It’s the customer that counts. With healthcare IT that means ensuring that the NHS, and private providers, can achieve their goals and deliver for patients. Unfortunately, as the regular tales of deeply troubled deployments prove, this does not always happen – undermining huge investments in time and money.

I would like to suggest a way forward. On the one hand suppliers need to have the integrity to advise customers on how to fulfill their real needs, rather than simply selling everything they can. On the other, healthcare organisations should take a good long look at their options. This can require a fresh approach.

There are three points that buyers should consider when choosing a supplier:

1. Do they have the proven ability to deliver solutions that do the job and which clinicians, and others, find good to work with?
2. Is the supplier agile – doing whatever it takes to ensure the customer can realise their goals?
3. Are they ambitious and creative – with a real determination to succeed?

I recently became aware of a case where someone was unhappy with what the big UK companies were offering and wondered if they should look to the USA. The jump across the Atlantic can be a big one, especially if you haven’t looked at all the small and medium sized suppliers in the UK and Ireland which have excellent IT developed specifically for local needs.

These are often companies that are already providing services for millions of patients and can readily handle health service needs. They are also the companies that survived years of being squeezed out by NPfIT specifically because of their ability, agility, and ambition. And certainly, if anything went to show that bigger is not always better, then it’s the national programme.

I have huge sympathy with any NHS organisation trying to determine where to go with its IT. In many cases the NPfIT experiment left them short of the expertise they needed to make the right decisions at a local level. Suppliers must pick up the baton and give genuinely impartial advice.

Not all legacy systems need to be replaced – some work fine, or should be gradually eased out. In other cases it may be best to concentrate on the basics first, ensuring there is a sound system for dealing with core needs like patient administration first, moving on to specialist applications later. There are even situations where a company knows that while its own products are ideal for most of a customer’s needs, there are others that would be best served by bringing in a partner.

Suppliers taking this approach build trust, and while no one gets everything right, they will give themselves, and the industry, a good reputation. They also need to look to the future. The best suppliers are there for the long haul and do more than just send out generic annual upgrades. That means ensuring that their products adapt to each customer’s needs – so their solutions are still delivering for many years to come.

Shane Tickell CEO IMS MAXIMS

Watching the progress and witnessing the government’s first defeat on its highly contentious plans to reform the health service, just a few hours after the Prime Minister mounted a passionate defence of the shake-up to the NHS, reminded me of a patient being diagnosed, operated on, discharged and then readmitted for the same condition!

With all the changes and opportunities that previous governments have experienced, the sad reality is that the health service, as it currently exists, is simply unsustainable. Spiraling costs in health and social care provision, due to extended life expectancy, being just one of the reasons as to why this is the case.

So is the bill good for us and should we just put up with the bitter pill in the short term? Perhaps it is just that the communication of the benefits has been poor or maybe it is a case of knowing we have to do something but this is all too much at a time when there are so many other financial restrictions.

The editorial simultaneously published by the BMJ, Health Service Journal and Nursing Times last week says that we shouldn’t accept the bill. It says: “the resulting upheaval has been unnecessary, poorly conceived, badly communicated, and a dangerous distraction at a time when the NHS is required to make unprecedented savings.” The publications suggest that parliament should establish an independently appointed standing commission “to initiate a mature and informed national discussion on the future of our national health system”.

So as the passage of the bill has been battling against ill winds, the focus is now on Andrew Lansley who has been widely criticised for its handling.

A No 10 source was quoted in The Times saying: “Andrew Lansley should be taken out and shot. He’s messed up both the communication and the substance of the policy.”

And so, the bill returns to the Lords, where it faces a mauling by peers despite the Government already making a string of concessions.

Lansley says the reforms will improve patient care, make services more accountable and cut bureaucracy. The changes will hand GPs greater control over the £60  billion budget to commission services and allow the private sector to play a larger role.

Health minister Simon Burns defended the reforms, saying: “By handing responsibility for purchasing services to doctors and nurses, we are shifting decision-making closer to patients and building on the trusted role GPs play throughout the NHS.”

