After 18 years working in the NHS, Mark Austin, CIO of Bedford Hospital, has seen a lot of change in the organisation and a lot of different people in charge, trying to push IT in a new direction.
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In 2013, it is all change again, with the latest health minister, Jeremy Hunt, calling for all patient medical records to be digitised by 2015 and the entire of the NHS to be paperless by 2018.
Austin is in no doubt about whether the latter of the goals can be achieved in five years’ time.
“No,” he told Computer Weekly. “I think going paperless by 2018 is a good aspiration, but totally paperless is just too big an ask.”
Austin described recent years in the health service to have been “strange” for an IT professional and to hear someone talking almost wistfully of the days of the failed National Programme for IT shows how odd things are.
“We have gone from NPfIT where everything was laid out with clarity and direction, to a place where the tech direction for reform disappeared for a few months,” he explained.
I think going paperless by 2018 is a good aspiration, but totally paperless is just too big an ask
Mark Austin, CIO, Bedford Hospital
There has been some progress though. The recent Safer Hospitals, Safer Wards report gave a clearer vision of the integrated patient health care record and Austin more hope. With praise for technology like e-prescribing – something he implemented at Bedford Hospital a year ago – it showed his team was moving in the right direction and in line with government plans.
But it wasn’t IT that would cause the hold up to the health minister’s goal.
“Integrated healthcare records are good but we are worried with some of our more established consultants and clinicians that they will struggle with everything going paperless,” he said.
“E-prescribing was a comfortable first step as they no longer have to go to the beds on wards or to the pharmacy to check their handwriting. This may be a little step but an important step, getting them used to the notion of looking at stuff on a screen.”
“Yes, they are used to PACS, digital X-rays and pathology, but these have all been small steps in the right direction. Medical records are different, some are a few inches thick, and getting people used to viewing those on a screen can be tricky.”
This isn’t to say the CIO doesn’t think the NHS will get there. Austin just believes the timetable is too ambitious and, more importantly, the necessary funding to make it happen isn’t in place.
“When the information revolution strategy came in it was around the patient and GP practices as the definitive record,” he explained. “The emphasis was right and the plan was to spread this out to hospitals.”
“But now this has been tied down to 2018 and the technology fund to help make this happen has only been open for a ridiculously short amount of time to request funds – it closes next week. This aspirational target may be good but there is no real money.”
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The goal should instead be about putting the idea into the minds of clinical commissioning groups and incentivising a more gradual move, said Austin.
“There isn’t a utopian silver bullet you can buy tomorrow to make everything paperless,” he said. “All you can do is attack departmental bits, remove paper from the likes of pathology, pharmacy, clinical letters, like we are already doing, nibble away at it and make it less.”
“I prefer the idea of paper light by 2018.”
However, whilst the overarching goal for the NHS may be moving at a slower pace, Austin is keen to make sure his hospital is keeping up with the consumer world.
Bedford Hospital recently completed its first wireless network deployment and the success of it is pushing the roll-out to cover more corners of the hospital.
It may not seem like revolutionary technology but with a recent FOI request from Enterasys showing only a third of NHS hospitals offered Wi-Fi to their patients, it is pretty forward thinking within the organisation.
“The devices [used by] consumers have driven people to understand how to use Wi-Fi at home and they [expect] it elsewhere,” said Austin. “Without the restriction of wires and distance there is so much that can be done.”
Bedford Hospital chose a system from Xirrus Wireless that enables both a private wireless network for use by employees or visiting public sector services, such as the Police or Blood and Transplant staff, and another virtual LAN (VLAN) providing a public facing SSID for patients and visitors.
“It means they use the same front door as us to access their email and what they want to on their personal devices, but they are kept away from the NHS network and data,” explained Austin.
Without the restriction of wires and distance there is so much that can be done
They went with Xirrus because of the ability to focus the areas of connectivity through antennae.
“The main advantage to me is with Xirrus you can see where the antennae are and move it around,” said Austin. “For example, if you see it is pointed to an area of a car park that doesn’t need coverage, you can move it around and point it inwards. It means more concentrated coverage.”
“Also, there are multiple antennae within each device so you don’t need as many access points. The paradox of wireless is for each wireless access point, you need a wire. So each time you deploy a new one there is more disruption, more cabling, taking down ceiling tiles, cleaning up afterwards, and in these old Victorian buildings there is even the question of planning.”
Although the whole tendering process and roll-out took closer to nine months, once the system was settled on it took just two months to get the kit and deploy it in the hospital. Now nurses are able to move around with devices rather than be chained to PCs on ward stations, be more flexible and boost accuracy by putting notes into systems at a patient’s bedside.
But Austin isn’t stopping there and believes now the technology is in place there is even more opportunity for Bedford Hospital.
“Looking forward we are thinking more about communication,” said Austin. “Trust laptops are set to work with [software called] Communicator. Some admin staff have already transferred their phones to Communicator, and so have I, so I run my phone calls over wireless, using Wi-Fi for voice.”
“We have presence on this so people can see when [users are] busy… and we want to add location onto this too and roll it out further to more employees across the hospital.”
The NHS is a large organisation and trying to make the whole thing shift in one go is never going to be easy. But with CIOs like Austin at the helm of individual hospitals, there are still strides being taken within Trusts ensuring technology is helping improve the healthcare system for patients and staff at a local level.