IG On The Run

Posted : 11/04/2012 | By David Birkinshaw - Head of Information Governance

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IT and Patient Care

IT and Patient Care

Can NHS IT impact on patient care? Unfortunately, there are a few examples where an IT “disaster” such as a network outage or a virus outbreak have adversely impacted patient care – cancelled appointments, closed theatres, sending some patients to neighbouring Trusts. These are not a great advert for IT. In my rose-tinted glasses world though, at least it shows that IT is being used in the running of the NHS.

What we really need are examples of IT positively affecting patient care. How about integration between care settings to speed up communication? Electronic referrals from GPs followed by electronic discharge summaries, for example. Surely they’re of benefit by speeding up communication; ensuring important information gets to the right person quickly has got to be good for patient care.

How about giving in-patients (and their visitors) access to the Internet through a guest wireless service? I can’t imagine my daughter being separated from Facebook/BBM for more than 2 hours at home let alone if by herself in hospital. It’s amazing she sleeps at night now. Perhaps the fact that the wireless router is in our bedroom and we turn it off at night has got something to do with that.

How about home monitoring of blood pressure or blood levels? How about video-consultations? How about appointment booking online? How about recording mood levels on your smartphone, sharing automatically with your MH team and they can proactively contact you under agreed circumstances?

There are many more example out there of IT positively impacting on patient care. Let’s have more!

Posted : 05/03/2012 | By Alan Brown

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The Death of the IT department

The Death of the IT department

Now that’s a dramatic headline. And as Mark Twain once said “the report of my death was an exaggeration”. However the role of the IT department is changing. For several years it has been the aspiration of the IT department to standardise – a single specification of desktop PC built in an identical way through an “image”. It made life much easier – we could come up with some great sayings: “we don’t have 3,000 PCs here, we have 1”; “fix for one, fix for all”; “ruthless standardisation”, and so on.

But life changed.  Laptops were always extra – going from one image to two was acceptable. Then there came notebooks, Smartphones and the iPad (other tablets are available). Still, we could standardise on each one of those. It might be manageable.

Now, life is changing again. This time though it’s different. People are turning up at work with their own Smartphone and their own iPad and expecting it to be allowed on the network and to be used as their work device. It’s not happening yet in the NHS but it is happening in the private sector.

It’s not surprising really: in your work environment you share a 10MB network link, have Windows XP and can’t download your favourite software. At home you have 50MB superfast broadband, Windows 7 or Linux, admin rights and a home network (managed by your 7-year old). In a few years time, staff will think they know more about IT than the IT department. It’s not true of course: they won’t understand networks, databases, servers, virtualisation, backups, etc. But they will have higher expectations that currently. The private sector is calling this the “shadow IT department”.

It does mean change (again). Rather than enforcing standard devices, the IT department will need to enforce policies and standards. Even now you can connect your SmartPhone to NHSMail – but it will enforce certain standards around passwords and encryption. So the IT department will need to spend more time focusing on policies and standards and less on images and PCs. The silver lining: they’ll also be able to turn away hardware problems when the device being used is a personal one.

What’s the next step?

Posted : 13/01/2012 | By Alan Brown

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NPfIT - What Next?

The National Programme is dead; it is an ex-National Programme; it is no more. That is how it has been reported in much of the media. To my mind that is an exaggeration - some of it is alive and healthy: RiO deployments and upgrades are continuing in over 60 Trusts across London and the South; N3 is joining it all together; GP systems are out there being used. But Acute EPRs? Cross care-setting? Patient access via myHealthspace? Not very healthy.

But rather than arguing over whether the National Programme was money well spent perhaps the more pertinent question is “what next?”.

Should you be answering those questions now? Well, yes.  For those systems successfully delivered there is less than four years left to the contract. At that point all of the free goods will become chargeable Even if extensions to current contracts are centrally negotiated, it is certain that they will not be centrally funded. So the “Do nothing” option will cost - the lowest estimate I've heard is £350k per year. On that basis alone I think you should be deciding now what to do next. If you are going to decide to Do Nothing or to wait as long as possible then make that a conscious decision not a default position.