He added: “I have met GPs in London who are looking forward to being able to commission services for their patients.”

However, it’s questionable whether those same GPs at the heart of the government’s policy, will feel it is most unjust if they are blamed for the potential failure of our local hospitals due to the enormous challenges that they face.

Jeremy Nettle, Director, Global Client Advisor for Healthcare, Oracle and Chair of Intellect Healthcare Group

This week the NHS Future Forum published its latest report spurring on headlines from the tabloids such as ‘NHS staff lacking compassion and ability to do their job’ and ‘doctors and nurses told to slim so patients listen.’

But for those IT and NHS professionals waiting for the long over due Information Strategy there were few headlines that could provide even a little direction on where their efforts should best be placed. In summary the report on information, needed…more information.

The report, much of what was leaked before Christmas, provided little that was new.

The key recommendations of the report around information were:

Patient ownership of data – a requirement for patients to be able to access their records online by 2015 and for the British Medical Association, Royal College of General Practitioners, NHS Commissioning Board and patient organisations to help to deliver a plan to roll this out, which includes an ethical and concrete consent process.

Data sharing - A move away from the National Programme for IT to interoperability and a call for the Information Strategy to clearly set out what is expected for providers of NHS services as well as a deadline.

• For contractual agreements to be put in place so ensure that the entire NHS has systems that allow full electronic data sharing against set standards.
• For hospital discharge summaries to be made available to the GP and patient at the point of discharge, and GP referral letters to be made available at the point of referral.
• For the universal adoption of the NHS number at the point of data capture across health and social care by 2013.

Information governance – The Government should commission a review of the current information governance rules and of their application, to report during 2012 to ensure appropriate balance between the protection of patient information and the use and sharing of information.

Using data to drive quality - A clinician who is responsible for organising data should be identified within every NHS and social care organisation.

Transparency - The need for a clear deadline for all information about clinical outcomes is put in the public domain and the need for the Information Strategy to emphasis the importance of patient‐generated comments through social media and for the NHS to use these to improve services.

Although there is little that is new, there are a couple of interesting points. Firstly, that the medical bodies will be asked to consult on the plan to allow patients to access their records online. However, there is no mention of suppliers/providers of the technology. The lack of communication between the technology world and the clinical world was one that led some of the major failures under NPfIT, could this be at risk of happening again?

A number of additional deadlines are set out, such as the adoption of the NHS number by 2013 (which was introduced 15 years ago) and for information about clinical outcomes to be placed in the public domain, but there is little information on the mechanisms that will drive these deadlines.

Perhaps more interestingly is the call for an emphasis on social media to improve services. While an innovative and forward thinking idea, this in itself needs an entire document and a huge amount of education aimed at the industry and NHS, considering only around half of NHS organisations actively use Twitter, for example.

The recommendations appear to provide a vague brief to build on and leave questions that it seems can only be answered by the Information Strategy, which will allegedly arrive in the spring.

Sarah Bruce, Marketing Manager One Health Alliance, Communications and Digital Media Consultant Highland Marketing

Last week, as Big Ben chimed out midnight and the fireworks erupted around the London Eye spectacularly, my mind went back to the chimes of Big Ben welcoming the Millennium.

We all waited with bated breath to see whether every computer in the land would come to a standstill as predicted. Intensive care units doubled their staff, emergency services were at the ready and many government departments and local authorities had contingency plans dusted off and ready to mobilise.

Due to a lot of planning and a huge investment in IT (an opportunity to replace elderly PCs) thankfully the Millennium had little impact. Twelve years on and dramatic changes in technology have occurred with the introduction of the ‘iPhone era’ where information, such as our friends’ relationship status to the latest headlines, is delivered to us in real-time through the internet, social media and mobile technology.

The ‘iPhone culture’ means that we can get instantaneous information about almost anything, like from Trip Advisor on how good a holiday destination might be and on trains, buses and planes, through to traffic congestion reports. But sadly we still can’t get information about which surgeon and or hospital has, for example, the best outcome for joint replacements.

