Integrating healthcare IT systems

The recent creation of the UK's first academic health science centre, Imperial College Healthcare trust, sets big challenges in bringing together the technologies of the organisations involved.

The new centre is modelled on similar institutions abroad, such as Johns Hopkins University in the US. It involves the merger of two London NHS trusts - Hammersmith Hospitals and St Mary's, Paddington, with Imperial College.

It brings together five hospitals - Charing Cross, Queen Charlotte's and Chelsea, Hammersmith, St Mary's and the Western Eye - with a world class university. Joining up clinical services delivery, teaching and research in this way has been shown to improve clinical outcomes for patients.

The new trust has an annual turnover of£760m and employs nearly 10,000 staff. It offers more than 50 clinical specialties, from conception to end-of-life care, and has one of the largest portfolios of services in the country. It expects to treat more than 1 million patients a year.

Careful management

Bringing together the IT operations of such a large organisation with so many disparate elements poses a major challenge, particularly in the context of achieving targets along the London IT programme road.

St Mary's had already taken an impressive lead in embracing London's IT programme. Now it is one of the first in London to deploy the London configuration of the Cerner Millennium care records service release 1. Millennium will be used across all trust sites.

"In the drive to a paperless environment for patient care records, such a merger of organisations presents special challenges," says St Mary's IT director Phil Jones.

"Essentially, it is a case of two institutions in the same business, yet each has systems and processes and support environments that are different at every level.

"In healthcare, we are dealing with clinical risk. For this reason, IT, which is increasingly becoming central to all that we do, has to be very carefully managed. I believe that IT in the medical and healthcare sector has to be approached with the same fastidious professionalism and ethical ethos as the medical profession itself."

Complex systems

ReStart Consulting has been working with St Mary's since 2004 on a variety of projects. One of these projects, the outpatients clinic system for managing diabetics, presented a particular challenge and required a complex set of interfaces to be developed to overcome unnecessarily costly database access.

The reason for the high costs was that the proprietary software licensing structure was based on the number of patients in the database, whereas the number of patients for whom there was an information access need was actually very small.

ReStart's interface enables at-risk patients to be pre-identified using a specific blood test, dramatically reducing the database access usage overhead. A filtering system searches all pathology results messages for HBA1C - which carries a 98 per cent probability of diabetes. These records are then flagged in a database - also developed by ReStart - that can be queried by the diabetes system.

The same system can be used for similar projects in areas such as paediatric HIV care, which also requires identification of patients through a blood test.