That aside, if you know your future organisational form/strategy then it is an ideal time to decide how IT needs to support it. Just look at some of the things that the National Programme has not delivered: true mobile working, local integration, embedded Business Intelligence, patient-facing functionality, cross care-setting information sharing, etc. Are these important to you? If not, then sticking with the current solutions may be best for you. But if you are going to do something bear in mind that it will take quite a while to specify and then procure a replacement system let alone implement it. So again, decide now and then take your time to implement that decision.

Posted : 19/12/2011 | By Alan Brown

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Efficiency in the NHS

Stephen Dorrell says that the NHS must achieve 4% efficiency savings for each of the next 4 years merely to "stand still".  Can this be done without better use of better IT...?

Posted : 27/10/2011 | By Geoff

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The Role of IT

“We only put the boxes on the desk and the cables in the wall”! If I had a penny for every time an IT Manager said that to me then I would have 76p. But seriously, the days are gone when IT “just” put boxes on desks and cables in walls. Yes, I know that putting boxes on desks and cables in walls is a big task itself – networks are complex, PCs need standard images, performance is critical, mobility is important and so on. But if that is all that IT is going to do for your Trust then you might as well outsource it (and many have). Cables and boxes are commodities and deserve to be bought from the cheapest source, just like paper clips and pens. They do not generally impact on patient care (except when they don't work).

What IT really does is enable, or lead, change. In many Trusts, IT has taken the lead in the misnamed “National Programme for IT”. We all know it wasn’t an IT project even though they labelled it IT and gave it to the IT department to manage. Luckily, IT Directors across the NHS knew that the technical elements of it were pretty easy (IEv6, Java and Smart Cards – Data Migration being the exception to that rule) and the real challenges came in changing processes to use the new applications. What made a RiO deployment, for example, successful was engagement with staff, excellent communication and good focused training. None of which is normally associated with core IT service provision.

Of course some IT departments have always known this and have always had a “change lead” type role, worked closely with the Medical Director and service leads. But now even more have learnt that IT is not about cables and boxes but about people and processes. Don’t let the new role of IT as change-enabler be lost, don’t slip back to the old days of just putting cables on desks and boxes in walls (sic). Keep the profile of change lead and keep changing your Trust to deliver better, more efficient services – that will have a positive impact on patient care.

Need I say that Apira resources specialise in change - we pick our team for their people skills not just their technology experience. Please comment with your experiences and views.

Posted : 24/10/2011 | By Alan Brown

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Interesting article about the Falklands in The Guardian

The Guardian reports on how medical professionals use all sorts of different methods to contact and treat patients on The Falklands

http://www.guardian.co.uk/healthcare-network/2011/oct/19/falklands-health-service-teach-nhs

 

Adaptability as well as interoperability?

Posted : 19/10/2011 | By David Birkinshaw, Senior IG Consultant

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FOIs for GPs

Not a lot of people know this, but for the purposes of the Freedom of Information Act 2000, a partnership of GPs are not considered to be subject to FOI requests.  However, INDIVIDUAL GPs are.  This was further reinforced by decision notice FS50360013 from the informaiton commissioner - search by clicking on this link... http://www.ico.gov.uk/tools_and_resources/decision_notices.aspx for the full information.

Posted : 17/10/2011 | By David Birkinshaw, Senior IG Consultant

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Interpretation of the requirement for Information Governance Audit 2011/12

Background

There appears to be some confusion this year around the requirement for NHS bodies to commission independent audit of their annual Information Governance Toolkit (IGT) submissions. I will try to clarify the situation as I see it.

I have not been able to find any documented central mandate that requires NHS bodies to commission independent audit of their IGT submissions in 2011/12

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Posted : 14/10/2011 | By David Stone, Head of Information Governance

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Implications of LB of Hounslow and Ealing Monetary Penalty Notices served under the Data Protection Act 1998

Background

The London Borough of Hounslow commissioned an out-of-hours social service from the London Borough of Ealing. Ealing also provided this service to its own residents.

In February 2011, Hounslow and Ealing were fined £70,000 and £80,000 respectively under the Data Protection Act 1998 (DPA).

The Monetary Penalty Notice (MPN) arose from the theft of two unencrypted laptops from an employee of LB of Ealing.  The laptops held the personal data of approximately 1,000 Ealing service users and approximately 700 Hounslow service users.

