As the credit crunch crunches, NHS trusts will need to be able to know how much they are spending on what and where they could get more for their money to make savings, meet targets and improve services.

That means they will need to be able to match up information about finances, human resources and activity so they can analyse it, make changes and monitor the results. And that is what BI promises to deliver. Daloni Carlisle looks at some of the BI solutions available to the NHS and what use trusts are making of them.

NHS organisations have been told to get their finances in order as the credit crunch crunches. The Operating Framework for the NHS in England 2009-10 warns that “very substantial efficiency savings” will have to be made in 2010-11, when the health service’s three year settlement with the Treasury comes to an end.

Given the financial situation, many NHS managers will be asking whether this is really the right time to be investing in Business Intelligence tools. If you listen to suppliers and trusts that are ahead of the IT curve, the answer is definitely “yes”; and not just for financial reasons.

They argue the key to the next three years will to know how much you are spending on what – and whether you could get more for your money to meet efficiency targets, deliver on key indicators and free up cash for service improvements.

That means acute trusts, primary care trusts and even entire health communities being able to marry up information about finances, human resources and activity in a way that allows managers and clinicians to analyse it, make changes to services and then see what happens as a result. And that is what BI promises to deliver.

Promising to put information into the hands of decision makers

“One of the things that keeps coming across strongly is that the NHS has to put information in the hands of people who are actually making taking management decisions,” says David Beeson, development and marketing manager of Ardentia, which sells BI tools to the NHS. “It is no good having information available only within an information department.”

Take the 18-week referral to treatment time target. In many trusts, delivering the patient-tracking list (the essential tool for managing and reporting on the target) is basically manual, taking up nearly all the health informatics team’s time. BI can change this – releasing valuable HI expertise for more useful tasks and handing information to the managers who need to spot and remedy potential breaches.

Today’s BI tools most commonly rely on integrating data from various sources in a data warehouse and making it available via a web page, with analytical functions that vary in their sophistication. There is a wide range of suppliers, most of them commercial – although recently NHS Islington branched out and engaged open source providers Pantaho Corporation. Their application, implemented by Pentaho-certified partner Thotwave Technologies, allows NHS Islington to identify patients at risk of emergency admission to hospital.

Daniel Wakefield, sales director of consultancy 21C, a Microsoft Gold Partner delivering MS-based BI tools to the NHS, says: “Data integration via a data warehouse is being seen as the only way to go. Individual reporting from single applications is quite simply too limited. The day of the dynamic dashboard fed from a single data warehouse fed by an ever increasing and changing volume of data source is here to stay.”

Progress on the ground

While there is a wide variety of applications and a range of uses to which they can be put, progress in trusts is varied. At one end are those that have taken the BI leap with just one of three core components – finance, activity and HR.

Bedford Hospital is a good example. Until recently, it was using the cut and paste model of service line reporting, with management accountants pouring over spreadsheets to generate the budgeting reports.

Then, in October 2008, it went live with Collaborative Planning, a budgeting and forecasting system from COA Solutions. CP is tightly integrated into the existing eFinancials and eProcurement systems and makes it easy to input and analyse financial information and produce reports, eliminating time-consuming manual processes.

Richard Mellor, who was financial controller at the trust when CP was implemented, but who is now head of finance at Scarborough and North East Yorkshire NHS Trust, says there is a real culture change for NHS managers as they move from a mindset of reporting against plan to one of querying their own data and forecasting.

He adds: “Ideally you would integrate the financial forecasting system with the system that provides information about bed usage and staff use – and, of course, some large trusts are doing that. But in most small trusts we are not yet that advanced. We are a long way from patient level costing.”

Brighton and Sussex University Hospitals NHS Trust recently ordered a HealthWare data warehouse from Ardentia. It will provide a single repository for data sources and will, says Ardentia, enable the trust to manage referral to treatment time monitoring, service level agreements (including the payment by results tariff calculation) and key performance indicators.

But even this trust is one step behind the likes of Southampton University Hospitals NHS Trust, which has linked activity reporting with Ardentia’s Pathway Manager and out-patient costing applications.

Beeson explains why this matters. “I think people are going to have to start saying I am interested not only in what I spend on the inpatient stay, but on what I spend on this condition,” he says. “We need costed care pathways.” Ardentia is hoping to pilot this idea soon.

Better tools and more interest

Kent and Medway Health Informatics Service has been offering BI to its clients for more than five years. It currently offers Cognos 8, the latest version of the market leading BI software that allows NHS organisations full corporate management capabilities, including dashboards.

Paul Bolton, head of information, says: “We have been building our data warehouse since we became a HIS. It started with some work for East Kent Hospitals, which was merged from three trusts with three different patient administration systems. We now get data from all four main trusts, from the Secondary Uses Service and some from mental health as well as PCT provider units. It is all normalised and extremely valuable.”

It is only recently that NHS organisations have begun fully using it, however. “We initially met with a lot of resistance, but since October there has been an upsurge in interest,” says Bolton.

West Kent PCT now uses the service to provide practice based commissioning information and financial reporting. It provides 104 GP practices with a Cognos log-in, so they can view and analyse relevant data. Medway PCT is also using the system for PBC financial reporting; while the acute contracting team is using Cognos for its reporting on £1bn of spend in the acute sector.

“I think people are raring to go,” says Bolton. “Although I do not think they realise how much work there is involved in developing some of these tools if they want to do it locally.”

Beeson and Wakefield agree that there is an exciting buzz around BI. The demands of policy makers, managers and clinicians for intelligent information is coinciding with software developments that promise to deliver on the potential that data warehouses seemed to offer five years ago, but which have so far not realised.

“We think this is a crux moment,” says Beeson. “We recently changed our strapline to ‘evidence based management’ because that’s what we think BI can deliver.”


This article was originally published as part of E-health Insider’s January Special Report, Business Intelligence.