Queen Mary's Sidcup NHS Trust was an NHS IT trailblazer
late last year when it became the first trust in London to use the
new patient administration system from the £12.4bn National
Programme for IT (NPfIT).
But alongside the technical challenge posed, trust chief
executive Kate Grimes said last month that its commitment to
tapping the NPfIT had also left it under financial pressure and
facing an income loss of about £3m. This was due to problems
encountered when rolling out the new systems from BT, which is the
local service provider for national programmes in London.
"This is very serious for an organisation already in financial
trouble," Grimes told an NHS IT conference organised by the Health
Service Journal.
Last year the trust had the second worst deficit in England as a
proportion of its turnover. But Grimes said that despite the
initial financial pressures, being the first in London onto the
NPfIT systems could help drive the trust out of financial
difficulty.
Problems with the new system began as soon as it went live in
November last year. Grimes said the system was sometimes
unavailable and problems with logging in were adding 36 minutes to
the time patients spent in the hospital, simply because of the time
wasted gaining access. This contributed to the trust just missing
its accident and emergency targets for the year.
The main threat to the trust's finances came from the drop in
referrals because other hospitals in the area had started using the
NPfIT's Choose and Book system to allow GPs to book appointments
online.
However, the Sidcup trust found out just before it was due to go
live with the Carecast patient administration system from IDX that
the system was incompatible with Choose and Book.
Although the problem is now fixed, there has been a significant
drop in referrals in the meantime, Grimes said. "If it had gone on
for many more weeks the survival of the organisation would have
been threatened by that."
Another fall in revenue came from the clinical coding systems
introduced as part of the new software. Hospitals need to code
their procedures so that they can be paid by the government.
"The new coding took a lot longer to do and a number of patients
were not on the system - so you do not get paid for them," Grimes
said.
This was due to system downtime, lack of training and a struggle
with the new role-based access approach to the application, she
said.
However, Grimes is determined that the new IT system that nearly
killed the trust will also provide the cure. The system will give
local GPs direct access to test results, not only for the ones they
order, but also to tests ordered by the hospital's own doctors.
This should cut the number of repeated tests performed by the
trust - a major cause of hospital inefficiency - and improve
referral rates from GPs, which will boost revenue.
With the new digital imaging and archiving system, the trust
will save about £300,000, while better management of the handover
of care between day and night staff as a result of the system will
save about £400,000, Grimes said.
The new coding system allows staff with a less detailed
knowledge of the system to code their own patients, creating an
improvement in data quality and improving revenue by about £1m,
Grimes said. "We were a good way down that development when BT
announced it was going to change supplier."
This illustrates the problem with an IT programme of this scale
in the NHS. Although the Sidcup trust was adapting to a new system
and beginning to reap benefits, BT decided to drop IDX in favour of
rival health software supplier Cerner, leaving the trust facing
another major IT upheaval.
As Computer Weekly revealed last week, trusts are having to live
with the consequence of decisions made by NPfIT contractors, which
they have no part in making, with limited means to seek
recompense.
A lack of contractual control was a drawback to the design of
the programme, Grimes said. "There is a lack of visibility of the
contract or any power or control over it. If a delay increases my
costs, I do not have any power to recover those costs."
She said that BT had "helped out", but it was not something that
was automatic in the contract.
Another drawback to the structure of the programme, which is
managed by Connecting for Health, is that problems take a long time
to resolve because of the lengthy chain of command. Grimes said BT
and Connecting for Health were working with the trust to try to
solve these problems.
Overall, the trust was not prepared for the level of business
change its IT overhaul involved, Grimes said. "Staff did not
understand how much IT drives their clinical processes and they did
not understand the changes they would need to make to their
processes."
While successful IT programmes in business are careful to ensure
technology and business processes are managed by, and accountable
to, the same authority, the Health Service decided to separate the
two when it created the NPfIT.
Whether other trusts feel the pain in changing their processes
to fit technology they took no part in designing could well depend
on what happens next at hospitals like Sidcup.
Steps to success
Queen Mary's Sidcup chief executive Kate Grimes on the effort to
make a major software implementation a success.
- IT staff need to be exposed to the business function, advising
the board on decisions and risks.
- The board must get involved with decisions regarding IT - IT is
one of only three committees reporting directly to the executive
board.
- Ensure your organisation is IT literate before roll-out.
- Money spent on end-user training in advance is less than the
cost of a lack of training.
- Chief executives need to be IT role models and focus on
benefits.
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