Connecting health with IT

Whilst there are a number of outspoken people who might wish to see the programme thrown out, the challenges of going back to the NHS IT arrangements of old or developing IT systems in a world with the National Programme in a wound down form seem just as daunting. For now the official line from Connecting for Health is that the National Programme is continuing. At the time of writing we are still waiting for the CSC contract negotiations to be signed off in the north, midlands and east, and there seems no limit to the number of adjectives that will be used to indicate that signatures are imminent.
The future of the southern cluster is surrounded by even more uncertainty. However, the reality is that whilst the contract resets might ensure that local service providers stick around for the foreseeable future it is unlikely that it will make any great or noticeable difference to the complexity of the implementation and the day to day challenges faced by those working on the ground.
The recently published Darzi vision sets out plans for a future NHS that will need to be underpinned by IM&T in a number of areas. Whilst it is fair to say that there are isolated pockets of IT across various health organisations that currently support parts of the Darzi vision, no one organisation, and certainly not the whole NHS, is making in-roads into fully supporting what it suggests. The reality is that whilst various NHS organisations (and the National Programme) might be claiming successes in specific areas the reality is that IM&T currently holds clinicians up due to the diversity of systems they are required to use, some of which clinicians report are making them less time efficient.

Sharing information
The key barrier here is fairly obvious; organisational boundaries. Computer systems in their current state seem unable to share their functionality and data between the different organisations as freely as the patients and staff move between them. If IM&T is going to successfully play its part in implementing the Darzi vision and provide a more streamlined patient experience these need to be broken down.
The good news is that there are tools that exist, such as the SHA, that can co-ordinate and drive across organisational change. The bad news is that many systems, such as local PACS, where the implementation has been deemed a success may not prove to be such in the long term as they struggle to be compatible with the demands of a more joined up health system.

Lorenzo software
Wasn’t this what the National was meant to achieve? Provided it continues it is looking like we are now done with interim solutions as the Lorenzo ‘final solution’ gains its first footholds (more informed readers will note that this was originally rather fittingly part of a podiatry service) in NHS organisations. The Lorenzo software concept was a challenging, risky and ambitious project in itself and this naturally breeds uncertainty around it. This in turn creates an even bigger challenge regarding the best way to implement Lorenzo alongside the Darzi vision. Although they do in many ways align, the former was conceived some years before (when efforts were focused on increasing capacity) but will perhaps turn out to run some years behind.
Organisations will obviously want to get the most out of the product in as far as it supports the Darzi vision, especially when it comes to breaking down those organisational boundaries discussed previously. But the end vision of Lorenzo is not just a PAS or reporting and results system that works across NHS organisations, it is intended to be so much more than that. The attitude towards local IM&T implementations needs to change.
Getting the software in as part of a project to replace or upgrade an existing system should be seen as the easy part. Organisations need to be acutely aware that driving organisational change beyond the initial functionality of the original software is essential and needs to be addressed very early on. It will ensure it is ready for more advanced modules such as multi-resource scheduling and document management. Whether this includes using an interim solution while the nationally provided software catches up is another factor that will need to be carefully assessed. The important thing to point out here is that this is about so much more than just the technology, so engagement across all fronts is surely going to play a key part in overcoming the challenges.

Operational management
Finally, there will always be areas of IM&T peripheral to the National Programme (which is rightly focused around the patient) that will need to be taken care of. Operational management in IT will need to be reviewed to ensure that departments are making best use of their resources. A more specific example of this is computer lifecycle management. There are tools provided by CfH, such as EWA discounts on licenses and the NHS Infrastructure Maturity Model (NIMM) but unlike software provided under the NPfIT umbrella there is little direct assistance provided for the implementation of a modern lifecycle management model. In addition to this, with so much focus on the large challenges around patient based systems it is going to be all too easy to neglect the other business systems, such as those used by finance, estates and IT operations, all of which need to be streamlined into any health organisation’s future IM&T plans.
In closing it is fair to admit that there is still a great deal of uncertainty surrounding best course of action for the future in NHS IM&T and realistically in the face of this the pursuit of good leadership is the only way to view the challenges if a successful outcome is desired. As Darzi is a ten year vision serious forward planning is required and whilst the vision on paper is a good one the real proof of this will be in its implementation.

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