On the eve of 2010, E-Health Insider reporter Sarah Bruce asked some of the big players in the NHS IT industry – and NHS trusts – what they expected to happen over the next 12 months and what their NHS IT 2010 wish list would look like.
- Sir Jonathan Michael, managing director, BT Health
- Andrew Spence, UK director of healthcare strategy, CSC
- Adrian Stevens, managing director iSoft UK and Ireland
- Donald Trigg, managing director, Cerner UK
- Zack Pandor, joint director of ICT at Herefordshire NHS and Herefordshire Council
- Steve Leggetter, e-record programme director, Newcastle Upon Tyne Hospitals NHS Foundation Trust
- Adrian Byrne, director of IM&T at Southampton University Hospitals NHS Trust
- Sean Riddell, managing director, EMIS
- John Wiltshire, sales and marketing director, Stalis
- Xavier Flinois, chief executive officer, Clinical Solutions
I’m a passionate believer in the role that ICT can play in making the NHS more efficient by helping to transform the way it works. In 2010, this transformational agenda will become increasingly important: not least because of the many challenges the NHS faces, such as an ageing population and the management of chronic diseases.
But the NHS will need to accelerate its use of ICT and draw upon its information assets to generate the knowledge it needs to support the right kind of transformation. In short – the NHS needs to get smart.
I’d like to see the NHS adopting more widely existing technologies that can help it realise operational efficiencies. Home monitoring devices, mobility and unified communications can help healthcare professionals do their jobs more effectively and also support better care for patients.
One of my wishes for the health IT industry is to keep up the progress that is being made in the rollout of electronic patient record systems and to celebrate our successes more. As an industry, we tend to hide our light under a bushel, and need to talk more positively about our achievements.
With an election fast approaching, it is inevitable that 2010 will bring a change of government. Regardless of whether there is a new Conservative government or a re-shaped Labour government, the emphasis will be on achieving cost savings within healthcare, whilst at the same time improving productivity and the quality and safety of patient care.
NHS trusts will have to do more with less and will be looking to get the best value they can out of every penny spent, as well at looking at new ways of working. And innovation and technology will be a key driver in achieving those objectives.
2010 will therefore be a time to capitalise on the investments and achievements of the past few years. We will certainly be entering one of the most exciting phases in the transformation of healthcare delivery, that of ‘exploitation’, where healthcare organisations start reaping the benefits and engaging their staff to utilise technology tools.
I am also optimistic that we will finally see a transition in attitudes, with a greater acceptance in viewing technology as an enabler, adding real value to the clinician, the provider and the patient.
Clearly we are optimistic that we will see greater clarification on the future of NHS IT generally, and the south of England particularly. We are confident that more trusts in the Southern cluster will migrate to our Lorenzo solutions, and similarly confident that we will witness a marked increase in the rate of Lorenzo implementations with CSC.
In terms of 2010, we are committed to ensuring customer service remains a number one priority. We’ve made organisational changes to our own business with this goal in mind and fully expect the new solutions being delivered under the National Programme for IT in the NHS to similarly improve services.
In recent weeks, academicians, management gurus and chief executives alike have marked the centennial of Peter Drucker. The self-described “social ecologist” coined the phrase ‘knowledge worker’ and spent a lifetime shaping change management strategies that elevated their productivity.
But Drucker’s insights were universal, including his fundamental belief that the purpose of business “is to create (and keep) a customer” and that value is “not what the supplier puts in, but what the customer gets out.”
In 2009, Cerner had over 160 live applications across 17 different hospital trusts with 29,000 NHS professionals as unique users. In 2010, Millennium users will increase staff efficiency and patient throughput with real-time bed management. Millennium users will reduce medication variance through streamlined administration processes.
Millennium users will leverage evidence-based medicine to improve payment for co-morbidities and quality measures. The coming year undoubtedly will bring new challenges amid the aftershocks of the Great Recession. But it also will be a time of opportunity. We look forward to playing a small role in helping trusts realise it.
The Audit Commission’s ‘oneplace’ website may have crashed during its first few hours, but the concept of providing the local population with joined-up information on local public services is a journey worth persisting with.
