"Enabling Occupational Therapists and Physiotherapists to Engage in the Information Age"
Ruth Garner, Irene Ilott, and Penelope Robinson
Introduction:
The UK Government believes that information is the key to the modern age and that information management must become a mainstream part of public services such as health and education. Is During the last two years, major is supported by the many recent national information strategies that have been published for England, Scotland, Northern Ireland and Wales. Not in the least is the Information for Health (DoH, 1998) strategy document that directs guides the National Health Service into the information age, for example. However, the big The question is - are those working in the health and social care sector ready to make the most of this opportunity? engage in the information age?
2 professional bodies, the College of Occupational Therapists and the Chartered Society of Physiotherapy, asked this question. They wanted to know how prepared their 57,000 members were to exploit the benefits of modern communication technology to enhance patient care, service delivery, management, education and research. To find out they commissioned a study to scope information management needs. The report was and published last July the report in July(Garner 1999).
This paper outlines the results of the study, the resultant recommendations and further work undertaken. It will focus upon two aspects: firstly, the change of 'hearts and minds' that is required in order for therapists to take advantage of the information age; and secondly, In particular it will feature the related education and training needs of students as well as clinicians, managers and educators, to achieve and implement this change.
The Study:
During the 6-month study a variety of methods were used to consult with occupational therapists and physiotherapists throughout the United Kingdom. The intention was to obtain information about current facilities and to identify future needs and barriers to information management across all the employment sectors. The publicity material, which was circulated to the whole membership via in-house publications at the beginning and midway through the study, invited views from technophobes as well as activists. The consultation process was supplemented by interviews with key stakeholders from other professions, attendance at national conferences and committee meetings, and a literature search using electronic resources and documents held by the professional bodies.
Finally, the study culminated with a consultation conference. The findings and recommendations were presented to 42 representatives from Special/Clinical Interest Groups. The delegates endorsed the recommendations.
The response rate to the study was disappointing with only 150 contributors from a combined membership of over 50,000 coming forward. However, these represented the range of employment sectors and views were obtained from students, clinicians, academics and managers from throughout the United Kingdom as well as Internationally.
The final report integrated key messages from all the different stakeholders. There were consistent concerns about:
- the feasibility of a nation information strategy which permitted local diversity;
- the lack of awareness of the national initiatives and involvement in local projects regardless of employment sector;
- the limited availability of appropriate technology at the point of healthcare delivery;
- the conflicting pull upon resources between direct patient care and what was perceived as an administration tool;
- the demotivation of activists with a long track record of involvement in this area because of the failure to achieve the potential of the information age.
Finally, the definition of information management was not explicit in, or consistent between, any of the National strategies and for the purpose of the study is was defined as being ‘concerned with how information is generated, interpreted, used and distributed’.
A Taxonomy for linking people to policy:
During the project a framework was developed for explaining the connections between individuals and information management policy (Diagram 1). This three-tier classification divides information management into the following layers:
- The foundation layer: Information passed from person to person. This layer encompasses the basic principles of information management that are used every working day when information is shared between people (e.g. terminology, definitions, record structures).
- The intermediary layer: Information passed from person to computer. This layer involves passing information from person to the computer. It includes the skill development in, and use of, information technology at a local level for uni-professional data collection, as a therapeutic medium, as an assessment and evaluation tool in patient care, for research and continuing professional development. This is the layer where people are prepared for moving into the information age.
- The advanced layer: Information passed from computer to computer. This layer comprises organisation wide networked information systems, the Electronic Patient Record (EPR), Internet access to accredited information, and the remote delivery of services and care into people’s own homes.
It is important to note that practitioners need to become comfortable within the advanced layer within the next 3years, yet this study has shown that the majority is only at the first layer. This is concerning considering the policy context which identifies significant milestones for the implementation of electronic communication across healthcare. For example, in Wales all healthcare professionals will have email and web browsing capabilities by the end of 2001 and by the year 2005 all acute hospitals in England will be using Electronic Patient Records.
This means that therapists must rapidly progress through the levels of this taxonomy if they are not to be disadvantaged.
How ready are therapists to engage in the Information Age:
The new National strategies that have been published over the last 5 years give strong messages about the essential nature of information and information technology in the development of high quality and effective services for users of health and social care services. There are also strong messages about clinicians being at the centre of the decision making process. However, we believe that this has coincided with a significant period of organisational change in the public sector. This has meant that the information strategies have not received the attention that they deserve. It would appear that overload and uncertainty are jeopardising their implementation, particularly the involvement of clinicians.
Because of the poor response rate, overload and uncertainty in the lives of therapists and the centrality of information to our practice, the Professional Bodies must take the lead in information management at this time- this is a significant period for influencing and determining an information framework for the future. There are several things that the professional bodies must do including:
- Advocate for the inclusion of their whole membership, especially those working outside the NHS, if developments are to be comprehensive.
- Highlight the benefits of information management to all members, especially in relation to their practice and patient care,
- Support developments and endorse and disseminate examples of good practice.
Changing the ‘hearts and minds’
There has to be a change in the ‘hearts and minds’ of therapists in order for them to engage in the information age and, in the second phase of the project, we have decided that one of the themes should be ‘managing change’. How can we best help managers and clinicians cope with the demands of the organisations, national strategies and local implementation? How can we help therapists to develop the information strands they need to manage more effective services and argue for more resources? How can we help to get essential information available at the bedside? How can we best support continuing professional development (CPD)?
