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Look back, move forward

EHealth Insider asked NHS IT directors, GPs, opinion formers and a patient to look at the state of NHS IT at the end of 2012, and at what 2013 is likely to hold.
18 December 2012

As 2012 draws to a close, there is a sense that the unfinished business of the National Programme for IT in the NHS is finally being resolved; and that trusts are starting to take important decisions about their future IT systems.

However, suppliers and trusts will not have a monopoly on shaping the new market; increasingly, ‘frustrated clinicians’ are getting involved in hack days and open source initiatives.

Meanwhile, the new NHS commissioning structures and government pledges to open up services to patients will have a big impact in 2013; particularly in GP IT – where decisions are being made perilously late.

All this means that EHI’s list of expert contributors are agreed that whatever happens over the next twelve months, 2013 is unlikely to be dull.

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Christine Walters, associate director of IM&T, Pennine Acute Hospital NHS Trust

Thankfully, the last twelve months has seen a new agreement between the Department of Health and CSC for the North, Midlands and East of England; which is great news for hospitals like us. Liberation from the National Programme for IT in the NHS gives us renewed freedom to really concentrate on the technology that will fulfil the needs of the organisation, while clinical engagement has a real purpose.

There is some really exciting technology becoming available now the market has opened up: electronic prescribing; electronic whiteboards; and mobile technology to name but a few. However, we have seen an increase in user expectations. For every year the NHS stalls in its progress towards modern IT the bigger the jump, and the more challenging the implementation of the right IT, becomes.

So I hope the coming year will see some significant and exciting decisions being made to shape the function and purpose of IT to start addressing this. Hopefully, we will get some good press, too.

Working with clinical commissioning groups, opening up systems, securing more interaction across organisational boundaries, introducing faster communications, and securing greater autonomy for patients to manage their own treatment are all waiting for us in 2013. Bring it on!

James Rawlinson, associate director IT services, Mid Yorkshire Hospitals NHS Trust

2012 feels like it has been a year of structural change, the impact of which will really be felt in 2013. Trusts have increasingly started to procure replacement patient administration and picture archiving and communications systems; which just two or three years ago was still no-go territory.

Trusts in the North, Midlands and East are seriously thinking about Lorenzo as a fit for purpose solution (and those first in the queue get a million quid). However, with the massive re-structuring of the NHS taking place (you hear of replacement / new / interim chief executive every day) IT procurement and implementations will have to match the wider pace of organisational change.

Budget ‘squeezing’ will continue to take place, but those solutions that can truly evidence and demonstrate real and quick cash releasing savings are likely to be approved. In addition, and rightly, the NHS IT market is increasingly opening up to small and medium sized enterprises, which can innovate and deliver products at speed. So I’m certain we will see some ground breaking solutions.

Finally, it will be interesting to see how the ‘new’ Health and Social Care Information Centre develops and tackles the challenges of driving through national IT intentions, whilst keeping an ear close to the ground.

Daniel Ray, director of informatics, University Hospitals Birmingham NHS Foundation Trust

As 2012 draws to a close we finally have some much needed clarity that trusts are on their own to connect, replace and develop their clinical systems and informatics. More and more tenders are now coming out for systems, including e-prescribing, and for full-blown electronic patient records.

This is great news for patients for many reasons. But the one I want to comment on is the secondary use of the data. So much emphasis is placed on death rates (and I’m not saying they are not important) but what happens to the 96.5% of patients that leave hospitals alive?

What percentage of patients received a full set of observations every 24 hours? Which patients received all of the drugs they were prescribed? These and many, many other types of data will enable trusts to monitor how care is delivered for all patients; not just for the small cohort areas in which they may have inflated mortality.

In 2013, we will also see the GP Extraction Service brought online, which is very exciting and will enable the identification of how whole health economies are serving patients.

Bill Aylward, EPR project director, Moorfields Eye Hospital

This year has been one of the most interesting for a while, and there are signs that health IT is beginning to break out of the planning blight associated with the end of the national programme. There is a groundswell of demand from frustrated clinicians, desperate to see the quality of IT at work catch up with what they are used to using at home and in other consumer environments.

This has resulted in a number of interesting initiatives, including the NHS hack days, the OpenGPSoC project, and the OpenEyes collaboration. Funding remains a challenge, particularly now that the days of significant central resources are gone. However, there are signs that the benefits of open source are gaining acceptance in a market not previously used to it.

The new customer service platform being developed by the NHS Commissioning Board, if done well, is likely to generate a great deal of interest and activity in the market. Finally, the large number and the variety of applications for the ITK challenge fund showed that innovation and the enterprising spirit is still very much alive. Predicting the future, especially in IT, is a dangerous game, but I am certain that 2013 will not be dull.

Matthew Swindells, senior vice president, population health and global strategy, Cerner

Industry has been waiting for the government’s vision for healthcare technology since the decision to abandon the National Programme for IT in the NHS. This year saw the shape of the long-term market emerge, even if crucial details remain unresolved.

The launch of the Department of Health information strategy in May was an important first step towards a genuine long-term plan. The NHS Mandate, published in November, added to this with ambitious targets for the next two years.

The ambitions are broad, but the direction of travel to put information at the heart of a patient-centred NHS is right. If that is to be delivered, clinicians must be at the centre of IT decisions. This is why the launch of the EHI CCIO Campaign last year was so crucial. It called for all NHS organisations to consider appointing a chief clinical information officer to lead on IT and information projects.

Its rapid success was followed this year with the launch of the CCIO Leaders Network. As localised solutions come to replace the national programme, empowering clinicians to shape and champion technology will be crucial to transforming healthcare.

