UCL Health Services Research. Research Environment

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1 UCL Health Services Research Research Environment Introduction Health Services Research (HSR) features widely across UCL, within and beyond the Faculty of Biomedical Sciences. This return groups together 13 Category A, one Category B and one Category C staff, active in health informatics, medical education, organisational development, clinical operational research and health psychology. The names of Categories A and C staff are emboldened, throughout the text. They are based in four specialised research centres. CORU (Clinical Operational Research Unit), led by Gallivan and, since 2007, by Utley, is a national centre of excellence in mathematical modelling of health care processes and interventions. CHIME (Centre for Health Informatics and Multiprofessional Education), led by Ingram, is at the forefront of international work on standards for clinical information systems and is a designated WHO Collaborating Centre, in recognition of its contribution to the community control of inherited disorders. ACME (Academic Centre for Medical Education), led by Dacre, is a national centre for the evaluation of clinical skills, the assessment of clinical competency and the development of the GMC procedures for assessing poorly performing doctors. CBSSM (Centre for Behavioural and Social Sciences in Medicine), led by Newman, is recognised internationally for its research into the impact of cardiac surgery on brain function. Nine of the Category A staff returned are HEFCE core-funded, two are funded on DH/NHS programme grants and two on research grants. Six other Category A health service researchers are returned to UoA8 (Bowling, Iliffe, Murray, Greenhalgh, Wallace) and UoA6 (Raine). Principal research links with these staff are in ehealth and health services development. The Centres address a wide range of interlinking applied, theoretical and methodological health services research themes; share infrastructure, resources and research support services, and have health services partners in common. CHIME, ACME and CORU collaborate in research activities and all four Centres have research links with clinicians at the Whittington Hospital NHS Trust, where CHIME and ACME are based. CORU has been awarded four successive five-year core grants from DH, through international peer-review. The most recent, in 2003, applauded its uniqueness and outstanding success. Research income (RA4) amounted to 10.6m, including fourfold growth in Research Council income ( ). In addition, 16.1m of research funding was channelled through other institutions in grants in which the staff submitted have participated - Research Councils, 6.5m; EU, 3.2m; DH/NHS, 2.6m; DTI, 2.4m; Other (e.g. Research Charities), 1.4m. The Centres offer 5 taught Masters Programmes (416 MSc students over the RAE period). 95% of health psychology MSc students proceed to PhD programmes, at UCL and elsewhere. 34 research students have been supervised, with 8PhD and 2MD completing (10 students are in the final writing up stage). 18 research assistants have been registered for PhDs over the period and, as a consequence, most doctorate students are part-time. The completion times implied by RA3a reflect the fact that most students included in the submission were also members of UCL research support staff. In 2001, UCL Biomedicine consisted of two faculties, Clinical Sciences (FCS) and Life Sciences (FLS), and five recently incorporated research institutes, of which four were separately submitted to RAE2001. To enhance organisational coherence and further 1/1

