Recent news paints an unflattering picture of technology in the National Health Service (NHS). This year alone the Health Secretary Andrew Lansley branded the NHS National Programme for IT (NPfIT) as an “expensive farce”, two suppliers (Accenture and Fujitsu) have pulled out of the programme, the Department for Health CIO responsible for the programme resigned in June, it emerged that cancelling a contract with CSC would cost more than continuing with it and fixing the problems and over the summer the Department set about a review which led to the whole programme being cancelled.
But what is the real story at the front line, in the hospitals themselves? As with many stories, the tale from Whitehall is very different from reality. At July’s CIO Transformation Summit University Central London Hospital (UCLH) CIO James Thomas made an inspiring presentation on the advances in technology implementation and networking improvements that he and his team have put into the trust. John Cornall and his team at the George Eliot Hospital in the Midlands have also improved patient care through technology innovation.
UCLH CIO James Thomas on negotiating regulatory scrutiny
Streams for success
George Eliot Hospital in Nuneaton, named after the famous English novelist who hailed from the Midlands town, is a district hospital for Nuneaton and the adjacent communities of Bedworth, Coventry and parts of Leicestershire. The hospital has 400 beds and provides all the services you’d expect to find in a district hospital including accident and emergency, maternity and cancer treatments.
The IT team, managed by IT director Cornall, has four development streams. Top of the list is a clinical IT development strand for the hospital workforce, a National Programme for IT and Local Health Economy stream, a quality/efficiency stream and a core infrastructure stream. The last of these lays the foundation for the other three in many respects and represents an area where this hospital, like UCLH, is making investments and modernising the way it delivers patient care.
“There is massive change in the NHS. There is a significant reconfiguration of services with fewer hospitals and there’s a lot of change in demand for our services. I cannot see that changing in the next two to three years,” says Cornall. “It is exciting. It’s a tunnel with light at the end, but the light keeps moving away. As an NHS IT team we have to be supporting the patients and clinicians with maximum safety.”
Cornall has just completed the integration of a wide area network (WAN) using Cisco technology and integrator Cisilion.
“It is a big investment decision and the business case payback is very difficult because the WAN is not the payback, but what it enables is the pay back through the utilisation of VitalPAC handheld device,” he says.
Cornall aims to improve the standard of care at the Midlands hospital by the introduction VitalPAC a handheld device for nursing staff to enter patient observation information, which can then trigger alerts to the nursing staff if there are medical conditions they should be made aware of. Cornall says this will lead to faster transfer of patients to specialist wards should it be required.
“That is far quicker than the paper-based system currently used and saves all manner of time and delivers better patient safety,” he adds.
“I also support the flexible working agenda of staff being able to be any place, anywhere and work so that they are far more flexible.”
Right on track
Another utilisation benefit Cornall will be delivering to the hospital using this technology is the use of radio frequency identification (RFID) to control the whereabouts of hospital equipment and to track patients. An example that Cornall explains is the ability to track pressure mattresses or specialist equipment such as infusion pumps, both critical and expensive pieces of equipment. With pressure mattresses there are national targets around pressure sores set by the government, and Cornall believes that tracking the mattresses and getting them to patients faster will help the hospital achieve those targets.
The new WLAN means that George Eliot will be able to modernise its telecoms network to unified communications and the well documented advantages it offers.
“There are efficiencies to be had so that we can reduce the number of phones and have presence tracking for our staff,” says Cornall.
“It is early days on cost reduction and it doesn’t have a target just yet. When we put VitalPAC in we will see savings in beds, administration and I think there will be savings in mobile costs,” he says.
Cornall sees the WLAN investment not only as part of immediate improvements to the hospital, but also as part of wider change in the NHS.
“There has to be a lot more collaboration,” he says of the growing role of communities of interest in healthcare provision as set out by the current government. “There will be a need for better networks.”
Cisilion put in a Cisco WLAN at George Eliot with 177 access points and a triangulation ability to ensure tracking benefits are realised. The project stayed within budget, even though the access points increased during the project.
Cornall, like James Thomas at UCLH, is full of ambition for the hospital and is moving its infrastructure forwards while Whitehall seemingly stagnates.
“We are doing a service review of our desktop estate. The iPad is very interesting for portability. We have 1400 devices at present, and one of my aspirations is to reduce that so that we can be more flexible. We have operated a single sign-on for all our devices and we have fast user-switching so that there are eight user sessions on one device at one time. This enables us to better utilise our PC estate and provide fast and more flexible access for our clinical users.
“I want to set up a clinical portal for patient data, clinical information and appointments. Currently you need to go into different systems and the trust want to bring all that together so that we can join up information. It is complete patient-centricity.
“We are trying to do a lot of infrastructure that the clinicians understand. Another development is the move towards an electronic discharge process: it was all paper-based.”
Programme ‘financially useful’
Cornall, who reports to the director of finance at George Eliot and sits on the executive group of the management team, believes the NPfIT was simply too ambitious.
“The vision was brilliant in aspiration, but it was too big to deliver,” Cornall says of the now defunct programm, although he admits it has benefited the Nuneaton hospital: George Eliot has taken on the iSoft patient admin system, as well as radiology and picture archiving technologies out of the NPfIT.
“It was financially useful for us, but suppliers don’t see the hospital as the customer they see the Department of Health as the client. So what you gain in scale you lose in flexibility, any changes have to go through a national review process, it can take two years,” Cornall says of life within the programme.
“We want to be agile and some of the national systems are not helping with that,” Cornall explains. “You can take a feed from the patient administration system, but you can’t push other data in and do any analysis and that is a missed opportunity.”