Introduction to Health Informatics
The Information Centre (IC) and user support
1. Learning outcomes check list for the session 2
2. Introduction 3
2.1 The 'modern data processing dilemma' - Perry 1987 3
2.2 From hierarchy to matrix management 4
2.3 Information and competitive advantage 4
2.4 Possible solutions to the modern data processing dilemma 5
3. Functions of an Information Centre 6
3.1 Consultancy 6
3.1.1 The new user who has a problem to solve but is not sure how to go about it 6
3.1.2 The established user who wants to embark on a new project 7
3.2 Access to corporate information 7
3.3 Application development in personal computing 7
3.4 The Help desk 8
3.5 The call centre and extension to the help desk 10
3.6 User forums 10
4. Functions that are not the responsibility of the Information Centre 12
4.1 Outsourcing 12
5. The Information Centre and the organisation 13
5.1 Position in organisation 13
5.2 Line of responsibility 15
5.3 Inappropriately rigid division into IT and Information management 15
6. Structure of Information Centres 16
Medium IC - Thierauf 16
Large IC - Thierauf 16
Devargas 1989 – IC Activites 17
6.1 Educational issues 18
6.2 Staffing levels 19
6.3 Information Centres in other HealthCare organisations 20
6.4 Training the Trainers 21
6.5 Good practice 21
7. Summary 21
8. References 22
9. Optional additional exercise 23
10. MCQs 23
1. Learning outcomes check list for the session
Each of the sessions aims to provide you with both skills (the 'be able to's' below) and useful information (the 'know what's' below). These are listed below. After you have completed this session you should come back to these points ticking off those you feel happy with.Learning outcome / Tick box
Describe what is meant by the modern data processing dilemma / q
Be aware of the changes in organisational management structures that has encouraged the development of personal computing / q
Describe the technological changes that have contributed to the modern data processing dilemma / q
Discuss the relationship between Information systems and competitive advantage / q
List the three main approaches taken to the modern data processing dilemma / q
Describe the main aims of an Information Centre / q
Describe the difference between a Information Centre and a traditional Data processing department / q
List the main functions of a Information Centre / q
Describe the 'consultancy' function of Information Centres / q
Describe the 6 factors thought to be important by Devargas when assessing someone's suitability for involvement in system development / q
Discuss the activities that the Information Centre should undertake regarding access to corporate information for end users / q
Describe how a Help Desk functions / q
Be aware of the call centre concept / q
Discuss the concept of user forums / q
Discuss the appropriate size of those projects deemed suitable for personal end user development. / q
Discuss the relationship between a Information Centre and the main IM&T department / q
Be aware of the concepts of facilities management and outsourcing / q
Be able to draw organisational charts showing suitable and unsuitable positions of the Information Centre in the overall organisational structure / q
Discuss the various lines of responsibility encountered for Information Centres. / q
Discuss the division of IT and Information management functions / q
Discuss the structure and main functions for each role in the Information Centre / q
List the characteristics of good training / q
Discuss the factors that need to be considered when considering staffing requirements for Information Centres / q
Be able to calculate roughly the staffing requirements for an Information Centre / q
Be aware of the "Training the trainers" concept / q
This section describes the information centre (IC) concept and compares it to the traditional information / IT department found in most UK hospitals up until a few years ago and still present in a large number.
Devargas 1989 in the preface to his short book provides a succinct definition of a information centre:
"The main mission of the information centre is to help and guide Business Professionals (whether in management circles or not) in utilising Information Technology in their work. The computer must be seen, by these professionals, as a tool which enables them to perform their work more effectively, efficiently and in the long run more economically".
The key point is to provide User empowerment teaching users rather than doing things for them as much as possible. The Information Centre must be pro-active and should be seen as a major organisational change agent (Thierauf 1988 p93). In contrast to the traditional DPD (Data Processing Department) which was reactive, inflexible and centralised. The Difference between the traditional DPD and the IC will become clearer as you work through this section.
For the Information Centre to be effective it must also possess a very effective communications function.
The following two sections discuss the reasons why the Information Centre was developed.
Using the titles given below create three lists of activities that a IC could undertake in your organisation. Do not worry if the same thing appears in more than one list.:
Save this in your Portfolio.
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2.1 The 'modern data processing dilemma' - Perry 1987
Perry, 1987, has amongst others, described a 'modern data processing dilemma' that existed in many organisations in the late 1980's. These included:
- Rapid uptake of desk top computers (in 1989 these where simple VDU, terminals attached to a mainframe). Resulting in users with the IT power but not the skills.
- Rarity of programmers/ data analysts to support requests for data analysis and general IT training.
- Conceptual shift in the organisations view of data from that of it being a relatively passive administrative thing to something that was a corporate resource. Producing problems with data management.
- Increasing backlog of data processing work (i.e. requests for reports). Perry, 1987 stated that IBM had a 3 year backlog and was growing at a rate of 10% per year.
- Data sabotage by end users in an attempt to control 'big brother' along with lack of ownership of data (i.e. only collected for the DoH - no use to us only used to plan budget! Therefore lets give then the data which will produce the largest budget).
Alongside the above problems the last decade has seen a revolution in the capabilities and availability of IT:
- User friendly software packages to allow data storage, reporting and interrogation (SQL, QBE, graphical point and drag techniques etc.).
- Availability of training.
- The workstation, laptop and palmtop computer.