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Posted : 14/10/2011 | By David Stone, Head of Information Governance

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E-Health Insider

What does the future hold for the RiO community and mental health system?

With the fast approaching end of BT’s local service provider contract for London, trusts are starting to think about a potential life beyond RiO. The much championed community and mental health system has enjoyed success in the last five years, but will it continue to meet the needs of the now emerging, more commercialised and patient-centric trusts?

The most current review of NHS care record system roll-outs was undertaken by Robertson et al in 2010. It showed that the key concerns of NHS staff focus on the future of the national programme, centrally negotiated supplier contracts, and limited system flexibility. Human factors have often been side-lined when developing electronic patient record systems. There has been some focus on patients, but healthcare professionals’ needs have often been neglected. This is a major shortfall in need of remedy. So, what does the future for NHS EPR systems look like? RiO – the good, the bad and the alternative On the one hand, RiO is a user-friendly system which is rich in functionality and has few rivals.

But it doesn’t follow most current business processes or the patient pathway. This causes issues for users, such as limited flexibility, and can make it time consuming to use. One consequence is that the Progress Notes free text functionality has been over used, resulting in rich qualitative data held but the inability to report on most of it. Staff are crying out for features such as configurable patient pathway protocols, to guide system use.This would also benefit reporting. Yet recent upgrades to RiO have been more focused on internal issues such as Spine compliance and fixing bugs. Surely this is something NHS trusts cannot continue to live with. It’s true that the impending RiO Releases 1 and 2 (the former to be deployed mid 2011 and behind schedule) will deliver some much-requested new functionality, such as results ordering and RiO to RiO. But is that enough, and what are the alternatives? While the sector is awash with clinical systems, there are few offering the expanse of RiO functionality. One that springs to mind is Ascribe’s Jade, an Australasian system in use at Central and North West London NHS Foundation Trust. Jade offers similar rich functionality to RiO and is paving the way on the prescribing module. Word on the street is that adoption has been high even among clinicians, who are well-known as sceptics when it comes to new systems. Other alternatives are also starting to make their voices heard.

Paris has recently won the Hertfordshire Partnership EPR competitive tender, and Patient Journey, based on Strand’s CareNotes, is fruitfully used at South London and Maudsley NHS Foundation Trust. So there are alternatives in the ring. Exit strategies 2015, the end of the BT LSP contract, is just around the corner. Trusts currently using RiO will be looking at options and exit strategies. Some have started developing IM&T teams to address the thorny issue - stick with the devil you know, or take the risk of moving to a new system? The ‘do nothing’ option - continue with RiO and review BT’s offerings in 2015 - has to be top of the list. Yet it is a dicey strategy that could backfire. BT might price RiO out of the Department of Health’s budget and force a move away. Or the system could continue to plod along, meeting only some of trusts’ needs, with many limitations for those with specialised services such as gender reassignment or sexual health. Going all out for a full procurement of a new system comes at the other end of the spectrum. This would require the largest input of both money and resources, and will probably only be possible for large, money-heavy trusts - which are few and far between. Not an option for the faint hearted. So, what can smaller trusts do? One innovative solution would be a hybrid system, in which RiO would continue to be used as a patient administration system and another offering would be procured or developed in-house to provide the all-important patient pathways protocols and business intelligence functions.

This would mean much-needed flexibility and speedy reflexes to change, both of which are sought after benefits by staff. The final option would be to develop an all encompassing in-house solution. But this would require specialist expertise from within IM&T departments. Trusts may be hard pressed to find and secure such specialists for a long-term project, while keeping the purse strings tight. In conclusion There are alternatives to continuing with the RiO system but they are limited, require money and will take time. That said, to deploy the new RiO Releases 1 and 2 will be costly and time consuming for trusts that remain in the national programme.

Trusts need to consider their options and decide if now is the time to take the jump and invest in an alternative, locally maintained system. One that might rapidly move with technological advancements and staff as well as patient expectations, and provide additional interoperability. To help them, they need to secure good operational management and subject specialists, to provide on the ball advice on their options. Finding a solid EPR base for the future is vital.

Posted : 03/10/2011 | By Denise Butterfield, Senior Consultant

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