Centre for Health Informatics         NHS Faculty of Health Informatics 

Centre for Health Informatics, City University, London,

Faculty of Health Informatics, Royal College of Surgeons of Edinburgh 

 
Improving access to, dissemination of and the application of
research undertaken by Health Informatics students
at Masters level in Higher Education across the United Kingdom

A Position Paper for the UK Faculty of Health Informatics

26 March 2009

1. Introduction.
The UK Faculty of Health Informatics (UKFHI) suggests that research by MSc students is the major
contributor to HI research in the UK. There may be scope for improved sharing of part-time and full
time Masters Students’ dissertations through electronic approaches and to the benefit of students and
research users in the NHS, with the Faculty taking a lead role (see grant specification 1).

Following that lead, this report provides a snapshot of the current 'state' of MSc research and explores
the potential for a new platform (repository) for related knowledge sharing. Opportunities are taken to
look more closely at the benefits of HI programmes to graduates and their career progression.
Moreover assumptions behind UKFHI's grant1 specification, and links with the 4 other grants within
the 'position papers' package, are investigated. This is a necessary additional step based on the
many and varied concerns facing HI and raised in Jean Roberts guiding paper for UKFHI strategy
development [2).

The result is a set of recommendations for discussion at the Think-Tank. Text summaries are
complemented by Systems models of the current UK MSc research position with implications for
change, and Specifications for mechanisms and a repository to meet future needs.

2. Objectives and methods.

Adjustments have been accommodated within original grant objectives to:

• Identify how knowledge sharing platforms in use across the NHS and Higher Education could
be used most effectively to share student research.

• Identify practical recommendations and an associated protocol, as to how student research

could better be shared across HEIs and across the NHS.

• Identify how UKFHI could best support the implementation of these recommendations.
The 'snapshot' of current MSc research was based on 3 online surveys released by UKFHI via a
circular on 10 March and available until 19 March (3). The graduate survey exploreed research
experience and publications whilst on HI programmes and general programme benefits to career
progression. The survey of programme directors considered student numbers and origins, especially
those completing MScs, and notable features of their own eLearning platforms. Future visions of MSc
research sharing, expanded with probes into student funding and locally available knowledge
resources, also appeared in the survey of NHS and health ICT company employers.

Source survey data, linked to Roberts' paper, informed the review of UKFHI assumptions.
Assessments of criteria for a repository and knowledge management tools were based on
web/literature searches, including a specific UK example (ProQuest).

3. Testing assumptions.
At least 3 features deserve closer inspection. Each has implications for future student support and
platform development.

3.1. MSc dissertations as the major source of HI research in the UK.

A primary focus on MSc research may be self-limiting. As Roberts notes [2]: “In many mature
academic disciplines, traditionally, research ‘proper’ starts at an academic doctorate level. In HI there
are an increasing number of work-place focused Masters level applied studies that can contribute to
the body of knowledge in this emerging domain, …”.

In fact, many HE institutions are known to have HI PhD programmes while MSc (and undergraduate)
involvement may contribute more widely to published and unpublished work beyond formal MSc-
specific research projects. The range of HI applications and research areas is similarly broad. These
areas, and the people involved, are often much broader than are suggested by, for example, the
National Occupational Standards (still developing) in HI (4).

Figure 1, based on work by the International Medical Informatics Association (IMIA, 5), also helps to
summarise Roberts' and our own observations. There are multiple dimensions to HI and multiple
contributors, even in the UK. So MSc dissertations may not be the only factor to consider within a
repository.

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 Figure 1. Map of HI research areas and multiple contributors to research (from IMIA, 5).

3.2. NHS employers as the major source of students.

There are a reputed 1.3 million employees in the UK NHS and a further 1.6 million involved in social
care. The student pool for research is clearly large in the UK.

However, HI is a global phenomenon with the UK (arguably) playing a leading role. So it is not
surprising that several HEs have deliberate and successful policies to attract overseas students. Nor
is the UK market necessarily limited to NHS employees. From experience, the student pool also
includes health IT companies, the pharmaceuticals and health products sectors, a growing social care
market, as well as those wishing to change career direction from other disciplines.