Looking ahead, 2013 also heralds major reform of the commissioning landscape, with the NHS Commissioning Board and clinical commissioning groups acquiring their full responsibilities in April. This coincides with major changes in responsibility for IT specifically, with the abolition of NHS Connecting for Health and the shifting of IT responsibilities to the NHS CB and new-look Health and Social Care Information Centre. Understanding the long-term implications for the market will be a priority in 2013.

Finally, the NHS is continuing to struggle with the pressures of increased demand, improving quality and pressure on budgets using the same old techniques it has deployed for decades. 2013 needs to be the year when the potential offered by information technology to allow the NHS to transform working practices, cut costs and improve quality is finally grasped.

Chaand Nagpaul, negotiator for the BMA's General Practitioners Committee

The key event in primary care IT was the decision by the NHS Commissioning Board to delegate responsibility for operational management of GP IT and associated funding to clinical commissioning groups at a late stage. Unfortunately, there is no clarity about the additional resources that CCGs will need to discharge this responsibility; for which CCGs have been given inadequate time to prepare.

Another key moment was the political commitment for patients to have on-line access to their GP records and e-consultations with GPs by 2015. This commitment was made prior to the government having fully considered the complexity of the issues and the potential for unintended consequences; and before the publication of an RCGP report on the subject that was commissioned by the Department of Health.

This means that one of the big questions for 2013 will be whether CCGs can be adequately prepared and resourced to implement the operational management of GP IT by April 2013. GP practices rely on competent and responsive GP IT support and maintenance on a daily basis, and any diminution or disruption of IT services will impact on patient care.

The other big question is how the government’s current proposals for imposing GP contractual changes for 2013-14 will include patient online access to records and e-consultations. How will this ambitious aim be managed? How will potential adverse consequences such as concerns regarding confidentiality be mitigated? How will GPs at large respond to any the increased workload arising from this?

We have lessons to learn from the implementation of NHS Summary Care Records about imposing IT changes predicated on a political imperative and timetable. Are we learning them?

Mary Hawking, Bedfordshire GP and NHS IT expert

This year has been a year of rapid changes - and changes to changes - at GP level (as well as elsewhere). Engaging with the emerging clinical commissioning groups and analysing the QIPP elements of hospital activity have made huge demands on time and resources (although there has been one good result - I have finally learned how to create pivot tables!)

Meanwhile, information vital to future planning has been released very late – Securing Excellence in GP IT Systems only came out on 4 December, and there is still no information about the funding that will be available for each CCG. This means CCGs will be taking on responsibility for GP IT from a standing start and with many unanswered questions in just three months’ time; not a long time outside politics!

There are various high priority initiatives for 2013: interoperability; patient record access; hospitals being paperless by 2015 (recently downgraded to 100% of referrals to be made electronically by Choose and Book); patient portals to replace NHS Choices; and new electronic patient record systems in secondary care. So it ought to be a good year for suppliers!

I'll be watching with interest: but I'm retiring on 31 March 2013 from general practice. Andrew Lansley finally convinced me it was time to go!

Dr Amir Hannan, GP and pioneer of patient records access

I predict that in 2013, clinical commissioning groups will take charge of local healthcare delivery and the true extent of the quality / financial / integration challenge faced will start to be revealed to patients, carers, clinicians and managers. The NHS Commissioning Board will attempt to explain itself with fine words, but actions may be harder to come by.

From an informatics perspective, the roll-out of EMIS Web, TPP SystmOne and INPS Vision 360 will continue in primary care and data sharing agreements may sprout with variable impact. Some acute trusts will begin the roll-out of locally-developed electronic patient record systems.

Further roll-out of electronic discharge letters will happen in pockets, but not as smoothly as possibly envisaged. The Electronic Prescription Service Release 2 will be more widely adopted, but patient access to records (as exemplified by my patient Ingrid) will not happen beyond a few sites without the required investment. There may be greater understanding of patient reported outcome measures and, perhaps, shared decision making, and greater awareness of the true opportunity afforded by open source.

My hope is that a few more places will have developed their own practice-based web portal (like www.htmc.co.uk) instead of accepting a centralised portal. This will help to develop a locally driven ‘partnership of trust’ between patient and clinician; and local health and social communities that invest in this will reap greater rewards.

More patients and clinicians will be using smartphones, apps and social media to connect; but that will bring its own issues of fragmentation – while those who become enabled and empowered will wonder what all the fuss was all about! The rest will have to wait as the cuts dig deeper waiting for handouts that do not materialise. Clinical, managerial, system supplier, patient, public and media engagement will become more critical as 2014 beckons.

Ingrid Brindle, patient representative, NHS North advisory board for online access to records

I'm a patient at Thornley House GP practice in Hyde and I've just spent my sixth year with online access to all of my GP records. So, what have I been doing online?

Well, I've booked appointments and ordered repeat prescriptions. I've also monitored my regular blood test results and copied them for rheumatology and opthamology, so they don't need to repeat them. I've been able to read my consultant letters and copy them, where relevant, to show to other consultants who are involved in my care - but don't talk to each other.

I needed to go to hospital while I was in France, so I downloaded two cardiologist letters and had them translated into French to take with me. I had a pre-op telephone consultation from London and was able to give the nurse all the information she needed without her contacting the practice.

In fact, I've taken all my medical records all over the UK and Europe, with just three passwords in my head! How would I have managed without it?


Related Articles:

News: Questions, questions | 28 December 2012
News: EHI's most read and commented 2012 | 27 December 2012

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