With the National Programme for IT now geared up for delivery, Paul Charnley (right), regional implementation director (RID) for the North West and West Midlands (NWWM) cluster, spoke to E-Health Insider’s Jon Hoeksma about the challenge of implementing the national programme.
Previously the chief information officer for Cheshire and Merseyside strategic health authority, Charnley also led Wirral Hospital NHS Trust’s implementation of its highly regarded patient care information system.
Speaking about how the national programme differs from what came before he says: “My background has been in working in discrete communities, where just standardising within those communities provides huge benefits compared with the silos that have previously existed. We’ve now got the opportunity to do this on a scale that covers the whole of the NHS, rather than in small pockets."
“Personally, my desire has been to take what I’ve seen work in local communities to that level, by taking that best practice and experience and doing it across an entire region."
Information and communication
As well as standardisation Charnley says that the concept of information following the patient is a critical change. “With the spine and introduction of the LSP [local service provider] offering we’ve got the ability for patients to be seen in a whole range of new places… At the minute patients follow the information rather than information following the patient."
Outlining his role as a RID, a position he shares in NWWM with Becky Ruben, he says: “We are in effect the conduit down from the national programme management board to communicate what’s happening with the programme downwards, and co-ordinate the local planning process."
On working with the LSP he says. “With the LSP, CSC Alliance, we deal at the high level with contractual issues, it’s probably no surprise that although we let the contract there are still discussions to be had about what precisely each party is doing. And we are working through as the first projects start to take shape, the exact responsibilities and interfaces and trying to put resource in at the best places."
He confirmed to E-Health Insider that CSC Alliance has signed back-to-back contracts with its core solutions provider iSOFT. “We are now in the middle of system testing, though there are always going to be issued raised"
Ironing out the glitches
The NWWM RID describes the current work underway as “pipe cleaning activity in the integration sandpit". Explaining the process he says the first stage is module testing; then linking through to the LSPs with system testing – testing the integration layer and bolting together the product – due to be completed in August.
“In the meantime, in terms of integrating that core system to the spine, we’re at the stage of getting through the system testing to getting through to integration testing, and then we’re into a product we can build on in a live environment model community at the end of August, beginning of September."
The aim says Charnley is to iron out any glitches before deployment begins. “Between September and December we’ll have production systems available to local communities so they are building their clinics, building their reference tables on top of the final production system that is delivered to them, with migrations tested and ready to go live in the New Year."
Charnley says that within his cluster 28 projects have already started “and we’ll have 100 by the end of the year". Early sites include University Hospital Birmingham and Dudley health community. The majority of early adopters are PAS replacements, together with three e-booking sites.
He adds that of the 28 sites where work is now underway, with a roughly a 60/40 spilt between acute and community sites. “For each community it depends on rather boring things like when PAS contracts end as to whether we are building from the legacy or reference solution."
“A wider healthcare community"
A key part of the RID’s role is to work with trusts like Birmingham to ensure that their plans are “within the context of being part of a wider healthcare community”. “So when they are building descriptions of clinics or specialities, or functionality within their hospital they bear in mind that the local PCTs will be using exactly the same system."
He says that healthcare communities vary in their degree of cohesion and there will be instances in which “individual healthcare organisations will have to accept a decision on behalf of the greater good, rather than do something in isolation".
Charnley confirmed that a full cluster implementation plan has been signed off, and that while there is contractual and performance rigidity within current implementation plans “we’ll have more flexibility from the early New Year, with P1R2 [phase 1 release2], to come back and revisit the resources needed and how we are doing this."
He stresses that P1R1 is about getting the infrastructure in place and that it will be with P1R2 that the clinical benefits will really start to come. “There is a significant step in clinical benefit between P1R1 and P1R2."
Bringing features forward
In some cases though clinical functionality is already being brought forward. “We’ve got some organisations that run results viewing through a PAS, so we’ve brought forward some of the components of the iSOFT product in what we call an ’emergency bundle’. It’s about taking sensible decisions about what’s already available in a product." Another example of functionality delivered ahead of contract dates will be order communications which will be made available in a couple of cases in the first quarter of 2005.
Implementation work underway includes working with clinicians and operation staff on standard configuration of tables and pathways in systems. “This means that local communities will get the national reference solution with a reference set of pathways, reference tables and order forms, cutting out a lot of the work that would have been done by each trust separately under the old regime."
The NWWM RID says the benefits of this approach are clear. “We believe in the 80/20 rule applies, 80% of what we do will apply across the NHS, and 20% will be down to local tailoring."
Accenture are also working with iSOFT on standard configuration in the other two iSOFT-based clusters [North East and Eastern], and Charnley says that considerable work is underway to ensure harmonisation between clusters, particularly of data and patient pathways.
On the progress of early PACS implementation sites he says: "It’s not likely to be before Christmas, but certainly in this financial year. We’ve got a challenge now, given that we do need to do 80% in the first two years.
“We’ll certainly have 40% beginning by the end of the year but we won’t necessarily have completed 40%.” He points out that to some extent PACS is “self-contained” from the rest of the programme, and “can be done in a short space of time."
Finally, asked what area he thinks will deliver the biggest early benefits to clinicians and patients, Charnley says "At Wirral, when we were able to show the results of orders, prescribe drugs, those were the key points at which it just became easier – you didn’t have to look for the green piece of paper in the wooden box anymore, the doctors could do something and didn’t need to write it down somewhere.
"So for me, basic order communications and electronic prescribing, which will come in the latter half of 2005 and early part of 2006, that’s where the RIDs have been saying ‘that’s where the benefits will come from’.
“Once that’s done and is available at the back end of next year, basic order communications at least, and is available across the community, it will be the beginning of a transformation. That’s why I get up in the morning."