Julie Moore: a lot more for a lot less

It’s difficult to talk about the future without mentioning the past. It’s even more difficult to talk about the future without mentioning the economy. We’re all conscious of the political diktat to do more for less. Successive governments have striven to reform the public sector to improve its productivity. Yet any nods to do just that invariably attract public criticism and media attention for allegedly cutting corners, undermining the principles of the NHS and ultimately providing a worse service for patients. I don’t believe that needs to be the case. I strongly believe we can support economic recovery and growth through innovations that ensure efficiencies are delivered with no detrimental impact on our services. In fact, based on my experiences at University Hospitals Birmingham (UHB), innovation delivers a lot more for a lot less.

As technology advances we have to harness it to keep improving the quality and convenience of the care we give. The patients we serve deserve no less. That means embracing and building new systems that improve safety, efficiency and, ultimately, patient outcomes.

When the first PCs were unveiled, many people probably dismissed Bill Gates’s famous mantra: a computer on every desk and in every home. More than 30 years on, it’s no longer just about the PC. In fact, we’re now being told that the PC is going the way of the typewriter, as cassette tapes followed vinyl. Computers and IT have transformed the way we live and we can hardly keep up with the pace of change. It is regrettable that the pace of change in health IT has not been as transformational, but the potential is enormous.

Historically, translating the amazing pace of IT development into medical technology has been where the conflict arises. It’s difficult to build robust IT frameworks within rigid financial constraints. How do we justify investment in projects when it’s nigh impossible to demonstrate a ROI? How do you adapt a one-size-fits-all framework for diverse organisations with a whole range of specialties? You only have to look at the demise of Connecting for Health to appreciate the challenge.

The key to successful delivery is simple – it must make things better and easier for the people who use it: it does not need to be perfect, just better than that which it replaces.

As long as ten years ago, UHB was developing in-house IT systems based around best clinical practice. We had started to tackle challenges innovatively and to some extent this involved a philosophical approach. We made a leap of faith to achieve our vision. There was no business case – it was impossible to make one. We didn’t throw money at the project but diverted resources and expertise within the organisation to get the best value for money. Clinicians did their day jobs, but also worked with our IT development and Informatics teams to inform how the new systems would best work for them. The result is an advanced clinical decision support system, the Prescribing Information and Communications System (PICS) that helps us deliver real quality improvements in patient care.

The principle of knowledge transfer that proved so successful between the technical teams and frontline staff is one that underpins our role as a leading teaching hospital. It’s a principle embedded in translational research and applied to everything we do. We don’t just look at what works: we look at why it works and how it could work better. In doing so we involve the people who do it on a day-to-day basis to ensure we develop systems that best suit their needs and expectations.

If that sounds familiar it’s because it reflects one of the principles of reform in involving frontline staff to deliver change and to modernise the NHS.

The other important element is to involve the people who are in the best position to know how to influence their own care pathway and support their care givers. “No decision about me, without me” is the latest catchphrase, reflecting the move towards giving patients high quality information and support to allow informed choice and shared decision-making.

It’s a strategy that aligns with UHB’s direction. We didn’t stop with frontline buy-in and were already working towards patient and carer buy-in some time ago. By April 2011, the Trust was piloting a unique in-house system called MyHealth@QEHB: a leading-edge patient portal that supports the delivery of high quality care through increased knowledge, support and communication.

Using real patient records and with greater functionality than other large-scale, web-based health portals, it proved so successful in liver medicine that it is now being enhanced and rolled out across other specialties.

MyHealth@QEHB allows patients in long term care to remotely access, via the internet, information held by the Trust, including test results, letters, medication details, as well as past and future outpatient appointments. If they choose, individuals can also interact with each other within the portal and create their own support networks. It has the potential to be the social network for the NHS: giving greater patient satisfaction, improving adherence and delivering better outcomes.

This innovative approach to patient participation in their health journey makes care closer to home a reality. Further, it has the potential to significantly reduce geographic barriers around providing care, which is critical not only to rural communities but also to providing highly specialised care and freeing the choice agenda from geographical boundaries.

The long term vision is ambitious, but early indications are that there is huge engagement among both patients and clinicians. In practical terms, it allows a diabetic patient to log their blood sugar levels remotely and receive a timely response from their clinician to adjust their medication. Just one small example of how the use of technology could contribute to fine-tuning personalised care and saving on the high cost of acute intervention. It’s this kind of support in the home that will allow people to live fuller, more informed, more enjoyable and potentially longer lives.

The key to any technological innovation and implementation is making it accessible and relevant to its users. There would be no benefit in devising bespoke systems if they were built to the IT team’s specification. As with our PICS system and MyHealth@QEHB, innovation is only successful as it is designed with the user, for the user. It is such constructive, disruptive innovation that will drive the NHS to deliver excellence in care.

But this sort of innovation has other benefits. The success of our systems has attracted international interest and we have now formed partnerships with commercial companies to make this available to other organisations world-wide. If the UK can deliver excellence in healthcare technologies, we should be helping other nations deliver it too.

Sharing best practice and innovation commercially and globally will support UK growth. The NHS needs to be a reformer, and it needs to be competitive. Healthcare providers need to play a part in the UK’s recovery by strengthening the country’s competitiveness and equipping people with the skills and technological advances that will allow them to stand shoulder-to-shoulder with global competitors.

With emerging markets in Asia, the Middle East and parts of Africa, it is vital that the UK remains competitive to take advantage of these growing economies and the openings they offer. They shouldn’t be viewed simply as a threat, but as an opportunity to tap into another source of revenue, capitalising on the currency of knowledge transfer.

I’m proud of what UHB is achieving in the West Midlands and beyond. I’m delighted that our staff and patients have access to some of the latest advances in IT healthcare systems to improve their experience, efficiency and outcomes. In ten years’ time, I believe I’ll be able to look back and say I’m proud too of the impact those innovations have had within a worldwide healthcare economy.

This essay appears in The next ten years published by Reform.

www.reform.co.uk