'Exemplar' digital hospitals trust hit by multiple tech-related traumas An award-winning IT rollout at one of the UK's largest hospitals trusts is beset with problems that prevent staff from accessing the data they need, creating inconsistent and insecure electronic patient records. A report by the Care Quality Commission (CQC), an independent regulator of health and social care in England, found …
A couple of decades back a hospital trust I worked for had an admissions system that required information to be input and read on two separate computers. The reception staff had to literally shuffle their chairs between the two machines. I suggested a KVM switch, but nobody including IT seemed to recognise how it could improve things. So nothing much has changed in twenty-plus years.
Most of the hospitals I've worked at (in the U.S.) are absolutely moribund when it comes to I.T.
In the name of patient safety and privacy, they have painted themselves into a corner and become the very thing they feared.
In my recent experience of outpatient clinics in the trust, there was a trolley full of thick files of paper with the records of former test results and consultations awaiting the arrival of patients. I mostly find this reassuring as in my present place of residence they were recently turning away patients owing to a ransomware attack on their all-electronic system.
Apart from the availability issue, electronic systems do seem to suffer from two disadvantages: the first is that the approach to security means that clinicians have to go through a cumbersome logon process each time they consult a record because they've inevitably been logged out in the interval since the last patient; the second is that the medical devices don't interface directly with medical records systems. Some still dump their output to thermal paper. Streamlining all of that would be possible, but the investment would be enormous and the clinical benefit negligible.
I think we have to accept that NHS administrators tend to regard electronic records as supporting the NHS internal market and a source of lucrative data that can be commercially exploited. Concern about patient wellbeing is well down the list - tinkering around with computer systems is not going to result in there being an appreciably shorter backlog of hip replacements.
Lets first assume that the new system had been designed explicitly to be suitable for the medical data processing it is being used for, and that some hospital staff somewhere in the world had found it fast and easy to use.
However, since the system, as bought, installed and configured, seems to be unfit for purpose, one has to wonder whether the team who bought, configured and installed the system have any familiarity with the medical workplace and, specifically with the tasks the new system is meant to support?
IF NOT, WHY NOT?
I've seen more than one complex system implementation go badly wrong simply because none of the team understood the task it was supposed to support. However, I've also seen one or two others that succeeded, at least in part, because their implementing team included at least one member with experience in that specialty.
"NHS administrators tend to regard electronic records as supporting the NHS internal market and a source of lucrative data that can be commercially exploited. Concern about patient wellbeing is well down the list"
Speaking as an ex-NHS (interim) manager, I think you do us a disservice by assuming that approach. What I saw in colleagues would not support in any way your assessment.
I fully accept this doesn't apply to (most) people working in individual trusts - or indeed GP practices - who are simply trying to deliver care as efficiently as possible. However, there's ample evidence to suggest that the NHS centrally has rather different goals and ultimately it seems those will prevail as they control the purse strings and write the contracts.
Part of the issue is that there is no single provider for NHS Systems, a lot of the time someone will do 70% of what is required. Cerner may or may not include a Pharmacy component which means that a separate Pharmacy system would have to be sourced & would (hopefully) be able to interface with Cerner. Another central system might have pretty much everything but some of it not as good as a specialised system so that part doesn't get implemented.
Back in the day of on-prem system it was possible to use an integration engine to extract records from one system, do a bit of formatting and then pump that into a second system, rinse and repeat until you have several systems that can pull the relevant information from other systems. These days I would guess a lot is cloud based and a lot of what could have been done by internal IT is now a paid for service from the supplier so integration may not be as simple.
With the under-staffing in the NHS front line at the moment, people may also not be able to get trained on systems so what could be a 2 minute process ends up being 10 minutes & a call to IT.
Almost certainly how they got where we are.
2010 - lets have a mandatory data exchange format for our hospital
2012 - shiny new software installed - but 70% ofl trust's PCs are still running an older version of Windows and the MRI is controlled by an Apricot
2015 - we need a new system for whatever, there's the one that supports the 2010 standard, but now we have the new 2014 standard, we better buy that one
2020 - yeah, we tried to do this on the 2015 software, but the new standard uses US dates and needs all the times entered in Central Pacific Standard, so the staff mostly use the 2010 system
2024 - let's have a mandatory data exchange format for our hospital
These days I would guess a lot is cloud based and a lot of what could have been done by internal IT is now a paid for service from the supplier so integration may not be as simple.
and probably quoted at several billions and resulting in yet another service to port data to over time.
The cancer (sic) of NHSTrusts and (currently) Integrated Care Boards (was Clinical Commissioning Groups) has fragmented the NHS in pursuit of ‘choice’.
The NHs is collapsing under 210 Trusts - all with CEO’s, finance teams, property teams, HR Teams, ‘local takes’ on mandatory/required training.If I work for adjacent trusts, I need to do 2 sets of the same mandatory training.
All efficiencies of ye old Strategic Health Boards and National standards have been pissed up the wall.
worse still is the wide areas some trusts cover, but only for specific specialisms. I had dealing with a Trust like that covering two very large, mostly rural counties and a much smaller but very densely populated county. The mostly shared space with multiple other trusts across that area and in at least some places, there was an "us and them" mentality, so I can only imagine the admin overhead of interoperating with so many different trusts that at one time would all have come under individual regional Health Authorities. I don't know enough about how either system worked to have an opinion on whether it's now better or worse, but the implied extra levels of admin suggest that cost at least has probably increased significantly.
Quite why there need to be over 3 dozen overlapping and adjacent NHS Trusts (before you even talk about Ambulance Trusts) within a 50 mile radius of me is befuddling.
All with boards, IT, HR, procurement, training, property, finance… and some only doing specific health jobs. All trying to work - in some way - with some national systems like ESR (payroll, HR and training) and Accenture ran NHS.NET (Microsoft 365). but in many cases duplicating effort and using local systems (esp. training).
It makes the Co-op look like a well oiled machine by comparison.
Posting anon to protect personal information.
There are already 2 major Pharmacy electronic systems used in the NHS.
The one used in the vast majority of the hospitals where my partner has worked as a locum Pharmacy Technician is JAC (now rebranded as WellSky), which can interface with the dispensing robots from differing suppliers, and also has the capability of automatic ordering based on stock tracking.
As each hospital has it's own formulary for drugs permitted this has to be input at each and updated.
The main issue she faces is that it also has 'Short Codes' for common dispensing terminology, and these differ from hospital to hospital.
Pharmacy has been in the forefront of digitising the NHS and, as such, any newer systems should integrate with it, rather than vice-versa.
You're never going to get anywhere when even within the same hospital, wards and clinics are allowed to follow widely diverging processes around how information is stored. My aunt was in hospital last year - it regularly took staff 10 or more minutes to find relevant information as they didn't know where to look for it - because the ward they normally worked on filed or recorded things differently across both paper and the hospital IT systems. Even the simple process of booking a porter to get her to a previously arranged outpatient clinic appointment had 5 different flavours - after she missed one because the "proper process" for her ward wasn't followed and thus the request wasn't sent to the porters, my cousin and I started taking her down to them ourselves.
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