- Networking capabilities (development of international standards, WWW, corporate intranets, LANS, email and home teleworking, etc.)
Many of these changes where mirrored by a change in both organisational structure and the perception of data both of which are discussed below.
2.2 From hierarchy to matrix management
During the last decade many organisations have undergone a radical change in structure from monolithic hierarchical structures to more 'matrix' style structures with devolved budgets and workers that are multi-skilled. The organisation can then be thought of as a network where projects make use of various people in the relevant departments.
A similar approach can be seen, to a limited extent, in some hospitals where clinical directorates are accountable for their own budgets. With this change in structure the power has also been devolved down to these team leaders and along with it the perceived need for information. This probably also accounts for the dramatic rise in requests for information experienced in the late 1980's. I believe this management revolution is just now beginning to hit the UK Hospital sector.
2.3 Information and competitive advantage
A lot has been written about the dependency that should be placed upon information systems to ensure that a company becomes successful (see Boisot 1994). This is often described as gaining competitive edge over others, however, there is little in the way of any empirical evidence for such general claims. Indeed most claims are based upon case studies or one off surveys which have no real scientific weight. Such inflated claims have now been modified to become more realistic 'sustainable competitive advantage' (King, Grover and Hufnagel, 1989; Symons 1984 p7). It probably depends upon the characteristics of the company as much as anything. For example some department stores use real time monitoring of sales to guide stock replacements and future product line development. Clearly those stores that use such technologies have competitive advantage to some extent. Within the health service most pharmaceutical companies have a similar system, Next time you go into Boots in the UK look at the technology used in the medicines dispensing section.
It is important to realise that the slogan 'information is power' implies that information is a commodity and therefore should be treated as such. This is different in many respects to accepting that information is a integral component to a business process, such as providing care to a patient.
The idea that ' information is power' in a modified form can possibly be linked to several developments within clinical medicine including:
- Decision support
- Medical audit
- Epidemiology (epidemic monitoring and modelling)
The topic of decision support will not be considered here.
Medical audit was the buzz word a few years ago but now appears, to have been replaced by Evidence Based Medicine (EBM). This is in contrast to the GP arena where audit has a ongoing role. Reasons for this may well include the fact that most people would simply rather be told what to do rather than work it out for themselves. It must also be noted that medical audit within the hospital environment is much more difficult because of the relative lack of relevant information systems and skills compared to the GP environment. For example in the UK it often revolves around individual case reports.
Epidemiology has always been very closely linked to the collection of data to make valid inferences and is increasingly becoming more dependent upon Information Technology for advanced techniques such as simulations and Geographical Information Systems. Much of the driving force behind many GPs initially using computers in the UK was the offer of a free system in return for anonymised drug data sets from themselves. Clearly the system supplier and drug companies saw this data in a very different light from that of the GP!
Commissioning between purchasers and providers in the UK is theoretically based upon data analysis techniques, however, in reality most of this is hot air in the authors experience. Contracts were often based upon last years figures and the data at all levels was manipulated to take into account its flawed nature. In the UK the 'contracting' process is now being replaced by that of commissioning.
Create a table similar to the one below (a trivial example is given). Fill it with two or three instances where you think the information collected by an individual is of limited value to themselves but to someone else might be considered to be a powerful resource. Save this in your Portfolio.Data collector / Data description / Person who values it / Comments
e.g Nurse / HIV status / Local newspaper reporter
2.4 Possible solutions to the modern data processing dilemma
Perry, 1987 suggests that organisations have three possible approaches to the above information dilemma:
- 'Hands off' In other words let the users just get on with it, it's bound to end in tears! Perry compares this approach to that of the manager years ago in the automobile industry who did not perceive foreign automobiles as a threat to domestic production.
- 'Maintain central dominance' over users by managerial control. In other words deciding that the users will just have to wait and suffer along with curtailing any 'illegal' activities such as attempts to manage their own data (i.e. building database or producing reports etc.).
- 'Create an Information Centre' designed to support and encourage users to gain the relevant skills. In medicine the term 'Compliance enabling strategy' has come to be used for those methods doctors use to encourage compliance. Similarly the Information Centre aims at encouraging compliance. This is similar to the situation In medicine where doctors are said to use 'compliance enabling strategies' providing patients with the appropriate information which will motivate them to do what the doctor wants!
Port folio Exercise:
Looking back at the information on the last few pages, do you believe there is a 'modern data processing dilemma' within your hospital or organisation? List the reasons for you answer on one side of A4
If you do, which of the three above methods do you feel your hospital or organisation presently adopts to tackle this problem?
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3. Functions of an Information Centre
Various writers list the main functions of an Information Centre slightly differently but most of them are remarkably similar. Devargas, 1994 provides a typical list:
- Access to corporate information
- Decision support services
- Executive support services
- Marketing of personal computing
- Co-ordination and planning of future information needs
- Product support in hardware and software
- Trial and evaluation support
- Application development in personal computing
- Library and newsletter services
While some of the above items are self explanatory others are discussed further below.
However, before doing so it is pertinent to realise that in a healthcare context in addition to those activities listed above for a generic organisation information centre such centres within the hospital sector need to address the additional issue of coding (Read, Smomed codes, HRGs and ICD10). Most hospitals have a coding department consisting of a number of coding clerks. All those who wish to collect additional data by way of user applications should, if it can be suitably coded, be offered the support to do this wherever possible. Applications should be designed with pick boxes of relevant codes to prevent excessive searching.