By Colin Jervis
Colin Jervis is an independent healthcare and management consultant with twenty years of experience of IT implementation in the NHS. In this article he gives his take on driving efficiency through IT in the NHS.
NHS records are still centred on organizations, disciplines and even individual clinicians.
The free flow of information is increasing in importance as the NHS faces the challenge of becoming more efficient at an unprecedented rate. Better use of IT is often seen as a means of making substantial cash savings. But is it?
In fact, the evidence is that large investments in IT on their own rarely produce financial returns, and that applies to all industries not just to healthcare. I have grappled with this reality for almost 20 years.
Simply automating existing management and clinical practices using IT will not save money or improve outcomes. It will simply add cost. The solution is new models of care supported by IT.
Let’s look at some of the key elements of the drive for efficiency through IT.
NHS and Paper
At a more modest level some of the favourites for realising financial benefits are remote working, electronic prescribing, document management and even the outsourcing of IT services. All can save money. But all require new practices and the determination to engineer savings. Let’s take the example of document management.
In today’s NHS departments of clerks chase and serve the paper record in a time-honoured fashion. As the rest of the world has embraced IT, the NHS has tightened its grip on paper.
The NHS stores about fourteen billion pieces of paper and about 160 million patient records.
Yet it aspires to become ‘paperless’ by 2018.
Speaking with twenty years of NHS IT experience, I can confidently predict that it will not achieve the literal definition of paperless in the time remaining. Nonetheless, there is hope that it will free itself from a paper-driven culture.
Electronic Patient Record
The recent announcements of £260m of funding for NHS IT and the digital challenge issued by the Secretary of State for Health has re-ignited the seemingly endless debate about how an electronic patient record (EPR) should be created.
We gain a clue from the national implementation of PACS (Picture Archive and Communications System)—one of NPfIT’s successes.
Now clinicians share and discuss diagnostic images with colleagues regardless of distance and organisation. Such changes came about with scarcely a whimper.
The EPR is often seen as a collection of transactional systems; typical examples being requesting and resulting; prescribing and administration; and departmental systems like pharmacy and theatres.
The databases that manage an EPR can store structured medical records using standard coding systems like SNOMED CT (Systematized Nomenclature Of Medicine Clinical Terms). And crucially, information can be exchanged between disparate IT systems in standard formats—something the NHS still grapples with despite the interoperability toolkit (ITK).
This is a great vision, but it will be many years before the bulk of medical practice is encoded. However, there is a practical interim solution, which is easier to implement and generates benefit faster.
Document management and the digital scanning of paper records can be used as an interim step to a fully digital EPR that could also form part of the end solution.
It is not necessary to scan all paper records. Recent data from a large London trust suggested that 30 percent of patient activity accounted for about 70 percent of pulled paper records. Identifying such patient activity is key to achieving savings.
Document scanning can save staff and storage costs and can improve patient care by making the record available from any terminal and to multiple users simultaneously. What’s more, it presents information to clinicians in a familiar form and therefore makes implementation easier.
Document management is a practicable step where reorganisation and management determination can save money.
However, in the longer term,the NHS must become a harmonious blend of people, processes and technology. The EPR is part of a much bigger programme of organisational and practice changes, which will be supported by greater use of IT such as wireless, handheld devices, data analysis tools and decision support.
IT is indifferent to physical location, caring little about organisations. This allows it to be a mainline that may coalesce the NHS and other care systems into a whole that sees a patient rather than a discord of data.
We have to be practical, realistic as well as visionary to get the most out of IT budgets and deliver real effectiveness and substantial efficiencies. But we must ensure that work systems already in place can be improved to really benefit from IT.
Colin Jervis of Kinetic Consulting can be contacted through
Colin’s recent book: ‘Stop Saving the
NHS and Start Reinventing it’ is available on Amazon in paperback and as an