2 integrate research effort, a formal international panel review (Chair: Sir Keith Peters) in 2005, resulted in the FCS and research institutes being amalgamated into a single Faculty of Biomedical Sciences (FBS) composed of 13 thematically based research divisions whose research programmes are aligned, where appropriate, with partner NHS Trusts. ACME, initially a component of CHIME, is now the centre of the new cross-cutting Division of Medical Education. CHIME has joined the Division of Population Health, alongside Epidemiology and Primary Care, consolidating research collaborations which have evolved over the past decade. This Division leads the new Global Health Initiative of UCL, in which informatics plays an important role. CBSSM has joined the Division of Medicine, where it fosters HSR. CHIME and ACME provide strategic leadership of informatics and education research strategy and related support services for FBS. Significance of the Research The rapid changes in health care delivery, clinical education and professional regulation, the pace of innovation in information technology and the exponential growth of knowledge in the biomedical and clinical sciences combine to ensure that our fields are dynamic and ever-changing. Prominent examples of the significance of our research in guiding policy and changing health services are: Clinical operational research (Gallivan, Utley, Sherlaw-Johnson) The methodological expertise and groundbreaking graphical techniques of CORU enable modelling and analysis of cardiac surgery outcomes data that is used by every cardiac surgery unit in the UK and, embedded within software packages marketed by Dendrite Clinical Systems, in hospitals in 15 countries. CORU was commissioned to provide evidence for the Bristol Inquiry and the methods developed are now embedded within the surveillance work of the Healthcare Commission (Gallivan outputs 2,3; Utley output 4). GMC Performance Framework (Dacre) ACME has, through two programme grants, designed, piloted and evaluated the GMC assessment procedures for poorly performing doctors. Electronic record architecture (Ingram, Kalra) CHIME s research outputs over 15 years have shaped and been incorporated into international technical standards (Kalra output 1) and the openehr Foundation, a UCL-founded open source web-based resource underpinning the design of new health care information infrastructures, developed and tested in projects conducted within the local NHS (Ingram outputs 3,4). Community genetics and informatics (Modell, Ingram) CHIME was designated a WHO Collaborating Centre in 2002, in recognition of its sustained research contribution, closely linked with clinical services. Modell and Christiansen (Visiting Professor from Witswatterand, South Africa) co-authored the widely reported USA March of Dimes 2005 study, mapping the epidemiology of inherited disorders, worldwide (Modell output 2). A national survey of sickle cell and thalassaemia screening services, in 2005, showed that 50% of the professional workforce had used the WHO Centre web-based APoGI resource. Organisational development of health services (Bate, Robert) CHIME staff were the first to receive preferred consultant status from the new NHS Institute for Innovation and Improvement. The team won a contract as international assessor of the New South Wales healthcare modernisation programme and the 2006 EU Health Care Management Association prize for a book reporting research on dissemination of innovation in health care (Bate output 2), with (Greenhalgh, UoA8). Impairment of cognitive functioning (Newman) CBSSM has achieved international impact through its studies of the mechanisms of causation and interventions to reduce morbidity in cardiac surgery, renal dialysis and transplantation (Newman outputs 1,2). 2/2

3 Research Culture and Coherence Our research is inherently inter-disciplinary, drawing on many academic collaborations, communities of practice, and industrial, professional and health care policy and delivery partnerships, locally, nationally, and internationally. The culture is both practical and academic: practical because we engage closely with partners in health care, investigating the systems that support their day-to-day work; academic because our primary goals are research and knowledge transfer. We evaluate methodological and technical innovations, to understand what determines their success and to articulate the principles by which they can best be designed and organised. Innovative research-led taught Masters education, is provided in: health informatics (EPSRC studentships), risk management, medical education (with the Royal College of Physicians of London), health psychology (MRC and CRUK studentships) and mathematical modelling. Research activity benefits from the dissertation components. For example, a recent project implemented innovative technology for capturing standardized health outcomes data, quickly, from patients and professionals, throughout the Internet and using mobile phones. This pilot created considerable interest, for its potential in research. MPhil/PhD and MD students use UCL s on-line Research Student Log to assist in the monitoring of their projects and identifying development needs arising from reviews. Graduate tutors hold regular meetings with student groups, reported through departmental teaching committees. There are Journal Clubs, open evenings and regular programmes of research student presentations, established and led by the PhD students. The UCL Graduate School runs a full Skills Development Programme, providing training intended to help research at UCL and to enhance life skills and employability for the future of our graduate students in today s international context. The programme has been designed to cover the range of skills set out in the UK Research Councils Joint Statement of Skills Training Requirements of Research Postgraduates. A wide variety of training options is offered; half-day workshops, intensive week-long courses, term-long programmes of training. The Graduate School continues to expand and improve its provision of courses, collaborating with other local academic institutions, through the Bloomsbury Postgraduate Skills Network. We have active Visiting and Honorary Professors from South Africa (Christiansen, genetics, WHO Coordinating Centre), USA (Detmer, UK e-science project, CLEF) and UK (Treasure and Jackson, active in clinical operational research in CORU). There are close R&D links with Australia (Heard, Beale, partners in openehr Foundation). Research Strategy and Structure UCL s research strategy is developed at Research Centre, Division, Faculty and School levels. Centre strategies are discussed in away days and regular meetings of staff, set out in annual strategic and operational plans. The Centres being quite small in numbers, dayto-day interactions among senior staff suffice to maintain internal review and sign-off of research proposals. Review at Divisional and Faculty level includes checks on short and long term objectives, time allocated to own account work, and implications for infrastructure and budgets. Strategies are approved at Division and Faculty senior management groups, led by the FBS Vice-Dean for Research. They are built into the UCL 3/3

