When it comes to deciding when is the right time to outsourcing information management and IT services support, there are several issues that must be carefully considered.

King’s Health Partners Academic Health Sciences Centre is a pioneering collaboration between King’s College London, and Guy’s and St Thomas’, King’s College Hospital and South London and Maudsley Foundation Trusts. King’s Health Partners is one of only five AHSCs in the UK and brings together an unrivalled range and depth of clinical and research expertise, spanning both physical and mental health.  It is designed to attract world-class research and provide a resource for innovative medical training and best-practice patient care.

To facilitate the AHSC’s knowledge collaboration, King’s College Hospital recently undertook a review of its clinical information management infrastructure and IT services support. The newly-released results of this independently-commissioned healthcheckhealth check provides some strategic indicators concerning platform standardisation, data storage and whether or not to outsource some, or all, of its IT services.

King’s College Hospital Foundation Trust is one of London’s largest and busiest teaching hospitals. Serving over 700,000 people in the London boroughs of Lambeth and Southwark, it is a centre for clinical and technology innovation in neurosciences, cardiac, liver transplantation and haemato-oncology.

As part of the preliminary work towards supporting AHSC, King’s has been collaborating with its other trust partners to further develop the integration of clinical services and data sharing frameworks. Towards this end, the trust recently undertook to review its IT clinical information management environment and IT infrastructure to ensure it is best positioned to support AHSC requirements.

Benchmarking KPIs

In addition, King’s required an IT health check of its IT service teams to confirm that they were delivering best-practice and best-cost support to the trust’s performance culture.

Chief executive Tim Smart, who joined the trust in 2008 from British Telecom, brought with him a keen business and organisational perspective based on competitive efficiencies and he wanted to see how King’s compared with commercial norms. This was particularly in light of the hospital’s reputation for implementing innovative and highly successful technology, without having been part of the National Programme for IT.

Director of ICT Colin Sweeney says: “I consulted with our CFO and we decided that the best way to achieve this kind of sweeping review was to invite in Metri, a benchmark-based business & IT consultancy, to review our data sharing strategies, audit our service teams, IT platforms and networking systems, review processes and benchmark cost and performance indices. In addition to comparing these key performance indicators with both peers and market best-practice, our CEO felt it would be useful to compare the cost-efficiencies of in house vs. outsourced services.”

Data harmonisation

Towards supporting the new AHSC, the first recommendation of the report was to establish an integrated network to better enable the partners to work together more quickly, easily and cost-efficiently. Several challenges were identified including the need for increased standardisation of key clinical information management systems, both internally and across the four AHSC partner sites where appropriate. 

Mr Sweeney explains: “If we consider the electronic patient record, even though both King’s and Guy’s and St Thomas’ are using iSoft’s Clinical Manager, we are working with different versions of the application.”   

King’s is scheduled to upgrade in a few months to the same version, iCM 1.4, which will facilitate information sharing. However it isn’t that simple. “Even with the same version of the same application, each of the Trusts has configured their systems differently to reflect their unique cultures and clinical specialities, so, to some extent each one poses proprietary challenges,” says Mr Sweeney.

The challenges of legacy complexity

Another hurdle to data harmonisation, both enterprise-wide and across the four King’s Health Partners locations, is the complexity of King’s legacy technology. Among other things, this features eight different operating systems (including Windows XP, Vista, 2000), various versions of the Microsoft SQL Server and Oracle databases, different interfaces, network configurations and more.

“The good news”, says Mr Sweeney “is that we have been working closely with our clinicians to integrate clinical systems across the partner sites and we are making progress.” 

Data volumes expand

Since the AHSC relies upon a continual stream of enriched medical information, feeding the central repository involves the generation of ever-greater amounts of clinical data. King’s is highly innovative in this respect, having implemented numerous point-of-care data capture systems from electronic white boards on the wards, to mobile devices in the field. King’s went live in December 2009 with its latest application, a bed management system that enables the input and access to a range of clinical data, including highlighting abnormal patient test results and infection statuses.  

King’s is also implementing a new patient kiosk system that allows patients to scan in their booking letter on arrival and identify changes their own demographic details, which are then entered into the PAS. The trust also increasingly uses mobile texting for appointment reminders and Mr Sweeney estimates that over the past year, SMS data volumes have risen by up to 40 per cent.

Cutting costs with virtualisation

This ever increasing amount of data, while an advantage to both clinicians and administrators, carries with it some downstream problems. As the costs of computing power and web-based access to data shrinks, people have got used to the idea that information is virtually free, but it’s not – the more data that is processed, the greater the management costs in everything from data compilation to analysis, access, storage and archiving. The more the data, the more servers needed to store it. One of the report’s cost-cutting recommendations was server virtualisation, which uses software to automatically rationalise and optimise server space to dramatically reduce data centre costs.

Market-beating KPIs

In addition to strategic guidelines on such things as platform standardisation and server virtualisation, the study revealed that King’s IT services (including the desktop help desk, networking and data centre support teams) exceeded management expectations on the upside.  

In most cases, the report found that IT service teams’ productivity was higher than other trusts of a similar size. The service desk’s cost-per-contact was benchmarked at a 47 per cent lower cost than the market average, and the cost-per-managed-server came in at 12 per cent below the benchmark. Yet productivity and internal customer satisfaction showed above-average results. In terms of outsourcing, when measured against the major external service providers, King’s IT service teams showed positive cost/performance ratios. 

This led to the recommendation that the trust should retain service support in-house, at least for the present. So the question of whether or not to outsource is not dismissed – just delayed. 

The question of whether or not to outsource is not as straightforward as it may seem. In addition to matters of control and data security, the main issue is whether or not outsourcing is going to save money. This requires comparing the KPIs of both in-house IT service teams and infrastructure management, and those of external providers on an ‘apples-to-apples’ basis – which itself may be elusive since this requires granular visibility of each service component. 

It is also rare that a trust’s IT infrastructure conforms to a single outcome: typically some service components are best supported in-house, while for others, the business case points to using a service provider (whether on or off-site). However, determining which component falls into which category is no trivial task since each environment is unique.

Ultimately, it may require independent advice to measure and compare KPIs, since few chief informaton officers have access to the latest market pricing benchmarks and many outsourcers are less than fully transparent about their costs and deliverables.

There is also an inflection-point at which increased activity volumes or infrastructure size suddenly makes outsourcing viable: for King’s, this point of critical mass has not yet been reached. That said, as AHSC collaboration increases, the amount of clinical research data across the AHSC partners expands and managing a growing knowledge repository becomes more complex, the partners may look to new ways for its efficient handling.