Complex portals projects can cost millions of pounds and take years to realise benefits, leaving users and project stakeholders frustrated. Felim McCarthy, senior clinical consultant at ReStart Consulting explains why, looks at how to avoid pitfalls, and considers other possible approaches to implementing shared care records.

You are one year into deployment of your clinical portal. Your programme update for the board needs to be submitted tomorrow, and you are expecting some difficult questions on progress when you present your PowerPoint in a week’s time.

Separately, you have a long list of emails from clinicians requesting changes or system enhancements to support their workflows. The finance director is worried about return on investment for this expensive project – and if you’re honest, so are you. That is before you even think about the money that could be put into the patient portal.

So just why is it so difficult to get a decent and speedy return on investment from portal projects?

Wrong focus for business case

A big part of the issue: the speed with which business cases for portals are put together. Central funding pots for NHS technology projects are competitive and seldom allow much time to apply. In the rush to apply for funding, business cases can be poorly defined, focusing on IT rather than wider transformation.

While outlining how a portal will improve patient care, save money and create efficiencies, there are wider transformation goals and effects on the organisation’s workforce that need careful consideration.

For example, you should seek counsel on how large-scale technology will change social behaviour. And what is the impact on your income streams – are there performance targets in place which, if affected by the portal, could threaten funding from your CCG?

Too often, the speed with which a bid for central funds needs to be put together means there is no opportunity to take these complex issues into account. And so the picture you had at the start of the project about likely costs and likely return on investment was fundamentally flawed from the outset.

No measurement metrics in place

In many instances, that business case will also have lacked appropriate metrics for measuring achieved benefits. Often, a failure to agree a baseline against which to assess progress means an inability to attribute benefits to the implementation.

Some organisations see the implementation as the installation of an IT solution and either ignore or dismiss the associated burden of transformation required to achieve the expected benefits.

What happens is that they just compare costs of technology processes such as how much budget is allocated to maintaining medical records, storage of records, or what was spent on deploying on electronic patient record. This is not a reflection of the total impact of the project.

Proving benefits quickly enough

Complicating the picture further still is that you will likely to be under pressure to demonstrate benefits speedily.

Clinical portals, for example, do not return savings within the first year; they actually cost more money to deploy. The finance director will be thinking: “If we spent £7m, we should see some cost-savings this year to help balance the books and prove the business case.”

The reality is that due to the complexity of these technologies, the expected, planned cost efficiency and financial savings are likely to be realised in the second and subsequent years after the implementation.

And realisation of benefits will only happen when people, processes and technology all work in harmony, which requires huge levels of organisation, consultation and planning to achieve in large IT projects.

The process is often a delicate balance between IT teams seeking a rapid deployment of a solution, and clinicians screaming out for technology that supports their workflow and improves productivity. However, large IT-led projects are rarely implemented within the user’s expected timeframe.

The sum of all this pressure creates a short-term focus and one disconnected from a clear five to 10-year long term organisational plan. Failure to link your portal project to organisational goals risks any investment being wasted.

Keeping momentum

One of the greatest risks in delivering return on investment for portals is the time it takes to deliver the entire programme.

Managing people throughout a long portal deployment can be challenging, especially when timescales slip and things don’t go to plan. If staff do not remain engaged or motivated, the project suffers from a lack of continuity and momentum.

Also, if key members of the project team or a substantial stakeholder leaves the organisation, they may be replaced with new employees or outside contractors who do not have the same knowledge or understanding of what needs to be achieved. Or they might want to take a new direction.

Portal projects also suffer if the person responsible for the deployment does not report to the board or does not have sufficient credibility at that level. Basically, if it’s not on the radar of the CEO, it’s not important. Given the amount of resource required to successfully deliver a portal project, it is crucial such projects as an executive priority.

What now?

An awareness of all of these issues before starting a portal project can make it much easier to prove return on investment. However, looking at alternative ways to achieve your aims may be preferable.

For example, try addressing each clinical or business need within your shared care records programme one-by-one, prioritising areas that offer immediate and high-impact benefit. If delayed discharges pose a particular problem for your organisation, focus on resolving transfers of care to improve discharge processes and reduce patient harm. As a byproduct you free-up much-needed beds for other patients.

Collating and sharing care records clearly offers benefits. But realising them involves careful planning, expectation management and – perhaps – a consideration of different ways of realising your aims.

Felim McCarthy is senior clinical consultant at ReStart Consulting