4 Research Strategy by UCL s Research Strategy Committee, chaired by the Vice-Provost Research. Health Informatics CHIME s research focuses on the implementation and evaluation of healthcare information systems and services and the organisational framework within which they operate. It devises, implements and evaluates practical demonstrators. The design, development and validation of systems, services and software constitute important research outputs. Funding: Research Councils, 1,562,700; EU, 510,153; DH/NHS, 2,025,023; Charities, 264,973. Key themes: Electronic Health Records Architecture and Standards (Kalra, Ingram) Community Genetics, WHO Collaborating Centre (Modell, Darlison (Research Assistant), Ingram) Health Services Development (Bate, Robert, Potts) Links with research of the Primary Care Department in ehealth (Murray, UoA8) and health services development (Greenhalgh, UoA8), and Gallivan and Utley Clinical Decision Support (Taylor) Education and Law (Murphy) Clinical Operational Research CORU research focuses on the development and application of mathematical models of clinical systems and processes. Funding: DH core grant, 2,010,319; SDO, 74,953. Based in the MAPS Faculty, it has significant collaborations with CHIME and the Division of Surgery. Key themes: (Gallivan, Utley, Sherlaw-Johnson): Evaluation of clinical outcomes - monitoring tools to support an open and just culture of accountability within the health service Women's Health - development of analytical methods to assist the planning of antenatal screening for genetic conditions and cervical cancer screening Patient safety - monitoring MRSA infections and pharmacy safety Service delivery - national initiatives in capacity planning, booked admissions, patient choice and the introduction of Treatment Centres. Links with CHIME (Bate, Robert), combining quantitative and qualitative methodologies Medical Education ACME studies innovation in the medical undergraduate curriculum, assessment of doctors as professionals, where doctors develop difficulties in their careers and how to assess them. Funding from successive GMC programme grants, 595,345; ARC, 174,793; other Charities, 75,976. Collaboration with CHIME (Potts). Key themes: Study of widening participation (Dacre, McManus (UoA44)) GMC Performance Procedures (Dacre) Innovations in education and assessment of undergraduates - in psychiatry including communication skills (Noble, Raven), rheumatology (Dacre), interprofessional and peer led learning Design, implementation and evaluation of new examinations - undergraduate and postgraduate medicine (Dacre, McManus) Health Psychology 4/4

5 CBSSM studies the behavioural contexts of healthcare interventions and services. It has developed PhD-based professional training to reach Stage 2 of the route to Chartered Health Psychologist award of British Psychological Society. Funding from NHS, 1,435,491; Research Councils, 70,078; Charities, 373,781; other Government, 1,424,406. Key themes (Newman): Self-management interventions in chronic disease The effects of treatments and disease on cognitive function and quality of life The role of carers and the development of interventions of carers Coping with chronic disease and its treatments Key Personnel Changes since 2001 NHS-funded chair in Health Services Management (Bate) created, jointly with UCLH Trust. Senior Lectureship in Health Information and Law created, with a clinical and legal professional background - recognising importance of patient safety and legal issues for health informatics and medical education. Bowling (UoA8) combined with Iliffe (UoA8) and moved from CHIME to Primary Care Department (PCPS) to form an HSR unit focused on the theme of ageing. Modell moved her WHO programme on thalassaemia genetics from PCPS into CHIME, to develop informatics aspects with Ingram. Research Achievements The scope of the research and its practical impact on health care has broadened and strengthened significantly over the RAE period, communicated through some 465 publications. Research outputs include peer-reviewed publications and conference proceedings, extensive international standards documents (evolved in international taskforces and adopted through inter-governmental ballot) and innovative software systems. The dissemination of a new concept or method of health service delivery often requires extensive and protracted design, development and validation of the approach and of systems (eg software) that deliver it. Contributions to HSR from the key thematic research areas of the four Centres are drawn together under four headings, as follows: Registries and Databases All HSR involves the collection and analysis of data. Sometimes this is a means to an end, for some projects creation of a database or disease registry is in itself a significant achievement. CHIME participated in two major escience projects, ediamond (Taylor) and CLEF (Ingram, Kalra), which have made large collections of clinical data available for future research. CLEF implemented novel data repository design and analysis tools, for bio-science research, with a particular interest in technical approaches for managing confidentiality, access control and de-identification (Ingram output 2). Modell and Darlison produced a national diagnosis register for monitoring the treatment and prevention of inherited disorders and highlighting correctable shortcomings (Modell output 4). Modell compiled data from across the globe for a March of Dimes report on birth defects (Modell output 2). Utley et al. combined clinical trial data and historical series in a model informing patients of the benefits of chemotherapy following lung cancer surgery (Utley output 3). Innovative Systems and interventions 5/5

