April 2010

Is our information person centred?

Person-centred information is information which respects the unique personhood of each individual. This may sound like jargon, but such a phrase does have implications for practice. This column will explore what a person-centred approach to information might look like and indicate some of the tensions such an approach could mean for our current information work.

‘Person-centred’ sounds a lot like motherhood and apple pie, something which it would be hard to argue against. However, all aggregation of data is automatically non person-centred and necessarily so and hence we do need to be careful in making ‘person-centred’ the only benchmark for information.

An important distinction needs to be made between the collection and use of information: perhaps all information collected directly from someone needs to be driven by a person-centred approach but that doesn’t necessarily apply to information use, particularly at levels where data is aggregated.

How should we be collecting information in a person-centred way?

This point will seem obvious, but only because it is so fundamental. Informed consent is perhaps the single most important issue we need to ensure in collecting information. We should always assume (unless there are good justificatory reasons for thinking otherwise) that people need to give informed consent to any information we collect about them. They can - of cause - only do this where they are aware such information is being collected in the first place.

How should we be using information in a person-centred way?

There are two principles I wish to highlight: confidentiality and access. We need to ensure that information used about someone is treated in confidence at the individual level. At aggregated levels, on the contrary, we need to ensure information at the national, DHB and team levels is made widely available. After all, public mental health services are funded by the tax payer and hence ultimately the taxpayer needs to have access on how services are performing.

Are there tensions in our current information collection and use?

There are three particular areas where tensions will exist with a person-centred approach to information: casemix, diagnosis and aggregated reporting.

The current casemix classification approach (casemix adjustment being the way we are able to compare services based on like cases) is not person-centred but focused instead on distinguishing inpatient from community episodes using 42 separate classes. It could be argued that a truly person-centred approach would dispense with such artificial distinctions between community and inpatient and instead focus on what is actually happening for the individual.

Diagnosis can easily become non person-centred in an information sense as opposed to a clinical sense. Clinical coders can retrospectively end up determining which diagnosis to use for costing purposes. This would seem a very non person-centred way of working. Better surely to ensure we are collecting and using information about diagnosis as near to the ‘real time’ event of diagnosis as possible.

All aggregated reporting can be seen as non person-centred at some level. The issue I particularly want to highlight is the timeliness of aggregated reporting if we want it to be person-centred. If we want aggregated reports to be useful for clinicians and service users we need to ensure that reports are made available as near as possible to the events and activities themselves. Otherwise we are in danger of producing historical reports of use only to researchers.

It would seem we have some way to go until we can honestly claim to have a person-centred approach to information.

Page last updated: 14 April 2010