In our first monthly examination of the state of key healthcare support services, Daloni Carlisle finds many trusts are upgrading their business intelligence systems.
“How to buy” is a new monthly section analysing key healthcare support services.
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Business intelligence is all the rage these days. But with a sad history of large-scale data warehouse implementations that have not lived up to expectations, and rapidly changing reporting requirements, many trusts are looking again at their systems.
Pennine Acute Hospitals Trust is one such example. For several years, it ran an in-house system with support from an external consultant. But recently this has left the trust feeling “exposed”, according to Christine Walters, associate director of information management and technology. “It is dangerous to rely on one person,” she says.
Now they are moving to a commercial provider, CACI. It was chosen on the basis of Ms Walters’ previous experience at Salford Royal Foundation Trust, the company’s wider track record in the NHS and its use of industry standard tools.
“From a strategic point of view, it offers a way to grow service provision and the amount of information we can start pulling in,” says the trust’s information manager Paul Street. “It is based on a [Microsoft] SQL database with reporting tools and there are literally hundreds of existing reports designed around NHS users’ requirements. All that functionality is proven in different sites.”
Like all acute trusts, Pennine is facing new demands for information – for patient-level costing and service line reporting, for new patient outcome measures and commissioning for quality and innovation data, as well as accurately reporting on cost improvement programmes. This all comes on top of the long-standing need for robust financial data to underpin contracting with commissioners, as well as the four-hour A&E waiting time and 18-week referral to treatment targets.
Ms Walters says this rapidly changing scene is a major consideration when it comes to choosing a business intelligence supplier. “It’s all about having the capacity to meet the changing needs of the NHS and we have to be flexible and adaptable,” she says. “A well respected provider has the resources to keep developing their product in a way that we don’t. It’s their expertise and their bread and butter.”
The CACI system is not yet live and the trust is now embarking on the all important data migration and validation as it moves information from the old system.
In the meantime, the trust is running some new dashboards provided by QlikView. “We have dashboards at board level, divisional level, department and ward level, as well a patient safety dashboard,” says Mr Street. “It is all feeding from the same source of data, from ward to board. It is giving us a view of our data using an off-the-shelf tool.”
Dudley and Walsall Mental Health Partnership is a year further along the same journey. The trust was created three years ago through merging two organisations. “We had a variety of very old legacy systems and manual collections. They were falling over and no longer supported,” says Natalie Penrose, head of performance and information.
Last year, the trust implemented a new electronic patient record – Oasis – and a business intelligence system from Stalis, another well respected player. It has been using the data warehouse and dashboards for a year now. “It does what we want it to do,” says Ms Penrose. “One of the main advantages is the speed and the ability to extract data virtually [in] real time. In the old days, it could take weeks to do manually.”
Time to change
It was not an easy journey. “It’s been a massive change,” says Ms Penrose. “You can either have a long project and go in with minimal risk or you can have a fast project knowing you are going to pick up some issues when you go live. We did the latter.
“We had to get clinicians on board very quickly and get the cultural buy-in. We also spent a lot of time on additional training, awareness and data quality. We have had to spend a lot of time cleaning up the data that we migrated from the legacy systems.”
Where Pennine Acute is starting its journey with financial data and using business intelligence to support its service line reporting, Dudley and Walsall started with clinical data and is taking a feed only from Oasis. “We did not have a lot of business intelligence before,” says Ms Penrose. “Now that we have consistent data we are developing business intelligence for our executives and boards, so they can understand the performance issues, really for the first time.”
This means monitoring the performance of teams and even individuals with the ability to identify “weak spots”, as Ms Penrose puts it. They are able to monitor key local and national performance indicators. The trust will look at taking in HR or financial data as the service evolves.
Although Walsall and Dudley chose Stalis before Ms Penrose started working at the trust, she is clear about what she would look for in a supplier: a strong track record in delivering a similar solution in a comparable organisation, value for money, flexibility and the ability to evolve, and ongoing support.
“I think the relationship with the supplier is crucial,” she adds. “We have a very good relationship with Stalis where we can be frank about what is and is not working, and what we need.”
The return on investment – always a thorny issue – is hard to get at, she says. “At a management level and board level we are realising the benefits now. Management is getting better information than they ever had before. It is helping them to understand the business and improve it. Now we need to try to give the clinicians some visible gains.”
The business intelligence marketplace in the NHS is certainly busy and highly competitive. In the past 12 months, iSoft (now part of CSC) has launched its own modular suite that it hopes will help trusts with iSoft systems to manage their data extraction more easily.
