EHI focus on: University Hospitals Birmingham

University Hospitals Birmingham NHS Foundation Trust has not been hanging around waiting for the National Programme for IT in the NHS to deliver systems. Instead, it builds what it needs in-house.

The trust started a decade ago by building its own, bespoke electronic prescribing system – PICS (prescribing information and communications system).

“The Department of Health was living in a space in which it assumed that NHS Connecting for Health was going to deliver something. We never really believed that,” executive medical director Dave Rosser says. “I worked for CfH, so I had a fairly good reason to believe that it would never happen.”

PICS the winner

University Hospitals Birmingham commissioned a team from the university’s engineering department to build a system specifically for handling tests in its liver unit.

It made sure there was significant input from nurses, who Rosser argues were left out of discussions about NPfIT systems, even though they work at the NHS coal-face and use them day-in day-out.

The system was then introduced to the renal department, where electronic prescribing was added, and after that demand took off throughout the trust.

After a brief hiatus with McKesson, who tried to make the system work on a SQL database, the trust TUPE- transferred staff from the university and has been developing the system and rolling it out ever since.

About 18 months ago, the trust decided to commercialise its in-house talent by entering into a marketing agreement with CSE Healthcare to sell the system. Rosser says there has been “quite a lot of interest”, but they’re yet to make a sale.

“I think it is because PICS is quite a big entity. Firstly, it is quite expensive and secondly, it is quite daunting – its range of functionality is enormous.”

A trust would have to pay £3m-5m to roll out the full system in a five year contract. But now CSE is offering trusts the option to implement parts of the system incrementally, with a cost of about £2m for the basic prescribing element.

Building a portal

PICS was only the beginning. The trust took iSoft’s iPM patient administration system in 2006 as an ‘interim’ solution from the national programme.

But it went on to develop its own clinical portal because it found iPM lacked the functionality it needed for a move into the new Queen Elizabeth Hospital.

IT project manager Deb McKee says the trust had “held on in the hope that the national programme would deliver something that would work”, but gave up as the timeframe for moving into the new hospital drew closer.

The hospital, which the trust started to move into last year, was designed for paperless working, and has no space for printed case notes.

The portal was developed in 2009 and fully integrates with the PICS system, digital dictation and electronic data capture.

McKee says they are continually developing the portal to give clinicians the information they need, and the next step will be integration with the picture archiving and communication system, so clinicians can use the portal to view images.

“We can do it and we know that it works, because we’ve tested it,” McKee says. “But we’re not allowed to use it because of NHS Connecting for Health - until they relax their integration rules we’re not allowed to do it.”

There have also been issues with trying to integrate PICS with iPM. Director of Informatics Daniel Ray says the trust hasn’t been able to feed data from PICS into the back end of iPM.

The IT team has managed to use Blue Prism to feed the data into the front end, but full integration across the trust is the main goal.

Big brother is auditing you

It is not the IT, but the information it generates, that really gets the IT team excited. “This is really Big Brother stuff,” Ray says, opening up an icon entitled ‘Clinical Dashboard’.

This is the trust’s own information analysis tool, which operates in every department where PICs is installed, and shows managers how departments and even wards are performing against national targets and other markers.

For example, a ward matron can see the number of patients who have had a fall within their ward, and compare that to other wards, and the number of falls in previous weeks. This means they can identify trends and take measures to stop preventable accidents.

Ray says Clinical Dashboard also helps managers to closely monitor the activity of junior doctors, which for a teaching hospital, is of high importance.

The dashboard presents information such as a doctor’s prescription errors, whether they accept responsibility for alerts about patients, and even how long they spend reading a patient’s history.

“This is just about asking the person about their activity if there’s a problem; it’s not about getting a big stick to beat them around someone’s head,” Ray says. However, he also says the tool has vastly improved the performance of the trust on a number of clinical and efficiency measures.

From PICS to PAS

The only place where it is yet to be introduced is in the A&E department; which is also the only place where PICS has not been implemented.

The trust has been working with CSE to develop its Oceano product, which is based on the architecture of RiO, the company’s community and mental health system, but with a lot of additional functionality.

It is due to go live with the Oceano emergency department module on 18 October. It expects that it will then need three months of integration work to get PICS working with Oceano, after which the Clinical Dashboard will be available to display the A&E department’s performance information.

But the trust has bigger plans. Rosser says it wants to be the first to buy the Oceano patient administration system, instead of moving from iPM to Lorenzo, which he says is “an adequate PAS, but not a PAS for the future.”

“We were probably taking a view that we had a 50-50 chance of getting a decent PAS out of the national programme,” he says. “We didn’t really have any significant hope that we would any high quality clinical programmes.

“We will move when they offer something that has better functionality than what we have, but that is a million miles away.”

Rosser says University Hospitals Birmingham decided to work with CSE on Oceano because there “wasn’t a willingness” from other suppliers to integrate their systems with PICS.

CSE’s strategic development director, Alistair Eaton, says the company should have a PAS product ready by summer next year. “We decided that now was the time to move into the acute market, we saw the end of the national programme coming and made that decision,” he says.

Eaton adds that CSE is already in discussions with other trusts about possible implementations, and expects a number of go lives to be scheduled for 2013.

However, Rosser says it would be a “severe failing” in the UHB-CSE relationship if his trust wasn’t the first to get it. “With the work we are doing so far with CSE we are really pleased... we would certainly hope that in two to five years we would be running an Oceano PAS,” he says.

The chief executive of University Hospitals Birmingham NHS Foundation Trust, Julie Moore, will be giving a “view from the top” at EHI Live 2011, which is at the NEC in Birmingham from 7-8 November, while Daniel Ray will be talking about the use of data in “outcome measurement”. Registration for the conference and free exhibition is open now.