A Few Good Men

Debbie Williams

Blog, Monday 9th November 2009

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It’s been reported in Computing magazine that there are only 174 clinicians using Lorenzo patient software to set up centralised electronic health records across the five early adopter trusts.

Five Boroughs Partnership, Bradford Teaching Hospitals NHS Foundation Trust, University Hospitals of Morecambe Bay, Hereford Hospitals and South Birmingham have only ever had 19 clinicians using the systems at the same time.

The low uptake is of course skewing the costs for deployment, and providing ammunition for NPfIT sceptics…with so few clinicians on board, the cost per user is currently many hundreds of thousands — possibly even more than a million — pounds per user per year.

Critics claim the low uptake is hardly surprising, given the teething problems witnessed amongst early adopters, and the fact that this part of the programme is already running four years late.  What’s more, it’s the taxpayer we are told, who will also have to pick up some of the bill if sceptical trusts refuse to deploy Lorenzo or Cerner software.

However, financials aside, the more worrying issue seems to be the lack of buy-in from clinical staff.  A truly national programme necessarily requires buy-in from every trust and from every clinician – without this universal support, the idea simply does not and cannot stand up.

The £12.7bn National Programme for IT – the world’s largest civilian IT project – is a hugely ambitious one, and obstacles are to be expected.  To make it a success will require a lot more blood sweat and tears from all involved.  The question is, is there enough support from the trusts themselves and from the clinicians who will depend on the system for the work they do every day?

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Fear for Increased Waiting Lists

Debbie Williams

Blog, Tuesday 29th September 2009

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It has been reported this week that Belfast Health Trust will no longer be able to refer patients to the private sector for operations due to a lack of funds.

Patients requiring knee, hip, heart and cataract operations are often referred to private clinics to help reduce waiting times but as the Trust can no longer afford to do this, inevitably waiting times are expected to rise.

Funds are tight for many businesses in the current climate and the NHS is no different so it is to be expected that there will be some areas that will feel the strain from a lack of funding, however it is important that patient care does not suffer as a result.

As the deadline for the 18-week wait has now long passed, trusts should be well on top of their patient data. By having a clear view of where patients are on their pathway of care, trusts can ensure the right resources are allocated efficiently, to guarantee timely access to care.

With budgets cuts ahead, and winter round the corner – with all the additional demand this brings, it’s vital that trusts keep control of their patient waiting times, to ensure high quality patient care.

Our Pathway Manager solution gives clinicians and managers a clear overview of where patients are in their pathway of care, flagging up potential issues at an early stage to avoid any breaches and ensure patients get the access to care they deserve.

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Just Have a Little Patience…

Debbie Williams

Blog, Friday 10th July 2009

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E-Health Insider has this week reported on Morecambe Bay NHS Trust’s ongoing deployment of the Lorenzo software for electronic patient records.

It has been nine months since the trust started deploying the iSoft program and while some progress has been made in that the system is live on the majority of surgical wards, the roll-out to other medical wards is still a further two or three month away and, as the article suggests, the honeymoon period is well and truly over.

As with any software deployment, users need to be aware that is a program and not a product. Implementation will not happen overnight but there are things trusts can do to improve the process:

  • Preparation – It is always worth running a full data quality check prior to implementation to ensure all data is up to date, this will save a lot of time inputting information.
  • Planning – Be sure that enough resource has been allocated to allow a smooth deployment and that capacity is able to meet demand.
  • Communication – Ensure all clinicians and managers understand the process and are working towards the same goal.
  • Organisation – Set out a clear plan for the project including task lists for all parties involved, regularly updated project plans to keep those involved in the loop and scheduled workshops to ensure users of the software are aware of its capabilities and structure.
  • Awareness – Don’t lose sight of the project or the end goal. It is perfectly ok to stop and take stock before continuing down the wrong route and make mistakes that will take time to rectify later.

Unfortunately there is no avoiding the time software deployments take but ensuring all involved are aware of this and working towards the same result will make the whole process much easier to manage.

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NHS Over a Barrel?

Debbie Williams

Blog, Tuesday 23rd June 2009

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BT’s contract in the National Programme for IT (NPfIT) has risen by more than £500m following the latest contract negotiations, according to Ovum. So did BT have the NHS over a barrel, or is it honest pay for a day’s work?

Did threats to leave the national programme help BT’s cause? It certainly would have caused major shockwaves if BT had walked away from its LSP contract, like Accenture and Fujitsu.

NPfIT doom mongers will say this latest payment is yet further evidence of a budget out of control. However given that BT has previously announced £1.2bn of writedowns on two of its global service contracts including NPfIT, it could be evidence of a change of approach from Connecting for Health, in paying suppliers a fair price for the work they do.

It must not be forgotten that BT is also taking over some of the NHS trusts in the South of England which had been supplied the Cerner Millennium system by outgoing local service provider Fujitsu. BT will supply some other trusts in the south with the Cerner system. It is also rolling out the Rio system to 25 community and mental health trusts.

Cost issues aside, the potential of the national programme to bring about further transformation in healthcare management and delivery is an exciting one. When and exactly what it will deliver is something that eyes the world over are watching for.

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Making Sense of NHS Jargon

Debbie Williams

Blog, Wednesday 10th June 2009

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The British Medical Association and the Plain English Campaign have criticised jargon used by the NHS to describe patients and processes within the organisation. Examples include naming patients as service users or clients and using other phrases such as ‘disinvestments’ instead of ‘cuts’ and a ‘proof of concept’ to describe a pilot.