The reality is that we behave as if the same technology we use within our everyday life is as equally pervasive within our healthcare. However, there is a silo infrastructure, which we have been unable to join up in any meaningful way despite the fact that it would release massive savings and enable real choice through patient involvement. Embracing such technology could not only support the ‘information revolution’ but create an ‘information evolution.’

What is questionable is the unidentified cost for becoming ‘E-dependent’, particularly in a world where technology projects costs are 60-70% infrastructure and support costs.

Budgets are being cut as users, in both the public and private sectors, demand more for less. Periods of rapid change in the way both enterprises and consumers use technology create not only huge threats for those wedded to old models, but also huge opportunities for new ventures and existing businesses capable of capitalising on the new trends.

As we reorganise and restructure the NHS, we must look at new ways to reduce costs, such as moving to Software as a Service (similar to the Pay as you Go tariff on a mobile phone). In addition, the NHS is increasingly seeing more organisations embracing shared services, outsourcing and even cloud computing. Interestingly the NHS has more shared service contracts than any other government department covering finance, HR and clinical functions. Could this be just what the newly formed Clinical Commissioning Groups might need?

2011 brought a lot of uncertainty, predominantly due to changes to the National Programme for IT, the continuously disputed Health and Social Care Bill and the absence of an Information Strategy. Let’s hope that 2012 brings more clarity so that organisations can work to bring in today’s technology into tomorrow’s NHS.

Exciting times ahead I believe and of course we have both the Jubilee and the Olympics to look forward too.

Jeremy Nettle,
Chair of Intellect Healthcare Group

This week I had the pleasure to attend the eHealth 2011 conference in Malaga. Driving in the fog to Gatwick, I was feeling slightly boyish that soon I would be walking along the sunny pavements of Malaga and getting my dose of vitamin D. How wrong could I have been. I arrived in one of the worst rain storms that Andalucía had seen in some months. Perhaps Spain isn’t so different from the UK after all.

However, what I heard this week simply endorsed my understanding that healthcare globally is going through major reforms to improve performance, such as the measurement of clinical outcomes and encouraging patients to take more responsibility in decisions around their own care. A bit like finding the Holy Grail I have often thought. But what I discovered is that the route many countries are taking is not to dissimilar to our approach in the UK and more specifically in England with the Information Revolution.

One of the key messages at almost any conference in any country I attend is that there is unanimous agreement that by involving the population in their own healthcare, significant reductions in costs can be made. In fact some researchers estimate that costs could be reduced by almost 20%. If these estimations are true, ensuring people take ownership of their health would certainly make the £20 billion savings over next four years – often know as QIPP or more frequently ‘the Nicholson Challenge’ – more realistic and achievable whilst simultaneously improving patient care.

So, what is the driver to make this happen and what will push forward the QIPP agenda? History tells us that in austere times innovation will be key.

Research recently carried out by Professor Sir Brian Jarman, into hospital mortality rates in England, found that the number of deaths in hospitals are more closely related to the number of GPs in the area it serves, than to the number of doctors in the hospital itself. Surely this is proof that it is time to grasp innovative thinking and extend support for the case to develop the virtual hospital – sometimes known as a hospital without walls.

In addition, if we want to see better health outcomes, improved equity, patient involvement, access and lower costs, then we need to focus more resources on primary and social care as well as general practice. Health systems dominated by specialist secondary care ‘have higher total costs and reduced access’, a recent World Health Organisation report says. There is clearly room for innovation here.

Given that there is no extra cash in the system, I eagerly wait to see how innovative we can become in order to improve the quality and access to healthcare in this country. After recently witnessing and enthusiastically applauding the winners at the recent HSJ Awards and eHealth Insider Awards, it is clear that there are examples of great innovation scattered across the country. My plea is that we can develop a way in which this good practice is disseminated across a federated NHS.