6 A distinctive element in our approach is the creation of novel systems. Kalra and Ingram have developed an extensive set of web-based applications for anticoagulation management and for rapid access chest pain services and heart failure assessment. (Ingram output 1) These are now routinely deployed within the Whittington NHS Trust, and used by GPs and pharmacies in North Central London. The systems are backed by a comprehensive electronic health record server, built by the team at CHIME. This prototype provided evidence of implementation for the CEN/ISO standard specification (Kalra output 1) and for the openehr international foundation founded by Ingram, with members now in 80 countries, creating architectural specifications for interoperable health records, sharing specifications and validations of open source implementations (Ingram output 3). The CORU team (Gallivan, Utley) designed a graphical method for assessing the performance of clinical risk models and distribute a set of tools implementing the method (Utley output 4). With Modell, they developed a mathematical model to inform design of haemoglobinopathies screening programmes (Gallivan output 4). The unit is very effective in disseminating its work. During , CORU produced over 80 publications in clinical, operational research and management science journals and many other official research reports. Bate and Robert have devised and promulgated an approach to patient-centred design of services, which has been adopted by the NHS Institute for Innovation and Improvement (Bate outputs 1,3). Work on brain function following cardiac surgery and identification of the principal agent of damage (microemboli) has led to development of neuroprotective interventions, through equipment and pharmacological neuroprotection, where the unit has run the largest studies in the world (Newman 1,2). Newman has designed interventions for carers including an innovative (MRC funded) study that trained ex-carers to support current carers of people with neurological illness and the BECCA project (HTA funded) that trains members of the public to provide social support, assisting carers. Evaluations of Systems and Services Rigorous evaluations of health technology, including critical examinations of teledermatology and computer aided detection systems by Taylor s group have been a feature of our work. A number of evaluations of a commercial tool alerting radiologists to abnormalities on screening mammograms, including a major HTA funded study, have helped change practice and policy about the use of this technology (Taylor outputs 1,2). Randomised controlled trials of self management interventions have demonstrated significant behaviour change in Type 2 Diabetes in two independent studies; changes in the symptoms equivalent or better than pharmacological interventions in lower urinary tract symptoms in men and reduced mortality and hospital admissions in newly diagnosed patients with heart failure (Newman outputs 3,4). Other prominent evaluations of service delivery include the successful trial of a novel approach for identifying and counselling carriers of recessively inherited disorders in developing countries (Modell output 1), the evaluation of patient involved in decisionmaking about palliative care (Potts output 3), booked admissions (Utley output 1) and treatment centres (Gallivan output 1, Robert output 3). Performance Management 6/6

