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 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.