3.3. UKFHI as a sole agent for change.

UKFHI itself has 640 members (at 20Mar09) [6]. It is not clear how many are MSc students.
Moreover, it is not clear how many share membership with the British Computer Society's Health
Informatics Forum (HIF [7]) and its international influences; with the UK Council for Health Informatics
Professions (UKCHIP [8]) and growing reach across UK practitioners; or with ASSIST, active in both
health and social care [9].

Nevertheless, some features are emerging. The HI community, however spread across organisations,
may provide a potentially much wider pool of students to take on MSc research. That pool could be
supported in their research activities by the wide range of useful documents and discussion facilities
currently spread across a multiplicity of 'communities' on eSpace [10].

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Figure 2 summarises the overlapping sources of expertise and students across HI professional bodies
and wider, possible linkages with eSpace HI related communities. There is scope to explore multiple
memberships among students and HE supporters (directors and supervisors) to encourage teaching
and research partnerships as well as with organisations involved in direct care and using HI principles
and tools.

Figure 2. The overlapping 'pools' of expertise and students across HI related professional
bodies and eSpace communities.

4. Survey results.
The 3 surveys achieved 28 responses overall. This response rate is relatively low, but results from
graduate students in particular are worth examining. More informed findings from all surveyed groups
might follow if the surveys were more widely publicised and the study period extended beyond the
ThinkTank date.

4.1. The graduate student population (22 respondents).

4.1.1. Demographics and reasons for choosing HI programmes.

The main reasons for studying MSc programmes were expanding career opportunities and extending
their knowledge. 61% of the graduate participants in our survey were male and 39% were female.
They started their MSc courses between 1992 to 2007 and finished between 1993 to 2008.

54% were full time students and 46% studied part-time. Most of them (72%) were indeed based in the
UK. Only 2 respondents were NHS employees at the time. 83.3% of the graduates are employed now
and 18.2% of them have more than one job.

4.1.2. Course relevance and benefits to work environments.

Table 1 shows particular courses taken and contributing to students' more recent work roles.
Proportions add to more than 100% because of the multiple courses on offer and the multiple work

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roles since graduation. It is noticeable that courses and work roles are not limited to the 'traditional'
areas of HI practitioners.

The vast majority (92.9%) had made significant improvements in their contributions at work through HI
knowledge. 66.7% attributed this primarily to the MSc programmes.

4.1.3. Career progression.

Table 2 compares responding graduates' salaries before and after MSc programmes. The point to
note is the number of students moving down the categories after graduation - ie. career progression
into more responsible and higher paid jobs.

4.1.4. Publishable research.

66.7% of the respondents expressed their interest to share their project in a knowledge sharing
server. Perhaps the most important finding for a KM repository is the relatively low number (18.2%)
who progressed their research reports into full publications. This statistic may reflect the (possibly)
motivated 22 responding graduates. A much lower figure might reasonably be expected from a larger
sample.

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Table 1. Respondent graduates’ MSc course subjects contributing to work and career
progression.

Subject Percentage
Artificial intelligence 7.1%
Audit 21.4%
Clinical systems 28.6%
Clinical work 28.6%
Communication and teamwork 21.4%
Computer learning 7.1%
Confidentiality and security 21.4%
Data quality and management 28.6%
Health Policy/Economics 14.3%
Image Processing 7.1%
Information management 50%
Investment planning 14.3%
Knowledge management 42.9%
Measurement/ Instrumentation 28.6%
Modelling in healthcare 14.3%
Networks 7.1%
Procurement 7.1%
Programming 14.3%
Software development 7.1%
Statistical methods 21.4%
Strategic development 14.3%
Telemedicine/ Telecare 14.3%
Table 1. Subject of the current job in Health Informatics graduates

Table 2. Comparison of salaries among responding graduates before and after graduation.

Salary band (pa) Before MSc After MSc

20,000-30,000 57.1% 12.5%
30,000-40,000 42.9% 25%
+40,000 0% 62.5%

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4.2. Programme directors (4 respondents).