7 The fourth strand in our work is the design, implementation and assessment of processes for monitoring the performance of clinicians. This has been a major strand of work within Dacre s group in ACME which has worked on the re-design of several examinations, notably, the PACES examination for the MRCP diploma (Dacre outputs 2,3). Launched in 2001, this is now an internationally recognised success. Research relating to ethnicity and gender of candidates in relation to their performance was widely reported in the National Press (Dacre output 4). Tests of competence for 23 medical specialties are in use nationally. Data has been collected on 500 poorly-performing doctors, in comparison with reference groups; believed to be the largest collection of this kind of data worldwide. A prominent contribution of Gallivan et al. has been the development of alternative analytical methods to allow figures for surgical outcomes to be adjusted for case mix for operation types where the risk estimates have to be derived from disparate sources (Gallivan outputs 2,3). Future Plans The faculty reorganisations discussed in the introduction, and wider UCL plans to focus future investments on cross-faculty research grand challenges, aim to maximise potential for interdisciplinary collaboration, within UCL and across its strong network of NHS partners a critical success factor for HSR. HSR is a priority theme within the Comprehensive Biomedical Research Centre (CBRC) awarded by NIHR to UCL s NHS partner, UCLH - two specialist centres also awarded at Great Ormond Street, Moorfields). The reorganised Population Health Division will encompass the majority of HSR centres in FBS. A cross-faculty centre for Health Services Research is planned, as a virtual grouping of HSR centres, under the umbrella of the CBRC. A Faculty platform technologies initiative, led by Salvador Moncada (UoA 2), is exploring ways to draw together the internationally renowned activities of the Faculties of Engineering, Life Sciences and Mathematical and Physical Sciences, in bioinformatics, complex systems analysis and imaging, with biomedical informatics and systems biology, in all Divisions of FBS. Significant pump-priming UCL resource (Director and 3 academic staff salaries) has been invested in the UCL Global Health Initiative. This provides a further axis of development of HSR - informatics is a key focus. Growth, overall, is accelerating: 19.55m of new research grant income and other funding support was received or awarded during the RAE period. Grant funds received that will be expended beyond the RAE period are: current grants 4.32m; NHS Culyer support, 1.2m; DH, 2.6m; Consultancies, 500k; EPSRC, 300k; other 30k. CORU's current DH contract extends until 2011 as do ACME DH and GMC programme grants. The GMC programme will expand the Fitness to Practice instruments, publishing data on the cohort of poorly-performing doctors and their attributes, and exploring innovative secondary assessment tools for revalidation of doctors. Interdisciplinarity, Relationships, Collaborations 7/7

8 Staff returned have discipline backgrounds in medicine, education, psychology, physics, mathematics, engineering, natural sciences, statistics, anthropology, law and computer science. Extensive research collaborations have contributed to the research outputs: UCL - Computer Science, Medical Physics, Primary Care, Epidemiology, Institute of Child Health, Institute of Neurology, Institute of Ophthalmology, Divisions of Medicine and Surgery NHS - Whittington and UCLH NHS Trust, Camden PCT and Mental Healthcare Trust, Islington PCT, GOSH, Guy s and St Thomas, Hammersmith Hospitals, North Middlesex NHS Trust, local pharmacies and GP surgeries, genetics counsellors in primary care. 20 Trusts outside London UK universities - joint projects with Manchester, Edinburgh, Sheffield, Open University, Oxford, Cambridge, York, Southampton, St George s Medical School, Leeds, UEA, UWE, Imperial, including four Research Council projects in the national e-science Programme International consortia and health care settings - five projects in successive EU Framework Programmes (Medicate, 6WINIT, EuroRec, Semantic Mining, Q-REC projects), Academic/Healthcare groups in Australia, Sweden, Norway, Denmark, Netherlands, France, Belgium, Ireland, Poland, Iran, Japan, South Africa, USA Examples of wider working relationships, providing practical user context for the research: Users and carers: Patient groups thalassaemia patients associations in London, nationally and internationally, CHIME WHO Centre; Carers and Carer Groups, CBSSM NHS and service providers: DH (Connecting for Health, NHS Institute for Innovation and Modernisation, Commission for Health Improvement, Healthcare Commission; mainly CHIME and CORU programmes) Professions: GMC, NCAS, Medical Royal Colleges, UK Postgraduate Deaneries, MRC Pharmacy safety network, British Psychological Society International research: UK representative in EuroRec health records consortium drawn from all EU states; Member of EU Project of CEE States on health informatics, affiliate member of International Medical Informatics Association. Industry: Collaborations and consultancies include Infosys, BT, IBM, Cisco, Oracle, Microsoft, Kodak, Pfizer, GSK, Health Level Seven, Canon, Baxter Healthcare, Amgen, BTG Group, Clinical Computing, Pfizer, Cordis, Neuren, GSK, 3m Pharmaceuticals Voluntary sector: Starthere healthcare charity, piloting and evaluating technology that won the 2007 national BCS prize for the innovation making the greatest contribution to society. Staffing Policy Institutional policies on recruitment and development are followed and good practice recognised and shared across UCL. Staff play key roles on UCL Equal Opportunities, Gender Equality and Disability Equality policy groups. RAs, PIs and PhD supervisors pursue a personal professional development programme run by the UCL Staff Development Unit. This is monitored through regular staff appraisal at departmental level, coordinated at University level. UCL places high priority on early career researchers (Potts), who attend courses focused on research skills for grant application and reporting, project management and supervision and on teaching skills required to gain membership of the Higher Education Academy. 8/8

