for a better future. Can numbers offer nursing a better future in a fast changing technical world? Can we represent everything that nurses do as lines of numbers?

9. Modernising IM&T in the NHS in Scotland “Our vision is to have the right information under the right safeguards at the right place and time using the right ways and means. And our plan is to exploit computing and communication technology to help us work towards this vision” NHS MEL (1998) 84

14.  Changing epidemiological landscape  Rapid improvements in (healthcare) technology  Ageing population  Increasing expectations  Rise of ‘Consumerism’ philosophy ‘ THE TIMES THEY ARE e-CHANGIN '

15. RCN Survey on NHS IT Developments 2020 respondents February 2004

16. Q10. In your opinion, what effect will the integrated electronic health care records development have on clinical care? N% Significant improvement102851% Slight improvement37819% No change603% Slight worsening221% Significant worsening131% Unsure50725%

17. Q11. What effect will the integrated electronic health care records development have on your working life? N% Significant Improvement78639% Slight Improvement39620% No difference21311% Slight worsening593% Significant worsening261% Unsure52726%

18. Q9. How much information have you had about the integrated electronic health care records development? N% Fully adequate information462% Reasonably adequate information 33717% Inadequate information47023% No information but I know something about it 40220% No information but I have heard of it 45623% This is the first I have heard of it52826%

19. Q8. How much information have you had about NHS IT Developments? N=2020 Managers Fully adequate information2% 5% Reasonably adequate information22% 39% Inadequate information22% No information but I know something about it 27% 20% This is the first I have heard of it26% 14%

20. Q15. As a professional, what consultation has there been with you about integrated electronic health care records? N=2020Managers More than adequate 2% 5% Adequate6%12% Barely adequate13%19% Inadequate14%17% None63%47% Unsure2%1%

21. Q16. How important is consultation about integrated electronic health care records with individual practising clinicians? N% Very important136868% Fairly important47524% Neither important nor unimportant452% Unimportant30% Very unimportant422% Unsure724%

22. Q17. How important is the provision of training to the success of integrated electronic health care records? N% Very important186193% Fairly important985% Neither important nor important 80% Very unimportant191% Unsure141%

23. Q18. How much IT training have you received within working time in the last six months? N% No training at all102351% No training in working time23412% Half a day or less41421% 1 day1347% 2 days915% 3 days261% 4 days231% 5 – 10 days261% 10 + days372%

24. Q20. How important is "around the clock" technical support to the success of IT implementation in the care environment? N% Essential147273 % Very important37419 % Fairly important1186% Neither important nor unimportant 121% Unimportant50% Very unimportant70% unsure231%

25. Concerns Clinical ownership: The RCN has called for greater transparency and for more information about the Programme’s progress. Concerns were also raised by members about the levels of clinical engagement and about the fact that cardinal lessons have not been learnt from previous large-scale implementations, particularly the importance of ownership by clinicians of clinical systems.

26. Token engagement: It appears that the rhetoric is set to address clinical concerns yet the speed of implementation, the tight delivery schedule and the fact the contracts are awarded (without clear evaluation framework to measure clinical ‘buy-in’) is of concerns to members. Concerns

27. Messages for members (and staff who are supporting them) Are you e-competent? (communication) Information sharing Facilitating patient, client and carer access to and use of information Needs assessment (individual and population) Record keeping Clinical reasoning; decision making using evidence Evaluation and audit Using technology in your practice (resource management & workforce planning)

28. Messages for members (and the RCN) to take to system providers Making IT SAFE Does the technology and the way it is used conform to Standards? Is it Acceptable to patients, clients, carers? Is it Fit for purpose and practice? What Evidence is there for the above?