Training is known from experience to be provided across the UK through a mix of face-to-face,
electronic and blended programmes. Few HEs are known to have policies in place to help students
convert merit or distinction level research reports into formal publications. Virtual platforms and/or web
based e-learning systems were raised by respondents as components for any future KM system, but
no exemplars were provided.

4.3. NHS organisations/IT companies (2 respondents).

Knowledge sharing facilities were available locally. Both organisations also reported direct benefits
resulting from student research. On the other hand, only one of them had current budgets in place to
support staff with MSc level training.

5. Review of knowledge management/sharing (KM) systems within and outside

health.
There is already a KM initiative within Connecting For Health (personal communication). This section
looks more widely at generic components for future development, starting with a specific example
from the UK, then extending into some of the fundamental practicalities of use in UK settings.

A common theme throughout this sub-section is 'ease of use'. Novelty of MSc students to the
research environment suggests parallels with disabled users of websites. Those new to methods,
technologies, service providers and fellow users in HI shared the same goals as the developing
standard from the British Standards Institute to develop an accessible and acceptable 'user
experience' [11], though the way forward is still disputed [12].

5.1. An example UK repository (ProQuest, 13).

ProQuest is based in Cambridge and incorporates the UMI Dissertation Publishing component. As
Figure 3 summarises, over 2 million graduate works have been published (made available) since
1938 across disciplines and countries. It is essentially a service to academic libraries to extend their
access to resources and providing a vehicle for their own materials. The onus of compliance with
standards and protocols rests, however, mainly with academic librarians rather than placing strict
responsibilities on the academics (graduates) themselves.

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Figure 3. Summary of a repository for dissertations and theses from the UK (ProQuest, 13). 

5.2. Required characteristics for repository use.

5.2.1. Reducing multiple logins and passwords within the NHS.

Again from experience, this seems a common concern across NHS staff and may be matched by
practices to block external systems accessed from NHS networks. Multiple logins may reduce
motivation within the NHS while exclusion of external platforms limits access to NHS staff as well as
those in other professions or overseas.

5.2.2. Access to existing repositories and tools as a guiding mechanism.

Despite risks of duplication of KM services typically available to HE institutions (Table 3), there may
be a case for all students to have the same facilities available to most NHS staff. This may be logically
linked to modules within HI programmes to ensure that all students know what's available and how
best to use the resources.

Table 3. Example online KM repositories and tools relevant to MSc students.

Name URL Address

http://www.emeraldinsight.com/Insight/menuNavigation.do?hdAction=InsightH
Emerald
ome
Elsevier http://www.elsevier.com/wps/find/homepage.cws_home
Embase http://info.embase.com/index.shtml
Entrez http://www.ncbi.nlm.nih.gov/pubmed/
Eric http://www.eric.ed.gov/
Informa world http://www.informaworld.com/smpp/home~db=all

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ISI Web of http://www.isiwebofknowledge.com/
Knowledge
OVID http://www.ovid.com/site/index.jsp
Proquest http://www.proquest.co.uk/en-UK/
Science Direct http://www.sciencedirect.com/
Scopus http://info.scopus.com/
Wiley Interscience http://www3.interscience.wiley.com/cgi-bin/home

5.2.3. Local management of quality, confidentiality and IPR issues.

There is growing disquiet with the peer review process in research generally, as reflected in dedicated
conferences (14). Students are also faced with ongoing disputes and consultations on secondary
uses of data [15] and complex legal issues over rights to published material, including both text and
images [16]. These are complicated matters with little chance of immediate automation.

Issues are probably best left to student supervisors and programme directors ahead of any document
uploads. Guidance may be derived from the Joint Information Systems Committee (JISC)
programmes on property rights [17] and related work by the British Computer Society (BCS) [18].

5.2.4. Ease of storage, retrieval and use through structured documents.

Lack of standards for report structure are, perhaps, understandable at MSc level. Coupled to a similar
absence of meta-data, this presents problems for document management once on any site. Solutions
may be available both for administrators and end users.