“More often than not, we are the source system provider,” says Gareth Dellenty, who heads the business intelligence division at iSoft. “We were hearing from a lot of trusts struggling with getting data out and making sure it was clean, so we developed a connector for iSoft sources.”
Tenders on the rise
Elsewhere, companies report a rising number of tenders, although they are of variable quality. “We are seeing a renewed vigour to move towards trust-wide business intelligence in the past 12 months,” says Graham James, head of CACI’s business intelligence group. “There have been several tenders that include data integration via a data warehouse. They are geared around specific requirements and the trusts know exactly what they want.”
But in others, there is a lack of clarity. “When we have asked about the business drivers, trusts really do not know.”
Stalis managing director Christine Whitehouse agrees. “Trusts need to know what they want. We had a pre-tender discussion the other day with a trust about just this. Unless trusts know what their information strategy is and what the drivers for change really are, they will end up with a series of standard reports that may not tell them very much.”
Once trusts have this understanding then it is about choosing the right supplier for the organisation. “It is not so much the tools that are provided or even necessarily the particular supplier,” says Ms Whitehouse. “It is the approach that matters and trying to respond to the expressed needs of a particular implementation, rather than saying ‘here is your data’ and leaving you to it.”
This is a common theme. Simon Mortimore is an independent business intelligence contractor who has worked with several NHS trusts and in other industries helping senior management teams to get the best out of their systems. He is currently working with Kingston Hospital Trust in Surrey. The technology nowadays is fairly generic, he says. There are some industry standards tools developed by Microsoft that are now embedded in most off-the-shelf solutions and, from a technology point of view, trusts can be agnostic.
Paul Henderson, divisional lead for business intelligence at Ascribe, agrees. “Trusts need a solution that will take data from many sources and add value,” he says. “They want to add tools that allow predictive risk modelling, or blend different activity sets. I think the black box vendors will be looking over their shoulders.”
In the driving seat?
“What trusts need to be looking for is not someone to do just the technology but someone to do the whole package,” says Mr Mortimore. By that he means the software, data and information quality, process automation and – the piece of the jigsaw that is so often missing in the NHS – the business skills side.
“I think this is a very rare talent. You need someone with an MBA and an IT background who can really understand what it takes to run a business and where IT fits in,” he says. “If you use a Formula 1 analogy, IT people are the designers, the information team are the pit crews but there are too few drivers – the people with the business skills.”
Some of this expertise does exist in other industries – for example the whole idea of “never events” now adopted in the NHS was developed in the airline industry. Predicting the risk of these events is something that, theoretically, business intelligence should help with.
He has some simple advice for trusts embarking on a procurement. “Make sure you have a business intelligence strategy and ask whether your staff have the business skills you need. Visit as many places inside and outside healthcare as you can before buying. There is a lot we can learn from other industries.”
Drawing up a suitable service contract
Once a trust has evaluated a case for buying in services it should ensure that a suitable service contract, for the provision of those services, is drawn up so that the contractual terms (in particular the risk profile for the service provider) are a core part of the tender process and the response to it are a core part of the evaluation process for selecting the right supplier for delivering those services. That means it’s important for trusts to understand the key issues to be addressed in the service contract. Whilst these will vary depending on the specific project, they will usually include consideration of:
- the services to be provided by the supplier and the payment arrangements;
- continuous improvement of the service by the supplier – e.g. through system upgrades;
- effective key performance indicators, with clarity on the minimum level of performance (i.e. service levels) expected from the supplier;
- effective service credit provisions to ensure that the contract has teeth if the supplier does not meet the agreed service levels. This requires the contract to include suitable contract management, reporting and governance provisions;
- term and termination - for example the cost efficiencies gained through a long term contract must be balanced against value for money if the supplier defaults. To deal with this risk, trusts should ensure that there are comprehensive and robust rights to terminate the contract. Triggers for termination may, for example, include material breach by/insolvency of the supplier;
- other available contractual remedies, such as the recovery of any loss suffered by the trust for early termination due to supplier default or the right to step-in and appropriate remediation processes;
- exit management: an exit plan should deal with (amongst other things) the return (or purchase of) assets and software; the treatment of employees; and the provision of information/know-how to a new supplier; and
- business continuity and disaster planning to ensure continuity of service
Rashpal Sarkaria is a commercial lawyer with Capsticks.