If the NHS is to shift the focus from providing a ‘sickness’ service to providing a ‘health’ service, we need to work in collaboration with a range of partners. There are many examples of good practice where this is being achieved, for example, here in Herefordshire we have trained our customer services staff in the local authority info shops in the Choose and Book system.
This is where IT can play a big part. For services to be joined up, information and systems need to be joined up, and that means NHS IT directors need to start talking seriously to our counterparts in the wider public sector.
The economic climate will also be asking some tough questions about whether we are getting value for money from our IT investments, and one sure way of getting more from less value is by removing the duplication of systems.
2010 will mean that all areas of UK public sector will be required to respond to a new administration – whatever the result of the general election. A new administration will require us to answer questions that haven’t been asked before.
It will require us to demonstrate the improvement in outcomes as a result of new interventions; and with the squeeze on the public purse there will be an unprecedented need to answer these questions faster than ever before.
Agility like this does not happen overnight. Although data at Newcastle is transforming patient care, it doesn’t provide us with information without investment in our people. There is a rule of thumb in IT that for every dollar you spend on the technology that you need to spend another dollar on the “soft infrastructure”- the people.
Without this investment in people we would not be able to respond to the demands that are going to be placed on us in 2010. My wish for 2010? That any change in direction is based on sound information. And, for that to be the case, that the information systems used are well supported by our greatest asset – our people.
Key themes of NHS IT will be surviving the economic downturn by introducing systems that support efficiency and offer genuine business and clinical benefits. That means IT business continuity to support areas that can move to 100% paperless working and bringing the concept of the virtual desktop into the real life environment of the clinician’s desktop.
IT services will also need to compete and prove value for money within how they are configured and delivered. We also need suppliers to enter into a genuine interoperability framework, enabling true systems integration between multi-vendor ‘best of breed’ products.
I wish that there could be a sensible debate about priorities in the current climate, and that this could be offset against a pragmatic view of risk. This would apply, for example, in the information governance arena; where we could attempt to introduce some dynamic new rules onto environments and systems that were designed years ago for a different purpose.
Within this, I would wish for an informed public debate around the risk of not sharing data against the risk of disclosure [or inappropriate access] because the impact and consequences of both are of different magnitudes.
It’s a rather over-used phrase, but I think that 2010 will be the year that healthcare IT becomes truly ‘joined-up’. Now that there is a clear central commitment to interoperability, I believe we will see more and more suppliers and trusts putting this at the heart of their strategies.
I think we will also see a step change in IT-enabled service redesign, as NHS trusts recognise how technology can help them do more with less in these stringent times. It’s been coming for some time, but I also think that next year will see an explosion in the number of patients becoming actively involved in their own healthcare.
Top of my wish list for 2010 would for more transparency around the true cost of NHS IT. While I commend the publishing of open pricing for GP Systems of Choice, I find it incredible that the approved pricing structures are so widely different.
Finally, I’d like to see a more ‘collabetive’ (my word!) approach between different suppliers. While commercial differences are healthy and will always exist, in the new interoperable world it is to everyone’s benefit – not least the NHS and its patients – if we cooperate with each other.
After five years of delay, the roll out of Millennium and Lorenzo will take place; but the speed is now likely be severely constrained by government spending cutbacks. The government should stay out of prescribing IT solutions for the NHS. But trusts should stop reinventing wheels by developing their own software and concentrate on educating management to more rapidly deploy robust solutions.
The NHS also need to wake up to the fact that the ASCC framework is a highly limiting and prescriptive procurement vehicle that only superficially evaluated the systems that were on offer. It was designed as a way of identifying additional service resources, not solutions – and the two, especially after all we have been through in the past five years, should not be confused.
Virtual health services will become an increasingly important part of local and national care delivery as the NHS looks at innovative ways to become more efficient prior to budgets being cut after 2011. Virtual frontline services without a doubt will become the preferred mode of interaction for any care that does not require a clinician’s expertise. The direct impact of such services will move ten fold from £100m to £1,000m during the next administration.
IT Integration and interoperability are still key drivers and will remain so through 2010. When systems are integrated, frontline health professionals, from the public and the private sector, are able to share data, deal with patient queries in the context of their medical history and support patients, in the most seamless way.