An IT support system designed to save lives, time and money is being made available under licence across the NHS by University Hospitals Birmingham Foundation Trust.

Birmingham Systems has been developed in-house by the trust, with direct input from clinicians.

Birmingham Systems encompasses Prescribing Information Communication System (PICS) - an e-prescribing and clinical decision support system - and Health Evaluation Data, a more recently developed clinical intelligence dashboard for healthcare performance monitoring and evaluation.

Both tools can be integrated with other hospitals’ existing clinical and patient administration systems.

“PICS development has always been done in collaboration with our clinicians,” says Ian Clark, head of Wolfson Computer Labs at the trust. “The underlying software was developed after extensive discussions with doctors and nurses. And the development team spent considerable time shadowing doctors and nurses on the wards.”

Improvements delivered by the system include: a 66 per cent reduction in prescription errors; total annual savings of £43,000 (9.5 per cent) in the critical care drug budget; and more than 90 per cent compliance with risk assessment rules for venous thromboembolism for inpatients.

Trust executive medical director Dave Rosser says: “Our system brings significant benefits to patients by reducing errors and improving safety, standardisation and effectiveness of care.

“It is also a highly effective way of controlling costs, supporting research and improving training, as well as evaluating and monitoring performance.”

He says: “If you give the operational teams higher quality, timely information, they will use that information to deliver improved quality care.”

When, in 2002, the Department of Health revealed its new strategy, Delivering 21st Century IT Support for the NHS, many trusts stopped investing in upgrading their existing IT systems while awaiting the supply of applications compliant with the programme systems.

Improved quality

However, Birmingham saw it as an integral part of its framework for delivery of improved quality healthcare and so continued to work on PICS.

The result is that it is already using a system that has been rolled out and developed within the trust’s infrastructure at a cost of no more than £25m.

“The quality agenda used to be based largely on patient surveys and retrospective audits,” says Dr Rosser. “There was a tendency to stick to that arena because it’s soft and fluffy. Once you get into measurable care you’re into the realms of dead patients, disabilities and dismissals. Getting it wrong is serious.

“For information to be of a certain quality it must be timely, accurate, meaningful to clinicians who will use it, and open to question and to adaptation and improvement.”

Advanced functions have been developed and incorporated within PICS to reflect user requests and compliance with national and trust-wide targets.

“Generally staff have found it easy to use and are positive about the system,” says Mr Clark. “The system continues to grow into new application areas using the same philosophy.”

One example of these new applications is the observation chart - an electronic early warning system that gives medical staff a five to six-hour headstart in treating acutely sick and deteriorating patients.

It works by compiling data input by staff and coming up with a score to measure the patient’s overall condition. If the score reaches a certain level a red alert is sent directly to an emergency outreach team who respond immediately. It means the symptoms can be dealt with on the ward and admission to critical care may be avoided.

The observation chart went live at the trust in June 2010 and is now in use across more than 500 beds, including burns, neurosciences, renal and parts of general medicine, trauma and maxillofacial. By the end of February it will have been rolled out to include all of the trust’s 1,213 bed spaces.

Critical care and anaesthetic consultant Nick Murphy says: “The outcomes are difficult to measure but intuitively it makes sense that earlier intervention will improve the outcome.”

Dr Rosser sums up: “Indicators are required to get a true picture and indicators ultimately prompt questions, which lead to benchmarking. There must be a clear methodology but equally there is no one magic number.”

He admits that it is difficult to put a cost on “quality” within the scope of healthcare but insists it needs investment as poor quality costs more.

“The spin-off is that quality tends to lead to cost reductions. The better the information, the more efficient the delivery of care and the better the outcomes for patients.”