Overcoming barriers to the use of patient data for by qyd44618


									Examining the potential evolution of eHealth systems architectures by 2020


A masterclass event was hosted by the Yorkshire Centre for Health Informatics, Institute of Health
Sciences at the University of Leeds, to examine the potential evolution of eHealth systems
architectures by 2020. The purpose of the event was to:

          Review research and innovation in computing architectures

          Explore the impact of digital development on healthcare delivery

          Identify next steps in e-health transformation

          Identify the requirements for interoperability within a global health economy

          Provide a long-term planning horizon for eHealth systems designers.

The event was supported by keynote presentations on major themes, plus invited short presentations
leading to round-table discussions and synthesis. The output will contribute to a four-day programme
on eHealth funded by Yorkshire Forward leading to a Masters degree in Health Informatics at the
University of Leeds.


On the 4th February 2009 the Yorkshire Centre for Health Informatics (YCHI), Institute of Health
Sciences, University of Leeds, hosted a CPD4HealthInnovation event on “Future eHealth Systems”.
The event was attended by over 50 influential healthcare professionals from a diverse range of
backgrounds including academe, healthcare providers including Connecting for Health (CfH), the
National Health Service (NHS), and major healthcare suppliers including British Telecom (BT),
Cerner, Computer Sciences Corporation (CSC), and Egton Medical Information Systems (EMIS). The
aim was to examine the potential evolution of eHealth systems architectures by the year 2020,
complementing the mission statement of the Continua Healthcare Alliance1:

    Continua Health Alliance available at: http://www.continuaalliance.org/
           To establish a system of interoperable personal telehealth solutions that fosters independence
           and empowers people and organizations to better manage health and wellness.

The purpose of the event was to review research and innovation in healthcare computing architectures
and to explore the impact of digital development on future healthcare delivery. Through this analysis
it was hoped that the “next steps” in eHealth transformation would be identified and requirements for
interoperability within a global health economy would be mapped onto a long-term planning horizon
for eHealth systems designers.

The event was supported by Yorkshire Forward, one of the country‟s largest Regional Development
agencies, with responsibility for driving the growth and regeneration of some of Britain‟s most
successful industry sectors in Yorkshire and The Humber (Y&H). Y&H is one of the most important
regions in the UK with respect to medical devices and offers significant opportunities in other health-
related sub-sectors which continue to grow. The Y&H region employs approximately 10,000 with a
resulting Gross Value Added (GVA) of £0.5billion. Yorkshire Forward‟s vision is for healthcare
technologies in Y&H to be at the forefront of developments in innovative healthcare applications
which it hopes to achieve through increasing the critical mass of healthcare technology businesses in
the region. Future initiatives focus on building network capacity, supporting strategic partnership
working and raising the profile of the region.

The output will contribute towards a four-day programme on “Designing Future eHealth Systems”
funded by Yorkshire Forward and leading to a Masters degree in Health Informatics provided by
YHCI. It is also hoped that more master classes will be run in the future to extend the discussions and
to address specific topics such as e-science architectures (with the e-Science Institute2 led my
Malcolm Atkinson leading in this area), ethics and information governance in detail.


Primary research was conducted via a one-day master class event which was organised into four key
themes: health provider needs; health supplier needs; architectures of the future; and, accounting for
globalisation and interoperability. The themes were separated by a morning keynote presentation by
Dr. Justin Whatling, BT, on “Business Models in Healthcare and Health ICT” and an afternoon
keynote presentation by Professor Justin Keen on “Information Architectures”. Each theme was
approximately 1-hour long and consisted of a keynote presentation plus invited short presentations

    E-Science Institute available at: http://www.nesc.ac.uk/esi/
leading to round table discussions and synthesis. During the day a number of attendees also took part
in a “video diary” where questions were posed on their predictions on the future of eHealth. Audio
was recorded throughout the day to accompany presentations and discussion, along with flipchart
notes on key issues and challenges.


Whatling presented on the changing healthcare environment and current and future business models
and challenges. The sustainability of the healthcare system has become “critically dependent” on
successful prevention models whereby maintaining health and productivity is crucial to long-term
economic stability.

                       Figure 1 Current Healthcare Challenges (Whatling, 2009)

We continue to see mismatch between the supply and demand sides of healthcare interactions (see
Figure 1). Health information and communications technology (ICT) has a critical role to play in
transforming the economics of such interactions illustrated within the eHealth semi-circle (see Figure
1). The inherent flexibility of IT can catalyse the service innovations required to sustain an
increasingly complex web of care, but are compounded by the difficulty to predict technology and
service configurations and limited by risk aversive behaviour. “Pilotitis” is endemic to satisfy whole
system business models which, though likely to be sustainable, require high up-front investments. The
consumer healthcare industry is emergent, fragmented and investment driven but there is no strong
lead customer to provide the impetus for mass adoption.