Structured documents are already required by some journals and there are notable policies
developing on open access from JISC (19) as well as research funding bodies. The semantic web in
healthcare [20] offers another, perhaps more generic approach. Principles of tagging content for
purpose and meaning, rather than presentation, links mechanisms for storage and searching with
separate issues of final presentation.

Output modes raise issues of mobile platforms. The Guardian has noted (03Mar09 [21]) that, at least
in developing countries, mobile approaches are becoming the norm. This is an interesting
development as it links mainstream and disabled users through common output formats (eg. audio)
with provision on more flexible handheld devices like mobiles and PDAs.

6. General summary and recommendations

6.1. Systems summaries.

Figure 4 presents a systems view of the current state of MSc research, drawing on sections 3 and 4.
Traditional HI areas in the work environment are not the only areas encompassed by HI and MSc
students are not the only ones involved in HI research. Nevertheless, more students might be
encouraged into MSc programmes through wider and more flexible opportunities coupled to
appropriate funding support; and into full MSc research projects through appropriate guidance. This
highlights the place for a repository as a tool to assist novice researchers and as a place for storing
their final contributions. It also highlights links with other 'position paper' grants as sources of funding
(Grant 5), students (other HI professional bodies, and grant 4) as well as settings (grants 3&4) and
general advice on research issues (all grants, notably 2).

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 Figure 4. Systems model of the current UK position on MSc research with implications for
change.

Figure 5 consolidates the proposed features for any future knowledge sharing platform, drawing on
section 5. The facility might have the widest audience if login access is simplified and available to
both NHS and external users. Supervisors and directors must be involved, to maintain standards for
uploaded materials, as well as students using facilities more directly. Guidance is required for both
these sets of ‘administrators’ and ‘users’. Search mechanisms, based on meta-data, are best hidden
from end users though a range of output formats to suit preferences and needs also deserves
attention. The ideal repository might combine access to resources with facilities to learn and discuss
process with fellow administrators and students.

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Figure 5. Systems summary of criteria for research repository. 

6.2. Recommendations.

Combining components from both systems models, and acknowledging strengths and weaknesses
from the 3 surveys, gives the following recommendations under original research objectives.

Identify how knowledge sharing platforms in use across the NHS and Higher Education could
be used most effectively to share student research. (Promoting research training more
generally).
• Promote wider understanding of topics and settings for research with HI involvement.
• Encourage wider uptake of research opportunities starting at MSc level in particular.
• Acknowledge linkages between all position papers in strategies to promote research.

Identify practical recommendations and an associated protocol, as to how student research could
better be shared across HEIs and across the NHS. (Repository requirements).
• Repository open to all students around globe
• Facilities to support research and convert reports into publishable papers
• Guidance on structuring documents, uploading and subsequent searching
• Quality, confidentiality and IPR issues addressed by local supervisors/directors ahead of
upload

Identify how UKFHI could best support the implementation of these recommendations. (Facilitating
role).
• Advertise and prolong the period of access to the 3 surveys to obtain a broader and wider
cross-section of stakeholder views on repository development.
• Explore overlaps with HI professional bodies and open discussions as a source of wider
expertise and source of students.

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 • Support pilot initiatives to refine repository specifications.

Aknowlegement:

Authors: Howard Leicester, Faculty of Health Informatics, Royal College of Surgeons of Edinburgh

Abdul Roudsari and Omid Shabestari , Centre for Health Informatics, City University, London,

We are grateful to Dr Janet Donaldson ( PUPA) for her contribution to the design of the student
questionnaires and to all the students and course directors who have respondent to the
questionnaires

The Centre for Health Informatics (CHI), is a component of the School of Informatics, and was
established at the beginning of 2005, evolving naturally from the previous Centre for Measurement
and Information in Medicine (MIM), a University Research Centre established in 1983. CHI engages
in interdisciplinary research with a strong emphasis on the application of information and
communication sciences and technologies in medicine (health informatics). Through its activities it
seeks to gain a better understanding of the processes of measurement, information and control; to
develop a creative environment within which formal problem-solving skills are applied to real-world
healthcare problems; and to facilitate the transfer of knowledge gained for the benefit of the
healthcare and related communities.

