Imperial College Healthcare NHS Trust brings together five hospitals – Charing Cross, Queen Charlotte’s and Chelsea, Hammersmith, St Mary’s and the Western Eye – and integrates with Imperial College London. The new trust has an annual turnover of £760m and employs 9,700 staff. Offering more than 50 clinical specialties, from conception to end of life care, the new organisation has one of the largest portfolios of services in the country and expects to treat more than one million patients a year.
Interim director of IM&T, Phil Jones, has been overseeing the work on systems integration. Overall, he explains the aim is to bring together the two NHS trusts with the research and education at Imperial College.
“The CEO is also the principal of Imperial College School of Medicine. One of the objectives of the organisation is to develop synergies between health and research. This is reckoned to be more easily achievable with a single structure” he explains.
But first, on the NHS side, Jones and his team have faced the task of bringing together two NHS trusts with different systems and different suppliers providing the familiar mix of systems for patient administration, A&E, digital imaging, theatres, pathology, maternity and so on.
“Not only do we need to integrate everything within Hammersmith Hospitals and St Mary’s but also across the two [former trusts],” he explained.
The lynchpin of the integration is the creation of a Master Patient Index through the implementation of a single patient administration system (PAS).
“We are aiming to achieve this through Cerner Millennium, available to us through the National Programme for IT,” he said adding that both former trusts had committed to using Millennium and a programme of work to implement the solution was well underway.
Cerner’s solution will replace current PAS systems, A&E and some other departmental systems. Beyond that, however, the new trust with its 50 plus specialties, has a wide range of other departmental systems along with those supporting research.
Some such as the picture archiving and communication system (PACS) are mission critical, others may be bespoke systems supporting a particular research project, while others may be very important to a particular service such as a colposcopy clinic.
“There’s a whole set of integration we need to do in order to be able to move from where we are to Millennium without destabilising anything,” Jones explains.
For this work, the trust has looked to ReStart Consulting for support, a contractor that had undertaken work for both trusts.
ReStart is using SeeBeyond for integrations between systems that can, according to Jones, get complicated.
Despite the complexities involved, he says the integration project is now “well beyond the foothills”.
“We have some good integration between the various Connecting for Health systems we have: radiology, PAS, the theatres product and the local data warehouse. There’s a range of systems all of which are interfaced using the various SeeBeyond products. We need to ensure that these products will continue to work when we switch over to Millennium.”
He expects Millennium to be implemented at St Mary’s this summer and across the whole trust by Q1 2009.
What will the benefits be? Jones replies: “It will give us a much more robust means of moving data between systems. Without such a strategy it would make it much more difficult for the new organisation to achieve what it wants to achieve in terms of rationalising services it provides and centralising services in one place.”
From a patient perspective the aim is to ensure that personal details given in one department do not have to be repeated in full to another, ensuring that basic information travels with the patient across the trust.
A three to five year strategy is how Jones assesses the current programme.
He explains: “From a systems integration point of view most of the work is happening now and over the next year. The longer term objective in the implementation of a care records service is to get to a point where most if not all of the information you need to know is available from a PC on your desk rather than in a mixture where you have got some information in the paper record, some held in the pathology system, some held in a PAS and a PACS – it’s integrated to give a converged view.”
Linking up with the academic side of the trust and finding ways of ensuring clinical work goes hand in had with research is another challenge and there are some significant questions to be tackled.
“How can we use the data repository in the data warehouse to support research, for example, paying due regard to patient confidentiality?” says Jones.
This end of the work is at early stages but it is easy to see the potential gains the future holds if the giants at Imperial Healthcare learn to dance.
Linda Davidson
This article appeared as part of E-Health Insider’s Special Report on Systems Integration. Other case studies presented in the report can be found here.