Whatling debated that the NHS does not have the money or experience to drive changes and that we
must collectively go through the delivery, innovation and deployment processes for the future
healthcare delivery business models. Our approach to health ICT to date has been built around the
needs of organisation and staff across consumer, payer/provider and social care markets.

   Figure 2 Convergence of Health and Wellness Markets in Future eHealth Delivery (Whatling, 2009)

By re-dressing ownership of health and wellbeing across consumer and healthcare institution
paradigms we can begin to create convergence between health and wellness markets. These markets
will be driven by multiple factors focused on outcomes and empowerment (see Figure 2). The
convergence of these markets will create new and exciting opportunities including shared care
assessment, outcomes management, co-creation of content, shared decision-making, second opinion
services, telecare, means testing and personal budgets.

          Figure 3 The Shift in Information Economy in the Machine World (Whatling, 2009)
Socially, the information economy will largely move into the machine world (see Figure 3) where
people will have access to machine enhancement to extend their own creativity. In tomorrow‟s world,
technology will allow people to be more effective people and will not be seen as a replacement to
human endeavour. This will have major implications on the “currency” of healthcare which will
produce transformational changes in the business models operating in healthcare and in health ICT.
Focus will shift from data- and information-centricity to knowledge centricity around the needs of the
patient based on integrated care pathways and care cycles.

                  Figure 4 Current Business/Service Delivery Models (Whatling, 2009)

A number of current business service delivery models and challenges were presented (See Figure 4)
which focus around patients, healthcare payers and providers, and ICT suppliers across four key
relationships: care services, ICT products/services, funds and evidence of delivery. The four
approaches (from top left to bottom right) are:

       Integration of ICT services into existing delivery channels as they are viewed as logical
        extensions of a healthcare organisation‟s portfolio. Cash flow follows well-established paths
        and there is no disruption of present delivery structures.

       Combining medical service provision and IT support where ICT services are not delivered in
        the context of conventional healthcare structures. Such offerings are seen as a threat by
        established healthcare providers.

       Managed care approach with “disease management concepts” is becoming an interesting
        option, but has legal constraints and opposition by health care providers.
          Private market approaches with direct payment by patients which are rare outside of countries
           with developed national health systems but are expected to increase.

A report published by the European Commission‟s ICT for Health Unit following a „procuring for
health benefits‟ telehealth workshop3 suggests there is a lack of appropriate business models in health.
For hardware, buying or leasing may offer a more flexible local solution and may be best for long-
term monitoring, though has a high initial cost, and a need for replacement and staff training. In
comparison, buying services has a low initial cost, but has a high recurring cost and less flexible
service. New business models are beginning to evolve through information arbitrage, infomediary,
and metamediary services. Adopting an “ecosystem” approach may be the answer, where
environments can be simulated experimented in to analyse successful business models for innovative
eHealth applications, focusing on financing, longer term sustainability, incentives of all the
stakeholders and on the role of procurers.

                        Figure 5 Think Differently Scenarios (Rayner and Jessop, 2009)

John Rayner and Eileen Jessop, Director and Assistant Director at The Health Informatics Service,
presented four scenarios for future healthcare and well-being systems in 2020 (See Figure 5). The

    “Report on Telehealth Workshop” available at:
scenarios were developed to encourage more focused and resilient strategy development in response
to change drivers such as the aging population, demanding and sophisticated consumers and the
exhaustion of traditional methods and tools for containing cost. Each scenario also included a set of
key technology deliverables.

    1. “Approved Cures” focused on treatment, care and cure with power being with the state.
        Government restricts the number provided by the NHS and Voluntary Clinical Care
        enhancement schemes are created alongside significant increases in private insurance.
        Universal broadband access is available to all and highly secure next-generation networks
        ensure seamless and robust operations of highly complex information structures between
        NHS and private sector systems. The best possible use of scarce resources is achieved by
        taking collective decisions about what individuals deserve and therefore have a right to, if
        individuals want more than this, they will have to make their own arrangements.

