A London hospital trust has successfully introduced
electronic patient records
The £6.2bn NHS IT national programme reached a milestone last
month. The first implementation of IDX's Carecast, the software
favoured by the programme in London, went live without any serious
problems.
About 1.5 million medical records were moved from University
College London Hospitals Foundation Trust's old systems on to
Carecast in the three-day handover period between 17 and 20
June.
In preparation about 3,500 staff were trained to use the new
system and about 200 IT staff from the trust and a similar number
from IDX and Connecting for Health, the government organisation
which runs the national programme, helped to ease the transfer to
the new system.
"UCLH has done terribly well with this implementation," the
central part of a £75m IT implementation at the trust, said Paul
Goss, director at Silicon Bridge Research, a specialist health IT
research firm. "IDX is technically a very strong product."
This success came despite problems with the deployment of
Carecast elsewhere in the health service. Fujitsu, the local
service provider for the programme's southern cluster, dropped the
product at the beginning of June, saying it could not get the
technology to work in hospitals. Last week it replaced IDX with
software supplier Cerner.
Even in London, where BT, the lead supplier in the consortium
providing IT systems to the NHS across the capital, remains loyal
to IDX, the success at UCLH might not be so easy to replicate
elsewhere.
The UCLH implementation coincided with a move to a £422m new
hospital and the trust was given special permission by the national
programme to deal directly with IDX.
UCLH chief executive, Robert Naylor, said, "I had a big debate
with Richard Granger [director general for NHS IT in charge of the
national programme] who was very accommodating and agreed that he
would not oppose us signing our own contract [with IDX]. We agreed
we could sign our own contract providing we become compliant with
national programme standards."
After a tender process the trust negotiated terms with IDX so it
could novate (transfer) the contract if the company lost out in its
bid to become the main supplier of electronic patient record
software to London. In the end such a clause was unnecessary.
Having a direct relationship with the supplier was invaluable
while trying to keep the project on track, Naylor said. "A prime
reason for our success is the strong relationship between myself
and IDX chief executive James Crook. We were speaking on a weekly
basis and both knew if there was a problem then I could talk to him
and remove a blockage. This is critical: people further down the
chain may not be able to solve problems because they do not have
the authority."
Goss agreed this was important to the success of the roll-out.
"Having a close relationship between the accountable officer and
the supplier is important. If IT is significant to your business
then you need to be able to control that relationship. If you
buffer a relationship it makes it harder to manage."
When other London hospitals implement IDX they will have to work
with, and through, BT and will not always have such a close link
with the software supplier. "One of the challenges of the national
programme is there is not a direct relationship between the chief
executive of the trust and the main software provider. They have to
work with BT as an intermediary. A three-way relationship is always
more difficult than a one-to-one. I think that message has got
through to IDX, the national programme and BT," said Goss.
The success of the IDX implementation at UCLH was helped further
because, at the heart of the trust is a new hospital building, and
the trust was able to redesign its business and clinical processes
around the new information systems, infrastructure and medical
technologies.
This required leadership from the top and engagement with the
trust clinical leaders from the start. "The success of our new
hospital depends on this IT project," Naylor said. "If the IT does
not work, then we will have a major problem in designing new
processes.
"A project of this size can succeed if it is supported by the
board and the chief executive. For the past three years I have
chaired every project board meeting."
Others on the project board include senior representatives from
finance and HR, as well as one of the trust's medical directors and
a senior consultant neurologist.
The medical director also chairs the project's clinical
information group, which has been meeting in parallel with the
electronic patient record project board and includes 30
consultants, who represent the trust's 1,000 doctors. It also
includes representatives from nursing, physiotherapy and other of
medical professionals.
Such a powerful group had the authority across the trust to take
the decision to put back a planned go-live date from the bank
holiday weekend of 28-30 May until June, and to explain why it had
been necessary.
"About a week before the [initial go-live date] we were not
convinced that the software for commissioning [which manages
hospital payments] was fully tested from end to end. We were
confident about the migration of clinical data," said Naylor.
IDX had assembled a team of 40 software experts for the initial
go-live date, which it had to reassemble for the final hand-over.
It was not difficult to reassemble this team, according to Rob
Baker, managing director of IDX in the UK. Despite the slight delay
Naylor believes the new software and IT infrastructure, combined
with new medical processes allowed by the new hospital, will
deliver huge benefits in patient care, efficiency and medical
safety.
UCLH has succeeded with this implementation because of the
strong leadership from the top of the trust's management. This may
not be so easy to replicate elsewhere in the NHS, according to
Goss. "In general chief executives have other priorities," he
said.
Whether Connecting for Health can replicate the success of
UCLH's IDX roll-out throughout the NHS will depend on getting trust
chief executives to move IT up an already congested agenda.
UCLH technology
UCLH has a wireless infrastructure that allows doctors to access
medical records from laptops wherever they are in the building.
Bedside screens used by patients for entertainment can also be
used to view medical records and digitised X-ray images.
IT systems will alert doctors if they are prescribing drugs
which are known to interact dangerously with those a patient is
already taking.
"This will improve clinical decisions and speed up the process,"
said UCLH chief executive Robert Naylor.