Quin Parker
The 18th century farm house (right) on the outskirts of Leeds where Liquidlogic has their offices is a curious mixture of old and new. The unlisted redbrick building used to be a ‘dower house’, used as accommodation for the late landowner’s widow.
Now it is a modern office complex with 40 employees ‘hot-desking’ and passing through automatic doors with remote control key-fobs. The boardroom used to be the family kitchen. In a similar fashion, Liquidlogic is using new technologies to solve old problems – how to manage patients who have needs in both health and social care.
"We are a relatively young company, just six years old, and we formed in June 2000," says Denise Harrison, co-owner of the company with managing director Ted Brierley, explaining that it was born out of the shift in public services away from processes towards the customer, following trends in the private sector.
One of Liquidlogic’s claims to fame is that they believe they were the first company to go live with software connected to the data spine. They installed their Protocol Single Assessment Process (SAP) software for health and social care in the North East and East cluster in Newcastle PCT in December 2004, as part of a contract with local service provider (LSP) Accenture.
Information sharing
"It has tremendous benefits for people looking after older people. The alternative would be for every social services department to be spine compliant" — Denise Harrison, co-founder, Liquidlogic
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The Protocol SAP system allows users to complete and share assessments as part of the Single Assessment Process, designed to ensure that care for older people is coordinated across health and social care agency boundaries and information shared appropriately.
Since the Newcastle PCT’s implementation, the first spine-enabled deployment in the North East, they have gone live with the SAP system in a further 55 trusts under Accenture, with around 4,000 current users.
Protocol is used by both health and social care professionals to manage their workflow and patient assessments, and connects to the Personal Demographics Service. The system is browser-based and sits on a central server, and if connected to the spine can access the address, contact and other details of the patient, comparing it to locally-held information.
"It has tremendous benefits for people looking after older people. The alternative would be for every social services department to be spine compliant," says Harrison.
Confidentiality is maintained on records in several ways. All interventions are auditable and explicit consent must be recorded from the service user for sharing their records on the database. Secondly, each user must have a care relationship set up with the patient before they can view their details. If the user does not, they must explain why they need access, and the reasons are recorded on the system.
Andy Clegg, technical consultant at Liquidlogic, who worked as a mental health nurse before joining the company, explained that privacy can be set on several levels, both overall and at the level of assessment: "You can restrict access to questions at an individual level. People will divulge information to different people. It might be that they have an incontinence problem. They might restrict access to that."
Harrison is adamant that electronic records are not the be-all and end-all of this kind of system, however. "If you look at a lot of very traditional health IT systems, it’s about the patient record.
"But from a clinical reading you want to see the conclusions, what assessments were made as a consequence of, for example, reading the blood pressure. It’s a clinical system."
Being proactive
The Department of Health’s recent white paper into care outside hospitals and in the community was enthusiastically received by the company. "From a Liquidlogic perspective we read it with enthusiasm. It plays very well to the strength of the product," says Harrison.
One aspect of the paper that Harrison is pleased about is its emphasis on early intervention and "a greater focus on prevention and the early use of low-level support services"; something that applies to anybody with complex needs and not just elderly people, she says. "From a business point of view for the NHS it makes a great deal of sense if you can undertake a proactive approach to intervention.
"The problem has been that we haven’t had the IT systems in place to really provide the comprehensive range of services that we need to do that.
"To keep someone at home who is properly managed is a feat in itself. They need to claim disability living allowance… It’s a much more focused range of services that you need.
"It makes a great deal of sense if you can undertake a proactive approach to intervention" — Denise Harrison
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"It’s all about personal choice in here. Personal choice can only be achieved if they have a range of services. They need to be joined up to make it happen."
If there’s any criticism she has of the paper, it is that the DH’s language isn’t strong enough. Statements such as ‘By 2008 we expect all PCTs and local authorities to have established joint health and social care managed networks…’ are not forceful enough, she says.
"It’s not prescriptive in some aspects of what it’s requesting," says Harrison. An integrated health and social care network should be a priority, she says. "It shouldn’t be down to the individual to try and negotiate the barriers of the different organizations."
Harrison draws a parallel between the paper and the Protocol software, saying that technology should help by making sure that the care plan and the processes put in place are auditable and don’t fall into the gaps between the different organisations.
The so-called ‘health MOT’, where people would be given the opportunity to log on and manage their own integrated care plan, is also something that Liquidlogic is excited about. "It’s about people being in charge of their destiny a bit more."
Patient access to records is inevitable, says Harrison. "What was interesting with My HealthSpace was the whole idea of self-assessment. That underpinned the whole idea of a proactive strategy."
Such a system could potentially benefit those even without regular access to the internet. "At one of the SAP deployments that we did in London, they had a computer in the Age Concern day centre where people could sit down with an advisor."
Further development
Liquidlogic are optimistic about the future. Their two user groups are very active, suggesting additions – for instance, Protocol’s ‘briefcase’, which allows staff to download records from the system to work offline with the same security in place as online, and then allows them to resynch once they have finished for the day, was put in to the system from users’ requests. Next on the list is a spellchecker.
They are aiming for 20,000 further users of Protocol in the next 18 months, in health and social care and other public sector organisations they focus on, such as housing and child protection. Around 20 health and social care organisations in clusters outside of the north east and east are also running the system. Liquidlogic are hoping for more.
"I would love the rest of the LSPs to take our software. At the moment we are focusing ourselves on the Accenture cluster, but people are coming out to tender for the SAP system," says Harrison.
An upgrade of the LSP software is planned for the summer, with an updated non-LSP solution following, which will be the same release. These will tak into account anything from the white paper. "We feel we are probably 90% there told but we will take the time to review this," she adds.
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