    2. “Consumer-Led Cures” also focused on treatment, care and cure but with power being with
        the consumer. Government encourages greater consumer choice with bespoke care, and in
        some cases branded, packages. Primary Care Trusts (PCTs) are re-born as Consumer Care
        Trusts (CCTs) which help patients to micro-purchase service packages. Telemedicine, virtual
        worlds, decision aids and self-service are widely adopted. Central to this will be a
        fundamental shift in power and control away from clinicians and experts more generally
        toward the informed and assertive consumer.

    3. “Mass Health Surveillance” where rising health care costs and a declining economy call for
        mass public health interventions. The primary responsibility for health lies with the individual
        and the family and full and mandatory public engagement is supported by online Health
        Action Plans with government health targets. NHS services are only made available to those
        who can demonstrate a year-on-year improvement devolved from integrated information
        systems recording patient metrics and citizen information. Basic telemonitoring and gaming
        technologies are a normal part of daily life. Those who do not care for themselves cannot
        expect those who are more responsible to do so.

    4. “Personal Health Environments” where sophisticated health care supports the achievement of
        full human potential through advanced personal biometric information monitoring for the
        wealthy, and municipal biometrics in health centres for less well off. Government introduces
        personal “well-being budgets” and rejects institutionalised offerings in favour of bespoke and
        “boutique” packages of advice and support. Fusing new technologies with the insight of the
           ancients, the discerning consumer can develop a package of wellbeing services, addressing
           the mind, body and spirit, sustaining the perfect balance to optimum health.

Marlene Winfield, Director for Patients and Public at NHS Connecting for Health, presented from the
perspective of the patient on what they require as health care consumers. The presentation was opened
with a quote from Dr. Richard Fitton: “Patients and information are the two most under-used
resources in the NHS”. Patients are spending an increasingly smaller amount of time with health
professionals and are provided with little (accurate and safe) information to manage their health. This
parent/child relationship has been apparent throughout the history of the NHS but tools are now being
developed that harness the power of patients and information. For example, NHS Choices4 and
HealthSpace5 act as secure portals of consumer health information enabling patients to access medical
records online, interact with their General Practitioner (GP) and get reminders on tests, appointments
and screening to name just a few services. Eldorna Smith, a fictitious patient of the future:

          Jointly holds and contributes to her medical records and interactive Care Plan, manages tests,
           appointments, screening and prescriptions online.

          Sees her test results instantly, self-monitors and gets feedback directly from her GP.
           Researches her health information using blogs and online social networks through securely
           sharing her medical records with others across the world in a “Wiki Health” environment.

          Gives feedback on online and offline NHS services and how they can be improved.

Dr. Mohammad Al-Ubaydli, Director at Patients Know Best6, believes it is worth stating beliefs to
save ourselves from argument and to consider their conclusions. “The NHS is full of good IT work”
exemplified by innovations such as PAERS7, MyFamilyHealth8, t+ Medical9 and the 3G Doctor10. Dr.
Al-Ubaydli argued the following beliefs he had about the NHS:

    NHS Choices available at: http://www.nhs.uk/

    HealthSpace available at: https://www.healthspace.nhs.uk/

    Patients Know Best available at: http://www.patientsknowbest.com/

    PAERS available at: http://www.paers.net/

    MyFamilyHealth available at: http://www.myfamilyhealth.com/
          The NHS exists to serve patients, although the best way to serve these patients has not been
           invented yet.

          Most inventors do not, and never will, work for the NHS. Equally in the private sector, most
           inventors do not, and never will, work for a large company because most quit their jobs to
           start a new company. Inventors love accountability but hate committees.

          Patients know best (if we let them). If patients begin to understand medical notes and see
           benefits in personal health records, you switch from paternalistic medicine to participatory

Mark Hawker, Teaching Development Officer at YCHI, continued the theme by presenting on the
new wave of digital consumers and how a typical digital consumer uses technology in their everyday
life, including online services and devices. Hawker presented on the applications of Web 2.0
technologies and ubiquitous digital devices that he uses and how many integrate seamlessly with one
another through robust Application Programming Interfaces (APIs). A key question is how the
healthcare industry is going to react to the growing “Generation Us” population who expect seamless
integration of service, and lighting-fast speed of response.

The afternoon session was opened with a keynote presentation from Professor Justin Keen, Director
of the NIHR CLAHRC11 for Leeds, York and Bradford, on information architectures and sources and
consequences of complexity. Professor Keen suggested three sources of health care ICT complexity:

          Health care in itself is inherently complex with many independent agents each interacting
           with each other, occasionally inducing changes, and creating complex adaptive systems
           containing emergent properties. The “language” and ordering of processes are fraught with
           fundamental problems which are impossible to predict.