One strategy in the dissemination phase has been to adopt a ‘drip drip’ approach where up-to-date information is passed to therapists via professional journals which falls through their letter box every month. A wealth of information is available on the Internet, and we do signpost these to members, but access to hardware makes this route problematic. Even if we were relying on therapists to access information from home less than 40% of the population in the UK have access to the Internet. So we have to direct members to local and regional resources, or give them the questions to find local and regional resources, to support local developments and needs.
Until the issue of access is resolved there is little point in national, regional and local developments looking for widespread marketing, information giving and education / training via the web, or through CDs, if developers want to reach therapists. Similarly if national programmes want to pilot products they must ensure that therapists have the hardware that will allow them to engage in any in-use evaluations.
Who is responsible for providing training for the health and social care workforce?
Information for Health (DoH, 1998) considers information management as a core professional requirement which is a priority for all stages of education. The strategy acknowledges that the current generation of professionals must be equipped to cope with this agenda. The NHS funded Enabling People Programme (EPP), now reformed as the NHS Education, Training and Development programme (NHS ETD), have made some strides with this, with initiatives such as the Learning to Manage Information (EPP, 1999). This is a landmark document for guiding national multi-disciplinary career long curricula, particularly for Education & Training Consortia that commission pre-and postgraduate training.
In addition, Education & Training Consortia have national funding for the development of skills in information technology. However, do people know locally what this funding is for, how it’s allocated, how to influence the deployment of this funding or, indeed, what their own needs and priorities are? From the response to this study we suspect not.
The NHS ETD programme now has a range of products that has been developed by clinicians, for clinicians, to support the development of skills and knowledge in information technology. During the study we found that few therapists knew about the work of this programme or the products available. While there is a web-site housing many of these products, many therapists have little or no access to the Internet to make use of it. Now the NHS ETD are putting all past products onto a CD and while this will make it more accessible for some, the majority will still have problems with this medium.
Furthermore the NHS ETD are looking to develop the Virtual Classroom linked the National Electronic Library for Health (NeLH). The NeLH is being developed so that accredited information can be accessed by professionals as well as the general public within 3 clicks of a mouse button and within 15 seconds. The ‘top floor’ of the NeLH is a training floor designed to enable health care workers to make full use of electronic resources. Access is, again, the issue.
In addition, the Higher Education Funding Council (HEFC) are funding several centres of excellence known as Learning and Teaching Support Networks (LTSN) and one of these is focusing on Subjects Allied to Medicine and one is focusing on Social Work and Social Care. These centres are to support education providers to deliver pre and post graduate training in, or through, information and communication technology.
Collaboration in developing skills and knowledge to enable professionals to take advantage of the Information Age.
Above we have mentioned the Education & Training Consortiums, which have a responsibility for commissioning pre and post-graduate training of healthcare workers. In addition there is the NHS ETD programme, funded solely by the NHS and the LTSNs funded by the Higher Education Funding Council. Three major initiatives, all with a remit to help people to gain skills and knowledge in, or through, information technology, but all three with a different funding source and no demonstrable links between them.
In addition, the only one to support training and development to therapists outside the NHS is the LTSN which has a remit for Social Work and Social Care, and the LTSN which has a remit for Subjects Allied to Medicine.
There needs to be some collaboration and partnership working between the 3 initiatives so that there is less chance for duplication of resources and training and less opportunities for gaps to remain open. In addition, therapists do not know, in general, that the LTSNs or the NHS ETD programmes exist and, those that do, are unaware of the focus of each of the initiatives and which to turn to for what help (even if therapists know what their needs are).
Evidence of good practice:
The project has picked up some evidence of good practice, but this has been slow to come forward. We have identified that one Education & Training Consortium has provided computers and Internet links for students on clinical placement, so that they can remain linked to the University and can support/encourage skills development in therapists who supervise their clinical practice. Another Education & Training Consortium has provided funding for learning resources to support research and evidence-based practice.
Europe has funded therapy systems development in Northern Ireland, a significant development as this spans health and social care integrated services. A similar European funded project in the North of England brings information to the team responsible for the treatment and care of patients with Spinal Injuries. European funds have supported the development in the Midlands of a tele-guideance project that takes vocational guidance to people with disabilities into their own home via a computer and telephone line.
Some Universities are developing remote Computer Mediated Communication programmes for health and social care workers, which are now fundable under the Higher Education Funding Council. An example of such a programme is the Masters in Continuing Professional Development at Greenwich University.
These indicate the varying degrees of interest skills and knowledge that exist within the membership of the College of Occupational Therapists and Chartered Society of Physiotherapists. However, this evidence of good practice is sparse and does not, we believe, reflect the foundation level of skills, knowledge, experience and interest of therapists. There is further work to be done before therapists are routinely engaging in the information age.
References:
Chartered Society Of Physiotherapy & College of Occupational Therapy (1999) The Garner Project: Scoping the information needs of occupational therapists and physiotherapists. College of Occupational Therapists, London. (copy of the Executive summary can be found on www.cot.co.uk)
Department of Health (1999) Information for Health: An Information Strategy for the Modern NHS 1998 — 2005. A1103
Enabling People Programme (1999) Learning to Manage Health Information. A theme for Clinical Education
Dr. Irene Ilott, College of Occupational Therapy,
irene.ilott@cot.co.uk
Penelope Robinson, Chartered Society of Physiotherapy,
robinsonp@csphysio.org.uk
Ruth Garner, Learn Net Advisors & Research,
RuthGarner1@compuserve.com
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