Jeremy Nettle,
Chair of Intellect Healthcare Group

Return on investment (ROI) is a very hot topic within healthcare given the current efficiency saving challenge and the broader financial climate in the public sector. Nearly every NHS business case must now demonstrate a rapid ROI to executive teams and boards.

Whilst we must always consider financial factors and ultimately ensure that services and technology provide value for money, it’s imperative that we remember the purpose of an NHS: To provide high quality healthcare for all and improve the health and well-being of our citizens. However, it is clear that the current model and cost of service delivery is not sustainable and that there must be a focus on efficiency and good financial management.

The concept of ROI in healthcare does however need to be carefully considered. Consider the ROI related to a sky-scraper or office block. It would seem counter-intuitive to ask the question ‘What’s the ROI on the lifts’ or ‘What’s the ROI on the window frames?’. When it comes to buildings both lifts and window frames are integral parts of the infrastructure and essential for any ROI to be achieved – but we cannot realistically determine what the ROI for the individual components is.

Similarly within the healthcare context – the ROI on doctors, nurses or physiotherapists is seldom questioned. These are all ‘must have components’ in the delivery of healthcare today. Clearly – information and technology cannot be viewed in the same light as the ‘human resources’ we’ve outlined, but patients or healthcare consumers do now have an expectation that electronic resources will be utilised to deliver safe and effective care. We also see that high performance healthcare organisations have made heavy investments in information technology (VA, Kaiser etc). So to varying degrees, IT and broader technological solutions are and will undoubtedly become more embedded as essential components for the delivery of high quality care.

The word ‘evaluation’ is less widely used and definitely not associated with the same degree of importance and focus as ROI. And yet, effective evaluation is critical to determine and understand ROI.

The healthcare world has been sub-standard in terms of its approach and use of evaluation to understand the impact of interventions, technology and process change.

When we review the evidence of the impact IT has on healthcare, there is limited information available on the impact beyond processes being streamlined, paper being removed and time being saved. There are some obvious extrapolations linked to notes storage, legibility and potentially the reduction of errors related to lost notes etc. In terms of harder metrics however (e.g. length of stay, readmission rates, medication errors, clinical outcomes etc) we are still building up the evidence base.

So this is a call for commissioners and providers alike to have evaluation built into the project plans and not to shy away from doing some hard measurement. We have excellent research capability in the health system and we need to apply the same rigorous principles to the process of evaluation for IT initiatives.

Only then can we begin to understand the true ROI on these ‘essential’ components of our healthcare infrastructure.

Dr Lloyd McCann
Medical Director – EMEA
Carefx (A Subsidiary of Harris)

Over the past few weeks, there has been a lot of very familiar talk about the NHS IT market “opening up”. However, this time round and following renewed announcements by the Department of Health about the dismantling of the National Programme for IT, there appears to be a sense that companies, which have latterly been shut out of NHS IT, might finally get a chance to have the door re-opened to them.

But with all the optimism comes the question over whether there is really any place for SME’s in the market. Moreover, do the inroads exist to enable them to take advantage of opportunities that do come along?

A couple of weeks ago, one of our industry advisors, Jeremy Nettle, blogged about whether there is likely to be a procurement spate or blight. So far, it seems that trusts have used the DH announcement to move forward with procurements that had previously been put on ice. So, you would think that this is music to the ears of smaller NHS IT providers waiting to strike.

But instead, at several recent events I’ve noticed a common trend of frustration from the small and medium size companies. Companies appear exasperated that despite the big announcement from the DH, there are no mechanisms in place to allow them to even attempt to compete with enormous, multi-national corporations who have big balance sheets or big reputations behind them.

On a number of occasions I’ve heard how big players, whose primary focus is not healthcare, are winning trust procurements without even having the product that the trust initially tendered for.

Stories of how small companies, who have fantastic working and proven products that address all of the tender specifications and are being dismissed at the first hurdle, appear to be coming increasingly frequent. With the big players then subcontracting them to provide the service instead.