          Tensions between governments and the medical profession have existed for many years and
           even today the UK Government is unclear what kind of NHS it wants. Activity on the ground
           is not connected with policy making. Investments such as the National Programme for IT

    T+ Medical available at: http://www.tplusmedical.com/

     3G Doctor available at: http://www.3gdoctor.com/

     Collaboration for Leadership in Applied Health Research and Care
            (NPfIT) have increased the pressures on medical professionals to co-ordinate their activities
            and demand compliance with structured pathways. These two factors coupled with moving
            from a producer-driven to a consumer-driven model of health care have resulted in a
            fundamental shift in working practices.

           Large scale complexity as presented in an EPSRC Large Scale Complex IT Systems
            Programme12. Key themes: System Understanding. The principal functional and non-
            functional properties of complex IT systems cannot be completely understood by existing
            “reductionist” approaches; System Interactions. Systems interact with their operational
            environments in many different ways; and, Systems and Organisations. Complex IT systems
            are specified, developed, used and maintained within organisations that may themselves be
            thought of as complex systems. The development, deployment, evolution and use of the IT
            systems are thus influenced by human, organisational, business, social and political factors.

These sources create environments where ICT is assumed to provide solutions for increasing
complexity but such integration can actually increase the “transmission” of risks across networks,
create new issues and challenges, and undermine central control. This has meant historical plans for
solutions such as electronic health records, for example, are now understood to be naïve. Professor
Keen presented suggestions for the future of health care, focused around a “regulated ecology”. He
proposed suffixing “Research and Development” to the National Programme for Information
Technology (NPfIT) to change the nature of its progression, having major effects on how contracts
would be awarded and managed. Implementing this change would require a far better understanding
of clinical processes, inter-operability standards matching those of countries such as Denmark, and
enabling the state to relinquish access to personal data (and data about doctors‟ work).

Dr. Duncan Russell and Dr. Colin Venters from the School of Computing‟s Distributed Systems and
Services Group, University of Leeds, presented an overview of “Architectures for the Future: Service
Oriented Architectures (SOA) and Beyond”. They discussed what they expected architectures to look
like in 2020 along with approaches to managing change over time and evaluating business value of IT
investments. Key discussion included the need for dynamic architectures that enable multiple
independent systems to interact in a dependable way, with challenges surrounding connectivity and
message transfer irrespective of underlying implementations. Grid computing was seen as an
important technology in the future alongside “cloud” or service-oriented architectures with peer-to-

     Large Scale Complex IT Systems available at: http://www.lscits.org/
peer discovery of services. They hope to improve the mechanisms of what was promised by service-
oriented architectures to implement dynamic discovery, and further explore the potentials of the
underlying technologies around grid computing where they are currently building a catalogue of
architectural styles across military systems and the attributes of those styles in terms of dependability
and scalability as well as many others. By providing mechanisms to enable secure interconnection of
services we can aim to create high-level, dependant, intelligent systems across the healthcare domain
with technologies supporting clinical processes.

Joseph Waller, Lead Spine-Wide Architect at BT13, presented overviews of the NPfIT, The Spine,
how they interact currently, and how this may evolve in the future. The NPfIT is the world‟s largest
civilian IT project14. Managed by NHS Connecting for Health, it aims to improve patient care by
enabling clinicians and other NHS staff to increase their efficiency and effectiveness by giving them
access to patient information safely, securely and easily. A key element of the programme is creating
an NHS Care Records Service (CRS) to improve the sharing of patients‟ records across the NHS with
their consent. BT plays a prominent role on the NPfIT and is delivering three of its major contracts:

          The Spine – a £700m investment over 10 years providing the core to user-facing delivery
           programmes including a national electronic patient records database, electronic booking,
           transfer of prescriptions and messaging.

          N3 – the fast, secure, national broadband network connecting all NHS locations in England,
           supporting new applications and enabling data, now including voice services, to be
           transferred quickly and easily.

          London Local Service Provider (LSP) – integrating healthcare information systems with
           electronic records across hospitals, GP surgeries and clinics at around 2,600 sites to support
           the NHS CRS in England.

Several tensions were identified surrounding current architectures and future developments. These
included whether services should be centralised or distributed, and whether centralisation should be
logical or physical, the challenge of shared records and their structure, information governance, and
data integrity through push and pull architectural models.

