The government may have axed the National Programme for IT in the NHS twice, but it has left behind some big pieces of unfinished business.

By far the biggest is what will happen to CSC’s local service provider contract for the North, Midlands and East of England, where just four ‘early adopters’ have deployed the Lorenzo electronic patient record system.

The DH has been locked in contract negotiations with the company for 18 months, with the latest ‘standstill’ agreement between the two parties due to run out on 31 August.

Duncan Robinson, at least, hopes that the negotiations will have a successful outcome. The associate director for IT at South Warwickshire NHS Foundation Trust is still enthusiastic about Lorenzo. However, he is becoming less hopeful that his organisation will receive it.

Still talking

“CSC and the [strategic health authority] have been talking to trusts to try and get sufficient expressions of interest so that a national contract can be signed to deliver 22 installations of Lorenzo,” he says. “But I don’t think that contract is at any point yet where it can be signed.

“We have always said we would be interested in taking the system, and it still forms part of our strategy and therefore our road map. But you do get less and less confident as times goes on and still nothing happens.”

Robinson understands that the parties involved in the talks were hoping to have five trusts willing to take Lorenzo in March, five in September, and 12 by the end of March 2013. But the timetable has clearly slipped.

“We said we will keep a watching brief. We told them that we wouldn’t be part of the first five, but that we might be part of the subsequent five in September; but so far the watching brief is saying that things haven’t been going well.

“This side of the M1, where it has been CSC, iSoft and iPM, we are a bit battle-scarred. Whether you call it pessimism or realism, we are carrying a bit of baggage.”

Digitising records

While the trust remains keen to adopt Lorenzo, it has been making moves to extend the life of its iSoft i.PM systems and to explore alternatives. As a first step, it bought Kainos Evolve, which is set to digitise its patient records.

The system, initially developed with Ipswich Hospital NHS Trust, will automate the creation, capture, handling and distribution of notes and other records.

Evolve will “sit on top of” the PAS, with hospital staff getting access through iPads where they need to access notes on the move.

“It will provide clinicians with a holistic view of the patient, so all the different interdepartmental systems and our two different PAS systems will no longer matter,” Robinson says.

In April 2011, South Warwickshire absorbed community services from the local primary care trust, as part of the ‘transforming community services’ programme.

Robinson believes that community staff will see “big benefits” from IT, as Evolve will enable them to access patient information from mobile devices.

“If you take district nursing, for example, they work in teams and are locality based. So all the teams come in the morning, because they have manual systems for scheduling, then they go out, taking notes and form packs with them, complete the visit, and then come back.

“They are constantly going out coming back, going out and coming back; and that’s not the best way of working. With iPads and smartphones they won’t need to go anywhere near a patient administration system, as, by taking the data that has been inputted, we will feed the beast in the background.

“This will increase efficiency, which means we will need less agency staff, so we are saving money. There is also the potential – and I stress only the potential – of buildings rationalisation, as we will have the clinical workforce out and about,” Robinson says.

Changing culture

Warwickshire has a mixture of both rural and urban areas, so the trust is planning to provide community staff with the ability to work offline; “briefcasing” the data that’s collected on patient visits, so it can be synchronised automatically with its systems when a 3G connection is next available.

However, Robinson says: “The massive challenge we face is culture. You have teams of people who have only worked in a paper-based environment, and technology is secondary to what they do.

“They are used to just being there as clinicians and, in effect, we’re taking them from a very non-tech environment to 2012. There will be a fear factor and some resistance; but to date the community portal workshops we have run have been really well attended.”

Getting a single view of the truth

Kainos is not the only system for which South Warwickshire has been an early adopter. It has also been working with i-Health BI, a business intelligence system developed by Insource.

This has been live at the trust since last September, providing staff with information about inpatient and outpatient activity, A&E attendances and waiting lists.

A referral to treatment time module should be added imminently. But Paul Johnson, associate director of information and performance, says his team is constantly receiving requests for dashboards to support transformation projects.

“It’s a project that is without end, as we will be constantly adding to the solution – particularly on the breadth of data we are putting in and the extent of analysis that we are doing,” he says.

Johnson said i-Health BI has allowed his team to automate a lot of its work. The system is updated daily from i.PM and has encouraged both the standardisation of reporting procedures and a new attitude towards collecting data.

As an example, Robinson says: “Outpatient click attendance forms have given us a little bit of peer group pressure, as there is a list of outpatient completion rates for each speciality with the consultants down the side.”

Unsurprisingly, “the completion rates went through the roof.” However, it is the control that the trust has over the system that is changing the way its staff work with information.

“We went for Insource as it wasn’t a black box solution,” Johnson explains. “For measures which aren’t in the default BI system, such as being able to flag patients who appear frail and elderly, we have been able to turn around a dashboard with measures and dimension 24 hours later.”

Finding a PACS, looking for stability

Looking forward, the trust has more big pieces of business to manage. The national programme’s picture archiving and communications system and radiology information system contracts will run out in the next two years, so it has issued a tender for a replacement solution, with a vendor neutral archive.

Robinson says: “We have had the PQQ responses back and we have long-listed eight suppliers in each of those categories with some crossover. The project plan which will take us through to go-live has no fat on it at all, as there is nothing to go on.”

The trust has been running a procurement for a laboratory information system, that will take two years. “With RIS/PACS/VNA we have 12 months from now [to get a new system in place] so it is a very compressed timeline,” Robinson points out.

Because it has refreshed its wireless network to support the deployment of the iPads linked to the Kainos project, the trust is also looking at a “bring your own device strategy” – although Robinson admits that “this is a big learning curve for us” as: “We are IT. We are highly skilled at what we do – but to date this isn’t what we do.”

The trust is also due to host the Arden Commissioning Support Service. But at some point, Robinson would like South Warwickshire to experience a period of stability. “There is a massive amount of transformation going on within the organisation,” he says.

“We need to reach a point where, without becoming complacent, we let that bed in. While it is bedding-in, the strategists in the room can be looking at what’s next.

“You know how it is; you have a vision of how it is going to look and then you deliver it – but people will always find a way of changing it for the better and new benefits and opportunities will arise.”