Whilst this method works in some ways, defining a company’s ability to provide for the NHS on their balance sheet as opposed to their product, could have some major implications.

Firstly, shutting smaller companies out has the potential to prevent the QIPP agenda from being pushed forward, stifling the innovation so often shown only by smaller more agile organisations.

Perhaps more scarily is the possibility that NHS IT could turn into another National Programme for IT in all but the name, with only a handful of big and ‘trusted’ companies winning the contracts.

One thing is clear- the Department of Health needs to address this matter now. Whether it is the encouragement of collaboration within the industry, a commitment around interoperability that ensures that all systems can integrate, thus not shutting certain players out of the market, or an easier route to procurement that allows smaller companies to participate without requiring huge amounts of their resources away, it is now time to make those changes.

Sarah Bruce,
Marketing Manager at One Health Alliance
Communications and Digital Media Consultant at Highland Marketing

According to the Institute for Innovation and Improvement ‘Innovation is about doing things differently or doing different things to achieve large gains in performance.’

Often, ‘innovation’ makes us think of technological developments. Whilst new technology makes an important contribution to innovation in the NHS, another critical component is service innovation. It involves designing the process our patients go through, the way we work and the way we redesign and develop our health services.

Following the approval of the Health and Social Care Bill this week, we know there is a utopian view that Lansley can achieve both innovation, service redesign and efficiency gains with his reforms, but can we really meet these objectives without the help of private money?

Radical changes in the way we commission services already mirror many aspects of the corporate sector, using fit for purpose models as opposed to the price is right mentality. Does this signify the privatisation of the NHS? Who knows and does anyone really mind as long as the standard of patient care improves?

Already the Department of Health (DH) has given approval for one NHS hospital, Hinchingbrooke in Cambridgeshire, to be acquired by a private company, Circle Health. In additon, the DH has identified more than 30 ‘underperforming’ NHS trusts increasing the prospect of private firms taking over.

The Guardian recently published an article detailing how a German company has been in talks to take over NHS hospitals, suggesting that there is already significant activity around the tendering of entire hospitals to foreign bidders. The key questions are what are the drivers here -, effective healthcare, patient choice, or off-loading the financial burden of the NHS to the highest bidder?

Advances in medicine coupled with increasing incidence of chronic disease and an ageing population have the potential to lead the NHS into catastrophe. In many respects the government has realised that single entity enterprises of such magnitude would be more of a hindrance than an effective national service.

So are we too stuck on tradition with the romantic notion that the NHS can just keep haemorrhaging money as we grow as a nation and be free at the point of access? I’m not sure.

The Guardian has written the article that suggests scandal. However, is it time to be more open minded on this and examine the potential benefits? As long as patients continue to receive the right care at the right time and in the right way, surely that’s all that matters.

Tom Humphries, UK Business Manager at Clinical Solutions

There is no getting away from the fact that what dominated the news headlines this week was the announcement of the death of Steve Jobs, chairman, co-founder and former CEO of Apple. For anyone unaware of this news, quite frankly you must be living in a dark cave.

In fact the online reactions – with many responses no doubt being tapped into iPhones or typed into MacBook Pros – attested to the far reaching accomplishments of a man many have likened to a modern Thomas Edison. From politicians to business and technology leaders, tributes flooded in:

“He changed the way each of us sees the world, we have lost a visionary,” said President Obama.

“Leadership doesn’t have a secret formula; all true leaders go about things in their own way. It’s this ability to think differently that sets them apart – and that enabled Steve Jobs to create perhaps the most respected brand in the world,” wrote Sir Richard Branson.

Microsoft’s Bill Gates tweeted: “For those of us lucky enough to get to work with Steve, it’s been an insanely great honour. I will miss him immensely.”

Even musicians paid homage:

“From my Mac to all Lovers … RIP Steve Jobs,” wrote Kylie Minogue.