     BT and the NHS National Programme for IT available at: http://www.btplc.com/Health/NHSIT/

     Brennan (2005) “The NHS IT project”
Rik Smithies, Chair of Health Level 7 (HL7) UK15, presented on interoperability in health systems.
He began by outlining what interoperability is, and why people need it. Interoperability is a way of
sharing data across multiple systems as it is impractical to hold everything inside one big system. We
need interoperability standards as there are many computer systems across the “patient journey”
creating “islands” or “silos” of information. Often these systems have many differences such as
granularity, platform, specialties etc. which may hold data about the same patient, but cannot be
identified uniformly throughout. Semantic interoperability is a way of systems understanding
messages that are passed between systems and so can interpret how that message should be processed
and shared. The goal of HL7 is to achieve semantic interoperability of medical systems, mostly
through messaging, where clinical data is shared using structured formats that can be understood by
both clinical computing systems. Clinical data is more than just medical facts, and should contain
meta-data elements such as dates, times, data types and identifiers as well as “relationships” to
represent causation, ordering and groupings and timings. So far, HL7 has created basic data types and
structuring of medical “facts” along with a standard “terminology” to interoperate with multiple
coding systems.

A terminology is like a dictionary of medical facts or concepts such as diseases and symptoms which
are allocated an arbitrary number (code) which eliminates language ambiguity. Terminologies that are
used as simple lists of codes have proved inadequate as they lack structure and reference to real-world
meaning. Structure allows computers to make inferences allowing generalisation for example, and
features such as post-coordination allows new terms to be built out of others. One of the most
complete and sophisticated terminologies is the Systematised Nomenclature of Medicine Clinical
Terms (SNOMED-CT) which is owned and managed by the International Health Terminology
Standards Development Organisation (IHTSDO). Other successful terminologies exist including Read
codes in the UK and Logical Observation Identifiers Names and Codes (LOINC). Together, HL7 and
SNOMED-CT promise to solve interoperability problems, although there are still lots of practical
issues to solve:

           Neither standard is 100% complete in coverage, or perfect for all clinical use cases.

           Many organisational issues exist such as never having enough resources, or adequate funding,
            which makes it difficult to respond quickly to new matters arising.

     Health Level 7 available at: http://www.hl7.org.uk/
          Billion dollar programmes depend on the organisations described above, which often rely
           heavily on only a few key individuals.

          Both standards are technically difficult to use and implement.

          Interoperability standards themselves need to interoperate. This is exacerbated by the fact you
           cannot get organisations to adopt the same interoperability platform (compounded by
           mapping difficulties), organisations adopting standards at different times (if at all), and
           migrations such as between HL7 Versions 2 and 3 are not always easy.

Short-term future projections for HL7 include building archetypes and templates which will allow
system interfaces to adapt better to what clinicians need. Such systems will allow clinicians to sketch
input screens and allow data to be collected and saved as a definition. This definition will then be
interpreted and executed as if it were embedded in the program code. Before this can be achieved,
there are hurdles such as competing standards for archetypes, mapping to open source systems like
OpenEHR16, current systems not supporting configurations and the risk that “templated” data is only
usable in the context it was captured in. Long-term projections are for a globally accessible, fully
connected Electronic Health Record (EHR) which can be accessed anywhere via any device, and
greatly increased speed of development and deployment of health systems with seamless integration
and “pluggable” health software.

Tony Solomonides, Director of Postgraduate Research at the University of the West of England and
active member of HealthGrid17, presented on the application of grids for biomedical research and
healthcare. Grids are “distributed software environments based on open standards and protocols that
enable the sharing of disparate, loosely coupled IT resources across organisations and geographies”
which are capable of being dynamically allocated dependent on resource need. A HealthGrid is an
infrastructure that combines grid and e-science18 concepts oriented towards biomedical advances with
early examples including MammoGrid, WISDOM and GEMSS. The SHARE project19, funded by the
European Commission, aims to promote the deployment and adoption of healthgrids across Europe

     OpenEHR available at: http://www.openehr.org/

     HealthGrid available at: http://community.healthgrid.org/

     E-Science definition available at: http://en.wikipedia.org/wiki/E-Science

     The SHARE Project available at: http://www.eu-share.org/
addressing technical challenges including integration, standards, deployment and trust and acceptance.
Ethical, legal and socio-economic factors also exist around ownership of data, best practices,
awareness, trust and acceptance and change management.


