Adam Drury says it is crucial to focus on the ways that IT and information can help the organisation achieve its objectives
NHS England released guidance Safer Hospitals, Safer Wards in July, which outlined a vision for achieving a fully integrated digital care record across all care settings by 2018.
There has been much activity within the acute hospital sector since the announcement of the associated technology fund, as organisations put forward proposals to use the available £500m to deliver their electronic patient record ambitions. As expected, the fund is heavily oversubscribed (760 applications for over £650m of funding) and there will be a significant amount of work to finalise the shortlist of projects that will have access to this funding in later in 2013-14 and into 2014-15.
However there are two main criticisms of the guidance and the funding that has been made available.
First, it is focused on acute hospitals and largely ignores the needs of other providers (except for fundamental enabling work such as NHS number compliance). This means many community trusts, mental health providers, community interest companies and private healthcare providers have difficulty in accessing this money to support their needs to improve patient safety and quality of care provision.
Second, it is focused on technology and IT solutions, not on solving “business problems” for which informatics could play a part of the answer to what are often long-standing issues in organisations.
Having a good informatics strategy, focused on the vision for how both IT and information can support the organisation achieve its objectives, is critical to ensuring that the value from investment in informatics (whether it is from the technology fund or not) is maximised and that opportunities to lower cost and improve quality of service delivery are taken.
Nine steps to success
Here’s how we can develop an informatics strategy that supports the quality and safety of care for patients and service users, regardless of whether there is access to central funding. The strategy should focus on solving business problems − strategy development needs to be driven by the business needs of the organisation and not the current or planned future informatics programme. It is important there is a strong alignment between the organisational objectives, ambitions and business plan and the planned informatics developments, as these will be key enablers to organisational success.
1. Focus on information needs and not systems that capture and report the information − the business requirements drive the information needs for the organisation, which in turn are delivered through one or more systems that are able to support the information requirements. By not focusing on systems or technology, you will maximise the opportunity to develop innovative and effective solutions that support the core business of care delivery and help ensure ownership across various levels of your organisation.
‘Do not over egg the business case for investment on cash releasing benefits’
2. Look at what other people have done already − there are many case studies of where NHS organisations have used technology effectively to improve productivity, efficiency, quality and safety. Having a good appreciation of what other organisations are doing and their direction of travel can help shape our thinking locally.
3. Ensure that process change is resourced as part of the strategy − good IT overlaid on a bad process still leaves a bad process, and the failure of many informatics implementations have a common “root cause” of lack of appropriate change of ways of working when the new solution is implemented.
Putting in a new system is a great opportunity to get users to review the way they work, look for new ways of doing things that improve both the working life of the staff member and the care of the patient, and then get the new IT system to support these new processes (and not hinder them). This needs to be a core part of the strategy to ensure maximum opportunity to achieve the benefits from investment.
4. Benefits and outcomes need to be clear, baselined and measured − it will not be possible to know if the informatics strategy has been successfully delivered unless it is demonstrated quantitatively. A focus on benefits needs to be in place from the start with a set of clearly defined, measureable benefits for informatics developments in place (with baseline measures undertaken) that can be monitored through the lifecycle of the strategy to demonstrate progress against plan.
5. Do not over egg the business case for investment on cash releasing benefits − in developing the strategy it is often highly tempting to outline how informatics will save the organisation money in its own right. This may be possible in some cases such as saving of paper and transport costs when electronic records are used more extensively, but in a lot of situations IT solutions are an enabler of overall organisational productivity and efficiency improvements, as well as directly supporting non-cash releasing benefits (such as quality and patient safety benefits).
Being clear about how informatics can support initiatives such as improved length of stay or reduction in prescription errors is critical to getting organisational sign-up to the strategy and alignment with a wider set of initiatives that are core to the organisation achieving its objectives.
‘Training is not just about pressing the right buttons in IT systems − it is also about “hearts and minds”’
6. Ensure leadership buy-in from the top to the bottom of the organisation − having the right leader for the informatics strategy development and implementation is only part of the story − it is important that there is full support from the board, chief executive, senior management team and all leadership levels throughout the organisation to ensure that the strategy is owned in the organisation itself.
7. Do not forget the clinicians and the patients − many organisations are now appointing chief clinical information officers into part or full-time positions to drive forward implementation of technology into clinical services. It is important that strategy has senior clinical support in the organisation and is developed in conjunction with clinical stakeholders.
It is also recommended that where possible patients should be involved in the development of the strategy − they will have a different set of requirements to the staff and it is important that their needs are catered for, particularly with the strong push towards patient accessing their own records as outlined in the recent NHS information strategy.
8. Ensure you clearly outline the need for appropriate capacity and capability in your informatics service − to deliver the informatics strategy, you will need the right number of people with the right skills at each stage of implementation. This will change over time so a clearly defined workforce plan should be a key part of the strategy. It is often easy to overlook the additional support requirements that will be needed in services such as IT service desk and desktop support as the organisation becomes more reliant on IT. Make sure an appropriate uplift in funding for these services is included in the associated business case for investment.
9. Training is not just about pressing the right buttons in IT systems − it is also about “hearts and minds”, implementing new processes and sorting out issues that have affected the impact of previous informatics implementations, for example data quality. Ensure that suitable attention is paid to the required training and business change support that users will require to get the best out of the new informatics solutions they will be using.
Bristol Community Health
Bristol Community Health has recently developed an informatics strategy for its community interest company community services provider organisation, to help it ensure that its informatics requirements for the next five years are clearly aligned to the development of its business.
Starting with some key issues in the organisation, in particular the need to find a replacement for the Rio system provided by the national programme for IT when this contract ends in 2015, clinicians and managers worked together to develop a set of high level requirements not only for their clinical system needs, but also informatics service provision, business intelligence requirements and the needs for enabling infrastructure. From the requirements, a series of options for delivering its business needs were developed which, following appraisal against a set of business driven criteria, formed the basis of its informatics strategy.
Lancashire Care Foundation Trust
Lancashire Care Foundation Trust has been working to ensure that any business cases for investment in IT enabled change projects from its clinical services are robust and contain detailed information regarding the planned benefits from implementation of service change.
A list of specific and measureable benefits was developed from the implementation of mobile working, which was subsequently baselined. The cash releasing and non-cash releasing benefits required, and their phasing, were documented in a benefit profile and the process for measurement and reporting of benefits agreed. The trust is now using an Excel based tool to track and manage the various benefits associated with the implementation of mobile working and is planning to use the same process for other IT enabled change initiatives across all its clinical networks.
Adam Drury is a principal consultant at Finnamore