First past the post at Aintree
Amid the gloomy picture of incompatibility, millennium bugs and central interference, one trust is achieving remarkable success in IT. Michael Cross found out how
Frank Dobson is the latest in a long line of health secretaries to make the alarming discovery that NHS information systems are not up to much.
He told Parliament last month: 'Only a fool would regard the information technology systems in the NHS as satisfactory. They are incapable of supplying some of the most basic information that people might require.'
Few people expect matters to improve in the next two years as the NHS diverts its IT resources to solving the millennium computer bug.
Remarkably, however, some islands of development are still taking place. If Mr Dobson wants to look at a trust developing the technology to extract basic information needed for good clinical practice and management, he could do worse than visit Aintree Hospitals trust in Liverpool.
After a three-year battle for permission to buy the pounds2.5m system, the first major components are about to go live. It is not the first trust to procure a system, despite - rather than with the help of - the NHS Executive. 'They put a lot of pressure on us,' says chief executive David Wood.
Although the prime contractor is Olsy, a division of the computer maker Olivetti, the system will stand or fall by the software, which comes from an almost unknown Maidstone company, System C.
Aintree first hired the firm in 1993, to design an accident and emergency system for A&E consultant John Thomson, a computer enthusiast. It went live in 12 weeks.
That system is now part of everyday life in A&E, dealing with 100,000 episodes a year. The 250 staff all use computers to book in treatments and create the first stage of an electronic patient record.
A&E information manager Geraldine Dickson says the most important function is speed. In the Aintree system, all the fields that a receptionist needs to fill in are on a single screen.
'I saw one other system that took eight minutes to book in a patient, you had to go through so many screens,' she says.
The receptionist types in the 'presenting complaint' and the system codes it automatically. Clinicians and other staff can see at a glance which patients are in the observation ward and what tests and procedures they need before discharge or admission.
Following the successful start with A&E, the hospital went out to tender for an integrated system to replace its ancient mainframe computer which handled basic patient information. It shortlisted four companies, all major suppliers of integrated information systems.
Then things started to go awry. A cost-benefit study found that a new integrated system would not generate enough savings to justify the cost of replacing the old computer.
The hospital re-advertised for a system that would generate more benefits for clinicians. System C was shortlisted, along with MDIS, an established NHS supplier which installed one of the earliest integrated systems, at Glan Clwyd Hospital in north Wales.
Aintree picked the newcomer.
The Executive, however, had other ideas. The official line was that the technology was too risky. This was not without justification: the contract had some echoes of the London Ambulance Service disaster of 1992.
Like the LAS, Aintree had chosen a small software company with little experience of the NHS to design a system running on networks of small computers rather than big mainframes. Unlike LAS, Aintree's computer project has, so far, moved ahead with impressive support from staff.
In the end, it took three years and two assessments by management consultants of Aintree's project-management abilities to get the system through. The business case was finally approved in September 1996, by which time the original costs were hopelessly out of date.
Aintree made an unusual choice of outpatient department to pioneer the system: physiotherapy is usually well down the list. The department handles 50,000 outpatient attendances a year. Rather than merely logging patient names and numbers, physiotherapists enter full clinical details, using their everyday professional terms, for subsequent analysis and audit.
The system's long-term purpose sounds elementary, but has defeated more than one project: to compile a record of exactly what has happened to every patient who passes through Aintree, for clinical audit, good management and to provide information for contracting under the new system.
Dr Thomson says this is the most important of all. 'If your system doesn't have audit, then put it in the bin.'
The system has already revolutionised audit. It is now possible to analyse live case notes (actually copies running on a separate personal computer, to avoid the risk of requests for audit slowing down the operational system).
A recent audit on head injuries examined 2,500 cases. Going through the case cards would have taken a week: the electronic system took 10 minutes.
No one is predicting that Aintree will abandon paper medical records. But the system has already transformed the handling of case notes. All half-a-million files are now bar-coded (a couple of weekends' heroic work, with the chief executive helping out). They are logged out of medical records and logged in by the requesting department.
Computerising the NHS is a long game. Even after four years of hard work, Aintree is only now approaching the critical stage at which all data about inpatients goes onto the new system.
D-day is 1 April for the mainframe to be switched off. There is still plenty of scope for things to go wrong. But one hard lesson learned about computer projects is that they work if the people who sit down at terminals want to make them work. On that basis, the omens are good.
Mr Wood's advice for other trusts thinking of sorting out their information systems: 'You've got to be prepared to fight for it. There's no alternative way.'