“If you have yr health consider it the top of the GIFT pile. SteveJobs did a lot in 56yrs&wished he had wht many of yoU HAVE… I did the Grammy webcast in 1996 for Apple at MadisonSqGarden as payment they said $1000 or 2 POwerPCs, ..I took the 2 PowerMACs,” tweeted Chuck Dee. (It was my young nephew that reassured me that Chuck was a well respected rap star not an ill-educated individual lacking basic literacy skills – “get with it auntie”, was my nephews reply.)

Such was the response of those paying their respects on Twitter, it struggled to keep up with the news feed. Thousands of users reported seeing the ‘Fail Whale’, a cartoon sperm whale that appears on the Twitter homepage when Twitter produces more messages than it can handle. May be this was a bizarre sign of reverence and a reflection of his impact on our global society.

However, as I personally reflect on his death, his elevation to near sainthood and comments such as “..the world is immeasurably better because of Steve,” – made by Jobs successor, Tim Cook – I think does he really deserve such veneration and credit? I certainly struggle to place him in the same visionary class as Edison, Einstein, Gutenburg, Arkwright and Brunel, for example – with whom many do – who really did revolutionise our world. He did not invent the computer, he merely speeded up what we were already doing – listening to music, communicating, sending messages and gathering information – and gave us smart looking gadgetry.

But not to take anything away from Jobs in terms of what he achieved as he was a brilliant, highly innovative technician, with great business flair and marketing ability. In fact I often quote Apple as a great example of how to build a ‘brand’. And I can’t deny that it is the increasing importance of technology that has kept me in a job for the past 25 years, and where would I be without my iPhone.

There is no doubt that Jobs has made a profound impact and has certainly helped to humanise technology in our computer-obsessed world. There are many instances where his innovations have enriched and improved our lives. If we take for example healthcare, the tools he created have supported patient empowerment and few have done as much to bring about the rise in use of mobile devices by medical professionals.

Many big-name electronic health records vendors have developed iPhone or iPad access capabilities and there’s also an increasing number of iPad-native EHRs, and these devices are proving their worth in telehealth and for remote diagnoses in time-sensitive emergencies. Plus the plethora of self-monitoring, smoking cessation, fitness and assorted other mHealth apps in Apple’s App Store have helped bring about a new era in personal health.

So, although not in the same league as Einstein, Jobs has made his mark in history. And to quote Neil Diamond, “iSad”.

Susan Venables
Client Services Director, Highland Marketing

With the advent of the demise of the National Programme for IT (NPfIT) will we see a procurement spate or blight?

Eight days ago we heard for the third time from the coalition government that NPfIT is dead and in last week’s blog, Sarah Bruce questioned once again whether this is finally it? Surely the cancellation of the contracts and a potentially enormous legal dispute could cripple the Department of Health, so is the intention just to let the LSP contracts ‘wither on the vine?’

Either way the announcement that Intellect will be working with the Department of Health’s Informatics Directorate is very welcome, especially after it has launched a campaign to engage with over 280 healthcare suppliers of different types and sizes.

Interestingly there are far more IT vendors now than at the start of the NPfIT, many who went away to other countries after being shut out from the programme have come back much stronger.

The view from Mike Sinclair, vice-chair BCS Health, is particularly interesting. He explains: “While we welcome this move, we are concerned however, that this is being done in the absence of an informatics strategy and without any guidance on the future of existing contracts or whether money will be devolved into the NHS alongside responsibility.”

Sinclair appears to be absolutely right. Will chief executives of NHS trusts now be applying for their part of the £12 billion? If this is the case then no procurements will take place as they wonder whether IT funding will be released from the centre. Or perhaps will we see the demise of the NPfIT as removing the ‘’handcuffs’ from NHS trusts keen to start their own procurements. Either way IT vendors should see some very interesting times.

As IT professionals we have a duty to support the government’s transformation agenda. But how will the systems and infrastructure be procured to support the transformation? It is key that procurement takes places within the appropriate timescales and if those timescales fall into many months or potentially years, then there will really be no transformation at all.

Jeremy Nettle,
Chair of Intellect Healthcare Group