The North East Clinical Health Informatics Forum members are from a range of disciplines and sectors. Forum members have a keen interest in how 'enabling technologies' can support the delivery of efficient, effective high quality care, working collaboratively to facilitate clinical involvement in technological advancements within their organisations.
The members firmly believe that the key ingredient to the appropriate and successful use of these technologies within the NHS is Clinical Leadership and engagement from 'ward to board'. The Forum wholeheartedly endorses the campaign and will support the delivery of the 'vision' in any way it can.
Involving credible clinicians in decision making delivering effective information management support from the outset will deliver a lot more success than not. How anyone thinks that those who have never provided care for a patient, let alone experienced at it, can without informed clinical support lead on providing eHealth solutions, is a mystery to me.
Informatics teams often contain business change who assist with the bigger picture and ensure that the requirements are both future proofed and encompass areas which the end users may not be aware of - it really should be a team effort. Having said that if you keep asking what people want or need you are unlikely to deliver anything; so sometimes it is better to deliver something a little short of the mark and develop further using feedback on a live system rather than not deliver at all.
Without the right information, it is impossible to assess progress on improving outcomes, identify the interventions which will really make the difference, support commissioners in putting quality at the heart of their strategies or enable patients to make informed decisions. That is why information will be power in the new NHS. Clinicians need to be at the heart of this process, ensuring that information systems work for them, not against them, helping them to do their job. This is the reason why the concept of the Chief Clinical Information Officer is so powerful.
Mike Birtwistle, Managing Director of specialist health policy and communications consultancy MHP Health Mandate
“Information is the backbone of any business”. This is what I was taught during my first role in NHS information services and the lesson stands true in each place I've been since. This campaign is not only about ensuring greater clinical leadership in the use of information in the NHS. It is about enabling better and stronger leadership through the use of information. In no other business would we consider developing products without the customer at the heart – with information in the NHS, the customer is primarily the clinician.
In my last column for eHealth Insider, I talked about my enthusiasm for open source software, and mentioned that the NHS VistA project looked very promising. So what is VistA?
Well, it is a comprehensive, evidence based, open source healthcare information system with several million users. It was developed by the Veterans’ Health Administration in the US, which provides health and social care to several million ex-service men and women and their families.
Development began in the late 1970s and continues to this day. The project has had, and continues to have, millions of person-hours and dollars of investment.
The American equivalent of the UK Freedom of Information Act bought the software developers’ code into the public domain and VistA became open source.
Today, several large successful commercial vendors sell systems based on VistA by adding proprietary components and/or selling support such as vxVistA, Medsphere, and ClearHealth.
The Jordanian Government recently made a strategic decision to invest in a national programme to roll-out VistA across the whole of Jordan, on the basis of its cost-effectiveness and quality. There are further deployments in countries as diverse as Germany, Mexico, and Finland.
Why does VistA appeal to me as a clinician?
VistA appeals to me as a clinician because of its evidence base and because it has been built with input from clinicians, who have clinical users in mind.
Surveys have shown that VHA staff are so passionate about VistA they are reluctant to work anywhere else! But I can’t imagine missing the IT I have to work with in the NHS, where I have often been frustrated by the poor usability of the software in front of me.
VistA is also highly scalable. If it was deployed at scale in the UK, then there would be additional advantages. We could have a single care record across primary and secondary care and the opportunity to conduct service research at scale.
At the same time, we could have the safety and convenience of a unified system, which would be great. At the moment, junior doctors have to learn several new systems every six to 12 months, when they rotate between hospitals.
As a clinician who codes, having the option to make improvements, and benefit from improvements that others in the international community of VistA users make, would also be a huge boon.
Finally, as a clinician and as a patient, I care deeply about patient safety. At present, I have no way of telling if the software being used to treat patients works as the vendors claim it does.
For all I know, it could be buggy, or even malicious; but because the source code is secret no one can find out. It would be much better to have the source code out in the open, where it can be independently verified as doing what the vendors claim, and checked for bugs.
Why should VistA appeal to NHS trusts?
Open source health care software such as VistA will prove to be a highly strategic investment. The use of open source software represents a competitive advantage and is increasingly standard to industry and government.
One scenario I can see playing out, in the current climate of financial austerity and fierce competition on clinical outcomes, is for a leading foundation trust and an academic health sciences centre to share the initial cost of adapting VistA for use in the NHS.
Freed from on-going software licensing costs, and able to cheaply and rapidly adapt to hitting clinical, quality, and safety outcomes, as well as research targets, the investment would be recouped quickly.
The National Programme for IT in the NHS hasn’t delivered; foundation trusts are empowered to take such procurement decisions; and adopting VistA makes sound business sense - so I’m quite confident it will happen.
What are the barriers to implementing VistA?
The biggest barrier is the need for an initial investment to adapt VistA for the NHS. The grass-roots ‘NHSVistA Campaign’ suggests that this one-off cost could be as high as £15-20m.
Existing NHS IT staff and management may be unfamiliar with open source software. And, since the sale of proprietary healthcare software represents a multibillion dollar industry, they will no doubt encounter any amount of lobbyist generated fear, uncertainty, and doubt against open source.
This may be where chief clinical information officers come in. CCIOs have a responsibility to help their organisations to make the best possible clinical software procurement decisions they can.
There is much to be learnt from CCIOs working aboard, such as those achieving such impressive results is the US Veterans Affairs hospitals with VistA.
The goal must be to engage clinical staff, chief information officers, and chief executives in delivering healthcare information systems that are a joy for clinical staff to use, are cost effective, and improve patient outcomes.
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