By Tony Collins
Laura Slatcher dreams of forms – reducing the number of them.
She works with a small IM&T team at Trafford General Hospital that is trying to standardise and reduce the number of paper forms doctors and nurses use in the care and treatment of patients.
As is typical for a hospital of its size there are up to 70 – mostly different – paper forms on every ward. Slatcher is working with clinicians to define ways of switching from paper to electronic records – which they are doing with alacrity.
“We have to standardise here,” says Steve Parsons, Head of IM&T at Trafford Healthcare NHS Trust in Manchester. “The doctors and nurses welcome that. They want to work better and more efficiently because they are under pressure themselves to do that.”
Trafford General bought its main systems outside of the £11.4bn the National Programme for IT [NPfIT]. The hospital, though, is one of the most technologically-advanced in the UK says Peter Large, Trafford Healthcare NHS Trust’s Director of Planning.
There has been no risky “Big Bang” implementation of a Whitehall-bought patient administration system. Rather, Parsons’s approach has been step by step progress over 10 years: implementing systems, learning from what went well and not so well, and integrating hardware and software from a range of suppliers. This strategy could help to explain why the clinical staff we spoke to at Trafford hold the small IM&T team in high regard.
In 2000 the hospital had rudimentary technology – isolated systems in some departments. Now the IM&T team is able to give clinicians what they have asked for; and at Trafford it’s the doctors and nurses who say what they want. Systems are not imposed on them. Here the technologists are in the background, not centre-stage as in the NPfIT.
Trafford and the NPfIT
Says Large: “We found ourselves in the position of being ahead of the game. When we were asked to commit to the National Programme we held back because we needed to know we would be committing to a better solution than was already available to us.”
Parsons adds: “Some trusts didn’t really have anything at all so were desperate to be in the first wave. From their perspective the national programme was a brilliant step forward. But the right products never arrived.”
One reason for Trafford’s success is the integration of the hospital main and departmental systems. Before electronic patient records, patients could come into hospital without their paper notes being available. Now doctors across the hospital’s departments and clinics can access at the hospital’s XML-based electronic patient records at any time, day or night – and from home if they have remote access.
Doctors can view x-rays and assessments of them from the patient record; and from system alerts and patient tracking, operational managers can see how well individual doctors and nurses are coping with the numbers of patients on their daily lists.
No black-box technology
The hospital’s three main systems are an electronic patient record from Graphnet, software to schedule and manage appointments from Ultragenda, owned by iSoft (now acquired by CSC), and the “Ensemble” integration engine from InterSystems.
What sets these and the hospital’s other systems apart is that they are not black boxes, impenetrable to Trafford’s technologists. Parsons insists that Trafford’s suppliers make their software transparent so that it can be understood by the hospital’s IM&T staff and integrated with other systems, at database “field” level if necessary. That way Parsons can produce any report clinicians need and usually in real-time.
When a supplier keeps its software opaque for reasons of proprietary and commercial confidentiality, Parsons is restricted in the type of medical and administrative reports he can ask the company to supply – and may have to wait hours or a day to get them. He wants none of that.
It’s this level of control that Parsons believes he has a right to expect – and he seems a little surprised that CIOs don’t always require openness from their software suppliers.