9 Close contact is maintained with alumni and professional developments. Graduates and research staff have achieved rapid career progression to senior posts in government, the NHS, industry and consultancy e.g. Healthcare Commission (Sherlaw-Johnson), National Patient Safety Agency (Woodward), UK Medical Schools (Haq, McLure), Institute of Cancer Research (Godden), Government Operational Research Division Home Office (Chow), Health Protection Agency (Jit), Industry and Consulting (Paschalides, Cook, Poonja). Infrastructure The Centres have access to all central and campus library and information systems and research support services of UCL. New storage area network, GRID computing facility, enhanced data and multimedia networking and research data management services are being procured during This is the highest SRIF investment ( 4m) of any UK university in this strategic infrastructure; important for future curation and sharing with NHS partners of confidential datasets. UCL Research Grants Administration provides customised access to a database of research opportunities and project proposal writing and costing systems and training. A common shared desktop environment is accessible anywhere on the Internet, facilitating collaborative work with partners. Access Grid nodes are available for virtual consortium meetings. Knowledge Transfer and Business Activities Knowledge transfer is central to our research missions from research into practice, from practice into research. 11 Consultancies with government and private sector enterprise, in the UK and overseas, have generated 548,000 of consultancy income, and contributed over 10% of total turnover and profits shown in recent accounts of UCL Consultants Ltd. Examples are: Gallivan and Utley are the scientific advisors to the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) and members of the Expert Group for many studies conducted by this organisation. Dacre leads design and delivery of RCP PACES examination, locally and internationally, and the CSU Deanery Project, providing assessments and interventions, regionally, within the GMC performance assessment process. Information strategy consultancy for: UK Clinical Research Network (Milan (CHIME honorary appointment), clinical network IT requirements, 9,600); national Connecting for Health Programme (Kalra, design of core health record infrastructure, using openehr trademarked archetype methodology, 37,600). Bate, Robert, Potts portfolio of research and consultancy, resulted in UCL becoming first University accorded preferred consultant status by the new NHS Institute for Innovation and Improvement. They won a consultancy contract ( 171,870), against competition including RAND Europe, to evaluate the state-wide programme of service developments in New South Wales. 9/9

