Portals are once again a hot topic in the NHS, with a starring role in the Power of Information strategy.
Yet, as Dr Lloyd McCann, medical director of Harris Healthcare Solutions in Europe, the Middle East and Africa, acknowledges “portal means different things to different people.” Indeed, there are three main ideas about the role of this technology in the acute sector.
The first is that a portal is a credible alternative to a new electronic patient record system – one that is cheaper, that avoids the disruption of a new system, and that allows clinicians to stick with ‘best of breed’ solutions.
As the National Programme for IT in the NHS winds down, leaving many trusts without the systems they hoped for just as they feel the ongoing squeeze on public finances, this is a major driver for portal implementations.
But some experts are not convinced that portals can be EPR replacements. The second view is that they are, instead, a useful step towards an EPR – one that allows clinicians to get used to working in an electronic environment while using familiar systems in the short to medium term.
The third is that they are useful even where there is a new EPR - allowing clinicians to connect information and communicate across a health community or with a specific user group.
Starting with the basics
The defining characteristic of a portal is that it is a web browser that sits on top of not one but of many clinical systems, bringing the information they hold into one view.
“That might be for patients to view or professionals,” says Dr McCann. “At the moment most trusts are developing portals for professionals and the majority of them serve single organisations, bringing together information from a number of different source systems.”
Predominantly, these source systems are the patient administration system, picture archiving and communications, the laboratory information system and document management, he adds; although others are coming on board rapidly.
From viewing to doing
The next question is whether the portal simply holds information, or whether it allows clinicians to do something with it; update it, order tests, generate correspondence and so on. “View and do is where people are going in terms of portals,” Dr McCann says.
Phil Birchall, healthcare business development executive at InterSystems, agrees that there is a significant move to portal technology, but says clinicians want more than a view of aggregated information.
“[Interest in portal technology] is a natural reaction to the situation that the market is finding itself in as the national programme comes to an end,” he says. “But equally, there is a lot of anxiety in the purchasing community as to whether a single, robust clinical solution exists.”
Often, he says, the portal story starts with a trust’s chief information officer or IT director wanting to give clinicians something tangible. “Very often it is about the desirability of providing a common desk top for clinicians,” he says. “It is visual and tangible. But the question then comes: is it enough?
“Our observation is that very quickly it creates highly desirable clinician engagement and demand for things they find useful. Very quickly, you have to start looking at the robustness of operational systems because clinicians want to do ordering, scheduling and prescribing.”
Creating a view-only portal can go two ways: it can stimulate demand that leads to an operational portal or to disappointment. Birchall argues that the difference between success and failure is often down to whether trusts see the portal as a tactical investment or a strategic one.
“With a tactical investment there is a risk of giving a quick fix but no follow through,” he says. “Trusts need to have a view of where they want to go and a road map of what will satisfy clinicians.”
The strategy will need to take in not just the vision but also how it will be underpinned with robust integration and interoperability, how the analytics will not just capture the data but also aggregate it into something useful for clinicians, and how to deal with information governance, security and so on.
Mapping the way ahead
This notion of a road map is widely accepted in the supplier community and is supported as essential both by Orion Health and CSC.
“It’s what we call our maturity model,” says Colin Henderson, general manager for the UK and Ireland for Orion Health. “We have products that take people along the stack, from integrating workflow and transactions to ending up with patient access and telehealth.”
For Henderson, there are four key steps in developing a fully functional portal: systems integration, developing a viewing portal, getting people to use it, and then introducing functionalities they want. “It’s like The Field of Dreams. Build it and people will come,” he says.
But he warns that it needs to be built well. “Presenting information is not enough,” he says. “You need to consider how to index information and how to present it in time lines that are meaningful to clinicians.”
There are issues such as single sign-on, launching applications within the portal, and access to consider.
“We have spent many years tailoring a portal for use by clinicians in the NHS,” he says. “Now we are seeing lots of new technologies emerging and there are lots of different ways of doing this. But the devil is in the detail.”
While some trusts go so far as to call their portal an EPR, and argue that it will eventually take them paperless, others are skeptical.
Nick Harte, solutions director at CSC, which has been developing portal technology in New Zealand for 20 years, argues that portals can provide some quick wins - but that, ultimately, they will take trusts only so far and no further.
“There are a few trusts in the UK that will go down the road of a genuinely portal-based approach for their EPR.
“But they are very few and tend to be in places where the chief information officer and chief executive believe that by buying bits and pieces and using local capability they are able to do it more cost effectively,” he says.
In general, he argues: “There is no substitute for an integrated system and we all know that. Ultimately, you have to have full semantic integration with full clinical support and that requires an information repository and a move to an EPR.
“For most trusts, portals are a transitional phase that will allow trusts to leverage their existing investments in systems until they are ready for an EPR and all the organisational change that involves.”
He argues that there will still be a role for portals – but he sees them more as a way of communicating with the outside world than as an EPR.
Some healthcare communities in England are already collaborating on community-wide portals or building use-specific portals, such as those being developed to share information about child protection, while the Power of Information arguably focuses on portals as repositories of resources for managers, clinicians and patients.
David Davies, senior director of collaboration and innovation at Cerner, also takes this view, saying that even where there is a new system, trusts are using portal technology to provide an electronic health record that captures information from other settings.
“[Our clients] recognise that all clinicians involved in a patient’s care need accurate, up to date, appropriate access to the full longitudinal record wherever it is created or added to,” he says.
“[They] are developing solutions with us that enable full relevant sharing of patients records from everyone involved in their care from the patients home to the acute facility and back again.”
Similarly Civica, which provides the community and mental health system, Paris. Managing director for health and social care, David Roots, says: “If a portal is implemented where Paris is the only system then it is redundant.
“What is more interesting would be a mixed trust that is taking over responsibility for, say, mental health and clinicians need to see information from different systems.
“But our overriding comment is that you should be clear about what you are trying to do with a portal, or you will end up re-writing the system in the portal - and that is not going to get any further than the national programme. There is a danger of wanting it to do too much.”