In one of his first major speeches as health secretary, Jeremy Hunt said the NHS should ‘go paperless’ by 2018.
A simple aim perhaps, but far from simple to deliver, as Andrew Fearn, ICT director of Nottingham University Hospitals NHS trust, one of the largest NHS providers in the UK, explains to ComputerworldUK.
“Since 1948 most NHS bodies have been working on paper. We have 1.6 million live patient records in our organisation. It’s a huge logistical nightmare trying to get them all in the right place at the right time. So it’s a big challenge for us to move to an electronic care solution,” says Fearn.
The trust has an annual income of £824 million, 13,000 staff, 87 wards, 1,800 beds and treats a million ‘care episodes’ every year.
Developing a ‘best of breed’ system
However Fearn is optimistic he has found a way to make sense of the enormous volumes of data the trust has to handle - by developing the trust’s own “best of breed” system.
This will involve reducing the trust’s 354 clinical systems by at least half, integrating them to create a ‘single source of truth’ and giving clinicians iPads and clinical noting technologies so they can access and input patient data on wards.
Fearn says the trust “had two options for electronic patient records (EPR). We could have gone out to procure a fully integrated EPR system from, say, Cerner or Epic. But money is tight and it could be difficult to make a case for that.
“So we’re making a best of breed solution ourselves instead. Our strategic plan is to start at the very bottom and get the infrastructure right. We have spent a lot of money getting that in the right place.”
‘Single source of truth’
Fearn is working to integrate the trust’s many clinical systems so staff can capture data once and use it many times. He says this will produce a ‘single source of truth’ on an individual patient, meaning staff will not need to ask the same questions repeatedly.
He says: “It’s like creating a big ‘data bucket’ we’ll throw all our information into. We’ll take the data from our clinical systems and then through open APIs and negotiating with suppliers, allow that information - data on patients like height, medical history - to be used by other systems.
“All the new systems will take the data, pass it through an indexation tool and then into the data bucket for us to retrieve as and when we need it for a variety of different systems. “
The trust currently oversees 354 clinical systems, a number Fearn hopes to at least halve.
He says: “I plan to get rid of the majority of our systems if I’m honest, through the use of clinical noting tools and so on. I’m looking at systems we have in place right now. Frankly it’s a challenge because we’re a tertiary centre running complex services. We have very specialist bits of info, so we need systems that can capture that.”
iPads on wards
Nottingham University Hospitals’ 60-strong IT team is in the process of deploying 4,500 Apple devices, mainly iPads, as part of the strategy to move to paperless records, Fearn says.
“We’ve got about 1,000 out there at the moment used clinically. By the end of March that will be 4,500 devices.”
The trust weighed up a number of mobile platforms before deciding to go with Apple. It eventually chose iOS because a number of the apps it wants to use are released on Apple first rather than Android.
“However we’ve put a structure in place so if in year or two we want to swap iOS devices for say, Android, we can do that,” Fearn says. “You don’t want to be wedded to a particular supplier because only their proprietary widget will work on your huge estate.”
Single view of the patient
Fearn says the Apple devices will be used to capture details of inpatients and provide alerts for early warning scores such as unusually high temperature or blood pressure.
They will also be used for tasks such as accessing health records, prescribing medication and requesting test results.
He says: “Each clinician will have their own device to capture clinical information for various different applications, stored in one data bucket. These will generally be iPads as digitised health records generally need to be able to be viewed on a tablet. It also means people can do e-prescribing, requests tests and results and so on, all from the ward on the tablet.”
Fearn adds: “Basically we’re creating our own EPR, by mashing data together from different systems but presenting a single view of the patient back through an Apple device.”
Fearn says that the trust is investing in clinical noting capabilities, for example digital pens and voice recognition software, to help move away from paper-based processes.
“The big thing is that as we digitise all paper records, the last thing we want is to continue capturing stuff on paper. So we’re investing in clinical noting capabilities. That information will then go into the data bucket. That includes electronic prescribing, results and reporting systems and also specialist clinical systems.”
The next big move for the trust will be setting up video consultations and conferencing to help reduce hospital admissions, according to Fearn.
The trust has chosen Cisco Jabber, which will provide a higher level of security and confidentiality than Skype, he says.
Fearn adds: “Going forward we’ll be moving to having video consultations instead of coming into surgery, wherever possible, and using technology to avoid unnecessary hospital admissions. Having a face at the end of the device to give you reassurance might be all that’s necessary.”
However Fearn warns that the current NHS funding structure needs to be reformed to encourage video consultations, as there is currently no financial incentive to reduce admissions.
He says: “There are challenges with video consultations, especially how you make sure the NHS gets the income to do that. We only get income from having people physically come in, so the NHS needs to address that.”
What makes a good CIO?
Having served as CIO in the NHS for 14 years, Fearn believes that resilience and passion are important CIO traits to have.
He says: “The key thing is resilience, without a shadow of a doubt. Also passion and drive to make sure you’re making things better. To be fair most people who work in IT in the health service have that ambition.”
Fearn also believes it is no longer possible to have a hierarchical structure in IT teams and CIOs should focus instead on bring together disparate, complimentary skills.
He says: “We don’t have a traditional hierarchical approach to technology. You have to have skills that can add and plug into a team. So for me as a CIO it’s creating a team with multiple skills that you bring together to deliver what’s needed. That’s when it works best.”