EHI focus on: Stockport

In May this year, Stockport NHS Foundation Trust signed a contract with iSoft to continue using the company’s PatientCentre patient administration system for a further five years.

That was before the Department of Health announced the “accelerated” demise of the National Programme for IT in the NHS; which should have delivered iSoft’s Lorenzo system to the trust as part of CSC’s local service provider contract for the North, Midlands and East.

So it might have looked as if the trust was biding its time; extending the life of the system it already had, while continuing to wait for Lorenzo. But the trust’s assistant director of information, Ian Curr, says that was never the intention.

“We’ve taken out of the national programme what is right for us – we’ve got PACS (picture archiving and communication system), we’ve taken a decision not to take NHSmail, we’ve got theatres – basically we’ve taken what suits us.”

Rolling out electronic prescribing

Instead, the trust is very much focussed on doing its own work, on its own terms. Its decision to sign a renewed £2.1m contract with iSoft was made primarily because it wanted to implement the company’s electronic prescribing and medicines administration system.

It plans to go-live with ePMA in February, and looks to be on target to become the third site in the UK to launch the system – following Pennine Acute and Leicester, which both achieved go-lives in the past month.

Stockport plans to pilot the system from February, and then go back to the board to seek approval to roll it out across the trust.

Although it has not been involved in NPfIT saga, the trust has not been immune the delays that can hit any major IT project. Curr says it has been forced to go ahead with its launch ePMA without having the patient administration system updated.

The PAS was refreshed in February, but Curr says even that took longer than expected. “Getting the 4.2 version has taken a long time; and we think that moving to 4.3 will take an equally long time. If we waited for that it would have held up ePMA going live.”

The trust is also in the midst of a project to update its integration engine. It was using iSoft’s Cloverleaf engine, but will replace this with the Viaduct engine that iSoft acquired with BridgeForward two years ago. Curr says the newer engine is much more modern, with “drag and drop” functionality.

The trust’s IT team will be ‘watching and learning’ as iSoft builds the first eight interfaces; and then it will build the rest itself. The interface between the electronic prescribing and patient administration systems will be one of the first to be built.

Ready for mobile

Aside from the iSoft upgrades, the trust is undertaking a variety of projects focussed on upgrading its systems, increasing integration and preparing for increased mobile working.

The biggest of these projects is by far a refresh of its communications network. The trust has been operating with the same network for the past eight years, and Curr says this was enough to prompt a complete overhaul, in which £1m is being invested.

“The analogy is that if you have an eight year old car there’s only so much that you can do to keep repairing it before you have to buy a new one.”

The trust’s ‘new car’ has parts coming from Cisco and service from Block Solutions, and it should be in place by March 2012.

The other main driver is to enable the trust introduce more, and better functioning, mobile working. The current network infrastructure was implemented with wireless technology that was adequate enough to support the Hospitals at Night service.

But project manager Hugh Hughes says it simply wasn’t mature enough to handle systems that demand more from a wireless network, such as nurses using computers on wheels.

“The staff were trying to do ward rounds and they were hitting blackspots, simply because the wireless network wasn’t good enough to cope with that,” Hughes says.

The new network will bring a lot more resilience. But it will also support the introduction of other types of mobile working – such as the use of handheld devices on wards and, in the future, providing access to community and home-based workers.

The trust also plans to look into increased CCTV coverage, and into tracking for devices and even people. To link all the systems together from a clinician’s viewpoint, the trust has also been working to implement single sign-on from Imprivata.

Single sign-on; not as easy as it looks

However, this has been a challenging process. Curr says single sign-on is not as easy to implement as is sometimes imagined: “A lot [of trusts] have bought it, but may not have made it work. We bought it two years ago and we are only just now beginning to get it to start working.”

One of the big stumbling blocks has been that the trust is using Windows 7 on its desktops – which it has discovered is not compatible with NHS Connecting for Health’s smartcards.

Hence, the trust has had to procure smartcards from a separate company. It is waiting on their arrival before introducing staff to the technology. It will begin by giving consultants in A&E access to the single sign-on as a ‘test-bed’.

Curr says the cost was unexpected; but the trust will offset some of it by using the smartcards for staff access to car parks, wards and other areas.

Building around document management

Many trusts put the PAS at the core of their integration approaches. But Stockport has taken a different route. Its Advantis clinical document management system has become integral to integration both within the trust and with its contact with the local primary sector.

The trust is increasing efficiency and reducing paper by allowing consultant to consultant contact through the CDMS for patient referrals.

New software will sit within the CDMS to create the equivalent of an ‘airport arrivals’ board for departments - alerting them when a new patient is referred to them. It should also automatically update the electronic patient record.

The CDMS is also being used as a ‘one stop shop’ for local general practitioners. Any GP in the area is able to get a log-on to view the system and any information it holds on their patients.

“It will let GPs see any medications that their patients are on, check if they have been to the emergency department, if they go to outpatients, or they will be able to see where they are on any waiting lists,” Curr says.

Add to that the creation of the direct document system, which is looking to save the trust £100,000 on printing GP letters, and the Stockport trust appears well on its way to becoming an integrated care provider.

The trust has recently acquired Tameside Community Services and is currently bidding to take over Stockport Community Services. With these two acquisitions, the need for mobile working will only grow.

Curr says the trust also wants to become a ‘proactive’ provider of care, rather than a reactive one, and to make sure that its IT can support this ambition.

“All of these projects are really about becoming a proactive provider, rather than reactive,” he says. “We want to move away from being simply an acute trust, and a separate community trust, to a full healthcare provider.”