10 CBSSM (Newman) has conducted numerous consultancies including negotiation with FDA in the design of studies of harm to patients through neuroembolism. openehr Foundation, founded by Ingram, Kalra and Heard (CHIME honorary appointment), at UCL, in 2002, has grown into an international community of clinicians, researchers and systems developers, with members in some 80 countries. It maintains a substantial electronic repository through which it publishes open specifications, software components and tools, accessed by some 500 visitors each day. This research-led activity was mentioned in a recent parliamentary statement concerning the future direction of the NHS national programme for IT. Kalra leads development of international standards in CEN (Europe) and ISO (international) for communication of clinical records between heterogeneous clinical systems. Innovative systems for cardiology records and decision support, funded by substantial past EU and Research Council grants (Kalra, Ingram), are in continuous use in local cardiology departments, pharmacies and GP surgeries. The project has extended across North London to cover 5000 patients. Business plans, developed with DTI and UCL Business PLC support, are undergoing due-diligence for a spin-out company to market the system and another to exploit novel software for capturing standardised health related quality of life data (Benson (CHIME honorary appointment), Ingram). CHIME runs DTI-funded Industry Forum for the MRC Clinical e-science Framework project. CHIME APoGI database (Darlison, Modell, Ingram) is widely used within the National Screening Programme for sickle cell disease and thalassaemia and in many countries (eg throughout Iran). Bate is principal partner, with NHSI, McKinseys and NHS Chief Executives Network, in leading the NHS service transformation agenda. G8 countries are creating national health information infrastructures. New research computing infrastructures are already in evidence, e.g. EU Health Grids initiative. CHIME is heavily engaged in R&D and implementation of this infrastructure, at national and European level - see Esteem Indicators. 10/10

11 Indicators of Esteem Prestigious Personal Positions/Awards WHO 50th anniversary medal for distinguished contribution; Director, WHO Collaborating Centre for Community Control of Inherited Disorders - Modell Academic Vice-President of Royal College of Physicians of London; Senior Consultant to the GMC on assessment - Dacre 2006 Baxter Award for Best European Healthcare Management Book of the Year - Bate, Robert Scientific Advisors to NCEPOD - Gallivan, Utley Honorary Member of Royal College of Physicians of London, in recognition of contribution to Medical Science - Newman, Ingram Leadership of ISO Electronic Health Records Communications standards Task Force; Kalra Chartered Statistician Potts Author of a leading health informatics textbook - Taylor National/International Bodies/Review Boards National: Expert Panel, Bristol Inquiry Gallivan OSI escience Steering Committee; MRC Health and Bioinformatics Advisory Board; CCLRC escience Advisory Board; UK Research Information Network Advisory Board; NHS Information Policy Board, Modernisation Board for London; UK Council of Health Informatics Professions - Ingram Chair ARC Education sub-committee, Chair MRCP(UK) Research Committee; Non- Executive Director National Clinical Assessment Authority Dacre; GMC supervisor Raven Communication skills UK teachers group Noble DH/Home Office committee reviewing use of escorts for prisoners attending for healthcare - Potts EU: Leadership of CEN EHR Communications Standards Task Force - Kalra Review panel of Health Research Board (Ireland) - Taylor Evaluation Steering Committee, Dutch Medical Research Councils Quality Collaboratives programme - Robert 11/11

12 ehealth Stakeholder Board; Advanced Cancer Genomics Trials Integrated Project Review Board - Ingram International: Member IMIA Working Group, Education - Murphy Director of openehr Foundation - Kalra Nuffield/Commonwealth Fund International Group of the 60 leading researchers and thinkers in health care, (New York & Pennyhill Park) - Bate International partner on $70 million 'Clinical Services Redesign Programme' ( ) - Robert Founder and Chairman of openehr Foundation - Ingram Editorships Editorial Board of BMC Medical Informatics and Decision Making, Health Informatics, Health Libraries Reviews, Postgraduate Medical Journal, Clinical Teacher, Journal of Intervention: Culture, Organisation and Management, Medicine Guest Editor IMA Journal of Management Mathematics, Journal of Applied Behavioural Science Named Lectures and Keynote Lectures Keynotes and Invited Lectures: Basic Science lecture to the European Association for Cardiothoracic Surgery (Stockholm) Gallivan; HISA (Australia), BHCC (Harrogate), Pro- Access (Krakow), US Academy Health (Boston) Ingram; World of Health IT (Geneva) - Kalra; Australasian Redesigning Healthcare Summit, BMJ International Quality Forum (Prague); Academy of Management (Atlanta) Bate, Health Informatics (Stockholm) - Murphy Invited presentation at International Bio-data Interoperability Conferences, Japan, 2005, 2006, 2007 Darlison, Modell 12/12

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