The Centre for Health Informatics has taught health informatics at MSc level for 18 years. We were
the first institution in Europe to offer such a programme. A large number of our 300+ graduates are
now pursuing successful careers in the NHS in health informatics, healthcare software solution
providers and related fields.

7. References.
1. UKFHI, (2009). Overcoming the challenges and harnessing the opportunities of health informatics
r&d. Information for organisations wishing to apply for grants to produce and present position papers
for the uk faculty of health informatics, January, 2009.

2. Roberts J, (2009)."The Scope, Challenges and Opportunities of Health Informatics Research and
Development", A discussion paper from the UK Faculty of Health Informatics. Available, at 18Jan09,
in documents section of: http://www.espace.connectingforhealth.nhs.uk/community/nhs-faculty-HI

3. NHS CFH eSpace UK Faculty of Health Informatics eBulletin - Events and Research (released
10 March 2009).
Student survey via: http://www.espace.connectingforhealth.nhs.uk/articles/sharing-health-informatics-
msc-research-student-fee?c=320
Programme Directors and Employers' surveys via:
http://www.espace.connectingforhealth.nhs.uk/articles/sharing-and-applying-health-informatics-msc-
researc?c=320

4. Health Informatics National Occupational Standards (HINOS) website, visited 10March09:

http://www.hinos.org.uk

5. IMIA Yearbook of Medical Informatics, 2002).

6. "UK Faculty of Health Informatics." Retrieved 22/03/2009, from

http://www.espace.connectingforhealth.nhs.uk/community/nhs-faculty-HI.

7. "Health Informatics Forum, BCS." Retrieved 22/03/2009, from

http://www.bcs.org/server.php?show=nav.6044.

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8. "UK Council for Health Informatics Professions." Retrieved 22/03/2009, from
http://www.ukchip.org.uk.

9. "Association for Informatics Professionals in Health and Social Care ". Retrieved 22/03/2009, from
http://www.assist.org.uk/.

10. "eSpace communities page." Retrieved 22/03/2009, from

http://www.espace.connectingforhealth.nhs.uk/community_insights.

11. "BSI developing standard." Retrieved 22/03/2009, from http://www.bsigroup.com/en/Standards-

and-Publications/Industry-Sectors/ICT/.

!!
12. British Computer Society, (2009). Response to the British Standards Institute’s draft standard on
accessible web experiences. Available since mid March 2009 via:
http://www.bcs.org/server.php?show=ConWebDoc.24998 .

13. Repository for dissertations and thesis from the UK ProQuest group, visited on 3 March 2009:
http://www.proquest.com

14. "Disquiet with peer review process." Retrieved 22/03/2009, from

http://www.iiis2009.org/wmsci/website/default.asp?vc=27.

15. British Computer Society, (2008). BCS Response to the NHS Connecting for Health Consultation
on Public, Patients and other interested
Parties’ Views on Additional Uses of Patient Data.

16. Thomas R, Walport DM. Data Sharing Review [22/03/2009]; Available from:
http://www.justice.gov.uk/docs/data-sharing-review-report.pdf.

17. "Managing and Sharing e-Learning Resources, How repositories can help." Retrieved 22/03/2009,
from http://www.jisc.ac.uk/media/documents/publications/bpelearningreposv1.pdf.

18. "BCS response to data sharing review." Retrieved 22/03/2009, from

http://www.bcs.org/upload/pdf/response-data-sharing-review.pdf.

19. "Open Access briefing paper version 2." Retrieved 22/03/2009, from
http://www.jisc.ac.uk/publications/publications/pub_openaccess_v2.aspx..

20. Cheung KH, Prud'hommeaux E, Wang Y, Stephens S. Semantic Web for Health Care and Life
Sciences: a review of the state of the art. Brief Bioinform. 2009 Mar;10(2):111-3.

21. McGreal, C. "From Congo to Kathmandu, how mobiles have transformed the world." Retrieved
22/03/2009, from http://www.guardian.co.uk/technology/2009/mar/03/mobile-phones2.

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