Throughout the day, several themes, issues and challenges were discussed, supported by the
presentations, discussion and video diaries. These have been split into six categories:

Evolving Role of the Patient

Due to the increased availability of clinical information online and increased access to resources,
patients are using the World Wide Web more than ever in the management of their own health. The
shift from treatment and care to health and well-being will see “expert” patients joining clinicians as
co-pilots in managing their health service interactions. How do we best educate patients on how best
to search for, and act appropriately on, information they find online?

Evolution of Architectures

Distributed and Service-Oriented Architectures are helping overcome barriers of logical and physical
centralisation of services. This includes new approaches to dynamic systems, where independent
systems from multiple vendors can be integrated in a coherent architecture which is dependable and
supports evolution of systems. Providing mechanisms to enable secure interconnection of services can
create high-level, dependant, intelligent systems across the healthcare domain with technologies
supporting clinical processes. The role of pervasive computing, combining network technologies with
wireless computing, voice recognition, Internet capability and artificial intelligence, will create an
environment where the connectivity of devices is seamless and always available. What lessons can be
learnt from Computer Science and applied to future healthcare systems?

Changing Nature of Clinical Processes

Several implications exist around technology design, record keeping and clinician/patients
relationships and whether ICT solutions reduce human interactions in care delivery. A better
understanding of clinical and diagnostic processes will help reduce inefficiencies and promote local
innovation. Tas Hind, Business Process and Functional Design Team Lead at CSC, works closely
analysing the impact of technologies on business processes and how management of organisational
journeys can aid care delivery. Hind presented a process model for renal care which demonstrated the
complexity involved in mapping even a single process. By involving stakeholders at each level of the
design process, we can understand more closely the implications future eHealth systems have on the
changing nature of clinical processes. How do we embed process-driven design into new and existing
healthcare innovations?

Standards and Interoperability

Whilst agreements were made of the benefits of coding when used by all, it was difficult to see how
this could be achieved using current methods of adoption. Suggestions were made on the role of
central arbiters who would control “standards for standards” with a move to a more open standard
format at a national level. The use of semantics and ontology-based definitions may be the answer to
alleviate a “one size fits all” mentality. A key challenge is how information can be presented in
different contexts and still be understood e.g. the use of clinical data for research. For this, we will
require common formats and communication standards and for these to be adopted globally. But who
will govern, manage, own and enforce these standards?

Governance and Security

There needs to be greater studies into the effects of risk transmission through networks and what the
implications of sharing data across multiple organisations are. Suggestions were made around
increasing the professionalism around security standards e.g. ISO27000 compliance and on what the
best models of security will be in the future. These models surrounded access protocols and whether
“alarms” or “locks” would be most appropriate, as well as personal data security and ownership and
responsibility of electronic medical records. Due to the evolving role of the patient and changing
nature of clinical processes will the Data Protection Act in its current form be sufficient in covering
the governance issues surrounding access?

Government Pressures

One of the main inhibitors of innovation is political pressures for short-term results where, for over 15
years, the government and medical profession are unable to agree on what technology they want, what
they want it for, and whether either side trusts each other. Target-driven, “surveillance society”
cultures may prevent any form of evolution of eHealth systems, or the sheer ferocity of technological
innovation may prevail over Governmental control. Are current policies working or do we need to
challenge and rethink the relationships between Government, suppliers and health professionals?


We concluded that there has been insufficient intellectual debate on the future of eHealth systems
architectures, and that there is not one unified vision for the future. Many key issues and challenges
remain to be addressed before we can look towards a “blue sky” vision of full electronic patient
record implementation, for example. The masterclass has set the ball rolling for a new Masters-level
module of the same title and a series of continuing professional development (CPD) courses being
delivered by the Yorkshire Centre for Health Informatics (YCHI). More discussion and debate is
needed on the presentation of high fidelity concepts related to environmental, ethical, legal, political,
social, and technological challenges including next-generation architectures, standards and
interoperability and information governance.


The Yorkshire Centre for Health Informatics is a leading international centre for health informatics
expertise, collaboration and research. Our mission is to improve heath care practice through high
quality research and evidence based education and training. The centre brings together partners from
the University, NHS and Industry to help meet the challenges in handling health information. Our
objectives are to develop knowledge through multidisciplinary research; develop „best practice‟ and
quality assurance within health informatics processes; disseminate „best practice‟ through education
and training; facilitate knowledge transfer by bridging the gap between health informatics researchers,
healthcare providers and health IT industries.

This paper was written by Mark Hawker, Owen Johnson and Dr Rick Jones. We are grateful to the
respondents, speakers and participants for their lively debate and contributions to the masterclass and
this publication.

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