What are the challenges for implementing a healthcare information system in the NHS?
Richard Corbridge, chief information officer, Clinical Research Network, NIHR: I think it’s engagement. How do we make the implementation of a system add to the delivery of healthcare and be about improving care and releasing benefits? Some of that is about design of systems and some of that is about how a system is implemented, ultimately the benefit has to be at the core of what is being put in place.
Farid Fouladinejad, IT strategy lead, CWHHE clinical commissioning groups collaborative: The biggest challenge is around meeting the expectations on integrated care across multiple organisations using different generations of standards and IT platforms while limiting impact on frontline staff.
Andrew Graley, director of healthcare, Polycom: There isn’t one single big challenge you can focus on. There are broad challenges and local issues. Establishing a good, working system has been done before – there are plenty of successful examples in Europe and north America.
Niall Poole, electronic prescribing and medicines administration specialist pharmacist, System C Healthcare: Culture change - getting over the “this is how we’ve always done it” barrier.
Tony Shannon, clinical project lead, Leeds Care Record: The key thing is to know what patterns are important to spot and harness to achieve change. For example, shepherding a mix of people, process, information and technology to achieve iterative, meaningful change that delivers real results. If done right, it should deliver better care for patients and better value for money overall.
What will be the next big disruptive technology in terms of IT in healthcare?
Corbridge: If the Apple Watch takes off like the iPhone then I would suggest wearables will be, collecting information on the go, sharing it with a clinician and allowing the data to be part of the way care is delivered.
Shannon: A move to openness, ie open source, open standards will be key to the future of healthcare, which is somewhat behind in this regard.
Graley: Technologies that will take healthcare services to the citizen are a big area of interest. Organisations are looking at how they can keep citizens healthy and out of the hospital. At the same time, citizens want to know ‘why can’t I see my doctor on Skype or FaceTime?’ because it’s convenient. Lots of people use these technologies every day in their lives – why not to access the expertise they need?
Why is implementing IT systems and management of data in clinical research important to the NHS as a whole?
Corbridge: Technology makes it easier to deliver research within the care pathway – for me this is the ultimate gain. If research can be delivered by virtue of care being provided and of course with the consent of the patient then the NHS can lead the world in this area. We have a theory of releasing information to enable new questions to be asked. That in itself will drive research and outcomes.
Poole: Electronic recording of prescribing, handling of decision support and drug administration mean many things can be audited (like timeliness of administration) that would not have been practical on a large scale with the paper based system.
How can you get clinicians on board with new technology? What does more IT offer them?
Corbridge: Getting clinicians on board is absolutely that culture word again. If a system delivers benefits and is useful for the delivery of care then the systems will be adopted from our point of view. Build a system (like those mentioned here today) that has the clinician at the heart of it and it will be adopted and benefits will be derived.
Poole: It’s too simplistic to lump all clinicians together - at the ground level many strategies may be required for a successful implementation and personalities will definitely be a factor. At the general level though, it has to work, it has to be worth the clinician’s time and there has to be a tangible benefit.
Shannon: The changes involved here involve a mix of people, process, technology. Key to that is that clinicians lead this change and get involved in user-centred design, agile development,testing, piloting etc.
Who decides if a system is successful or not and how is it measured?
Grayley: I often observe the success of a solution being measured by the ROI (return on investment) but what we really want to see is the RTH (return to health.) Clearly defined objectives and measuring those criteria is usually standard practice.
Corbridge: For our organisation, success is when the people making use of the system start to drive forward its innovation, its availability and what it will do next.
How can the NHS promote examples of best practice?
Corbridge: Sharing does make a difference; we have worked with vendors, the media and through presentations to share. A supplier form for care settings where suppliers are encouraged to share more is a great forum, as are things like the EHI Awards. The NHS needs to share to meet the challenge it faces, but I do think it tries to do so, it’s just such a huge scale.
Poole: Vendors have reference sites for potential customers to see what their products can do – why not the NHS?
John Parry: The move from pilot to whole service change has been a problem in the NHS for years. We are now seeing much bolder whole system changes, that deserve recognition. Greater use of reference sites, encouraging visits to successful areas etc. The NHS needs to promote its failures as well, and permit senior staff to report less than effective implementations wihout it being career limiting.
Graley: Sharing of best practice has been promoted by the NHS for a long time. There are regular conferences, exhibitions and competitions highlighting healthcare IT best practice. Perhaps formally making it a mandatory requirement on IT departments to share their own findings in all the key areas, should be written in to standard operations?
Discussion commissioned and controlled by the Guardian, hosted to a brief agreed with the NIHR Clinical Research Network. Funded by the NIHR Clinical Research Network
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