The relationship between health manager and doctor can sometimes become blurred as it is, without gobbledegook phrases adding to the problem. One doctor in Kent highlighted that so much information they receive is constructed in this ‘management speak’ that too much time is spent reading and understanding documents, rather than treating patients.

In order for trusts and hospitals to run smoothly, it is vital that health managers and medical staff communicate to each other and patients in a language that all can understand. Sharing information in the right way and in the right type of language is essential within the NHS to ensure all involved can strive to the same goals and ultimately deliver a high standard of patient care.

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Keep Everyone in the Loop

Debbie Williams

Blog, Wednesday 3rd June 2009

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It was reported on E-Health Insider today that a North London Trust has stated that any patient who will not allow the trust to upload their details in to the electronic system will not receive care.

Following one patient’s request, who asked not to have an electronic patient record, the director of strategy wrote to the patient stating that the trust was under legal requirements to maintain local patient records and they would now only be doing this electronically. If the patient continued to refuse, due to their duty of care, the trust would not be able to provide treatment.

The main patient concerns seem to be centred on when the records will be streamed onto the national records system. With the number of data loses and security issues surrounding personal data it is understandable that patients may be concerned – it’s therefore vital to deploy secure electronic systems to ensure patient records are managed safely.

Perhaps trusts simply need to make their patients more aware of the new structure for electronic data records systems. It is the patient’s data after all, so they have a right to be concerned about how it is used. Reassuring them of the benefits of the system as the changes take place will minimise these concerns and ensure no one is refused treatment.

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Latest Report Argues Poor Data Quality

Debbie Williams

Blog, Wednesday 22nd April 2009

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The latest Audit Commission report, ‘Figures You Can trust: Data Quality in the NHS’ has stated that there has been a significant lack of progress in data quality since it’s last report in 2004.

The Commission argues that organisations are still failing to embed good quality data into their daily activities and there is still a lack of coordination when it comes to reviewing and improving data quality.

This is a growing concern if Trusts want to meet the agenda set out in Lord Darzi’s review and the Commission feels boards should take more of a lead in ensuring Trusts meet data quality requirements.

To meet the requirements set out by Darzi and the Audit Commission, Trusts need to address the problem of data being stored in disparate, hard to access sources.

Creating a single repository for all data sources is one option for healthcare managers, clinicians, finance staff and executive directors to get streamlined access to data of high quality so they have the information they need to monitor patient progress and ensure timely access to care.

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BT Heads South

Debbie Williams

Blog, Tuesday 14th April 2009

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Like a phoenix from the flames, BT has emerged as the new local service provider in the south of England, bringing some degree of direction for hospitals and trusts in the region in the wake of Fujitsu’s departure from NPfIT last year.

BT is to take over responsibility for supporting eight NHS hospitals in the south of England running Cerner Millennium software, and it is thought the outline of a framework deal will next week be announced for the 30-plus NHS hospital trusts in the south of England, still waiting for a new IT system five years after the start of the NHS IT programme.

The price tag for BT’s contract extension is rumoured to be in excess of £100m, according to sources of E Health Insider.

Some will welcome the news, seeing at as evidence that NPfIT as a truly national programme is firmly back on track. Others see this latest contract renegotiation and not inconsiderable price tag as further confirmation of spiralling costs, of throwing good money after bad, and some might say of repositioning deckchairs on a project that is doomed to sink.

Whether you’re optimistic about NPfIT or firmly with the pessimists, this latest news again raises the question of whether a truly national programme is desirable, let alone realisable. Many people favour a more localised approach, with hospitals and trusts free to choose the systems that best meet their requirements, and the flexibility that this inherently gives them.

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NHS Reviewed

Debbie Williams

Blog, Tuesday 10th March 2009

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A new paper released today by Gordon Brown – being described as an ‘information revolution’ – has announced that, similar to TripAdvisor, Amazon and eBay, patients will now be able to leave online reviews of their local services to give the public more influence over the health service.

By the Summer, patients will be able to leave comments on individual doctors and their experience of the system on the NHS Choices website, in a hope that the general public will be able to shape the services that they receive.

Brown has said: “People take it for granted that they will access other people’s reviews and ratings before buying something on eBay or Amazon, and yet we do not yet have systematic access to other people’s experiences when choosing a GP practice or nursery.”

“We have clearly got the balance wrong when online businesses have higher standards of transparency than they public services we pay for and support.”

This certainly is an interesting concept and it will be interesting to see how the comments that are posted on the site reflect the individual Trusts and the services they deliver. From our perspective, feedback on how patients feel about their pathway of care and waiting times in specific areas will be particularly interesting. But we will have to wait until the summer to find out what the nation thinks of healthcare provision…

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Uncertainty in the South

Debbie Williams

Blog, Tuesday 24th February 2009

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Last week, in came to light that Worthing and Southlands Hospitals NHS Trust had made the decision to switch off its Cerner Millennium records software and is moving back its old Sema-Helix software.

The switch follows the termination of Fujitsu’s LSP contract in the South and South West last year, and raises further questions about the impact of the termination, and how Trusts are coping.

At the time, Ardentia stated that the termination could introduce uncertainty and delays to healthcare IT projects being carried out in the region, warning that computer programs that were not fully up and running at the time of the termination would be those most at risk. We must ask the question, has Worthing and Southlands been a victim of this change and uncertainty within NPfIT?

To avoid similar situations, Trusts in the South – and indeed across the country – must be sure they have the correct processes and systems in place to ensure access to essential information and allow a better flow of patients, enabling managers and clinicians to plan and manage their workloads more effectively and deliver an improved level of service.

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