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£213m IT plan for Guy's and St Thomas'

16 April 2012   Rebecca Todd

St Thomas' Hospital in London

Guy’s and St Thomas’ NHS Foundation Trust plans to invest £213m in IT over the next five years, including the procurement of an electronic patient record system, clinical portals and mobile devices for staff.

The trust’s IT strategy was passed by the board in December last year and sent out to suppliers.

It aims to achieve; a resilient infrastructure that will perform 24/7; a 'third generation' PAS/EPR with integrated major specialty systems; mobile working via portals; integrated research systems; and a network that extends beyond the hospital into the community.

The strategy sets out a total capital investment over the next five years of £113m, which is £65m more than the current planned spend of £48m.

There is also an anticipated total revenue requirement of £100m over the five year period, which is £40m above current revenue projections.

Group IT director Scott Sommerville said it was not a hard task to get the strategy passed by the board which, if anything, was keen to invest more money and faster.

“I was able to describe back to the organisation what its ambitions were and how technology needed to be used in order to achieve that,” he said.

Each project will be presented as an individual business case with costs and benefits. The first project, for a “noteless paper light” programme - is going to the board next month.

Guy’s and St Thomas’ is one of the iSoft7 group of trusts in London and the South that chose to stick with their iSoft i.PM and i.CM systems ahead of the National Programme for IT in the NHS.

This group recently agreed a new deal with CSC to retain their systems. But the Guy’s and St Thomas’ strategy says the clinical system - iCM - is “limited in scope for expansion.”

It also says the trust needs to make such a heavy investment in IT because there are problems with the multiple systems that staff have to use at the moment, which "have been developed incrementally without a coherent plan."

Work has been completed over the last two years on making the fixed network and wireless network more resilient and able to support the future needs of the trust.

However, the servers and storage used to deliver applications are in “varying states of reliability.”

The strategy document projects an investment of more than £25m in supporting infrastructure over five years. This new infrastructure will be capable of operating 24/7 and supporting a mobile workforce.

The plan is to implement an interim e-prescribing system in this financial year with a picture archiving and communications system and radiology information system likely to be rolled out over 2013-15.

But Guy’s and St Thomas’ wants to achieve a paperless environment with the implementation of the EPR, which is to be procured between 2013 and 2015.

Sommerville has built up the trust's programme management office to run the strategy. He has also created a design team with a chief architect, enterprise and clinical architects doing detailed design work.

And he has commissioned a “root and branch audit” of the IT systems, processes and people to identify where the risks lay ahead.

“We will use consultants and suppliers to deliver a large part of the expertise. The key is that we retrain our people as we go through this process so we end up with the expertise in the organisation,” Sommerville said.

“It’s an ambitious plan, we need to be really diligent in our upfront planning and really professional in the way we approach this.

“I feel highly excited about it myself and the team are really quite energised. We look around the NHS and don’t see a lot of organisations attempting to do what we are doing.”

The cost of procuring an EPR and the development of big systems such as PACS over the next five years is estimated at more than £35m.

An estimated £8.4m will be invested in integrated desktops to provide a view of information pulled together from various systems.

Staff will have a single sign-on with automatic access to all the information they need to do their job, the strategy says.

The inpatient view will enable a “paperless ward” with live bed state and electronic ward observations and there will also be a community portal and GP portal.

New devices will be made available to support this new flexibile working environment such as lightweight laptops, tablets and small hand held computers.

A new programme called ‘Hospital in Pocket’, introduced this year, will see all existing phones, BlackBerry smartphones, bleeps and pagers replaced with a smaller number of standard devices.

Laptops will be developed with “offline” capabilities and tablet devices will be introduced alongside bedside terminals. In parallel to this, the trust will be investing nearly £13m in systems access services.

“Increasingly sophisticated software will be deployed to monitor and control staff access whilst simplifying the process of accessing trust systems and services,” the strategy says.

The trust is also looking to invest in video conferencing capabilities, which will ultimately be extended to patients in their homes, and explore the use of telemedicine, starting with A&E.

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Related Articles:

3 News: ISoft7 complete five year deal | 21 February 2011
News: ISoft7 reach £25m agreement | 23 December 2010
Last updated: 18 April 2012 12:49

© 2012 EHealth Media.


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Exit Strategy

Neelam Dugar 139 weeks ago

Jack--Whatever the clinical system (Wardware, your EPR etc), dont forget to agree an exit strategy at the time of contract. I would suggesting help from a HL7 CDA & IHE type of independent expert to help you.


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iSOFT7 Exit strategy

ColinS 138 weeks ago

One of the major areas we concentrated on when re-negotiating the i.PM and i.CM contracts with CSC was around the exit strategy as we recognised that the existing CFH contracts were lacking in this area. We believe that when we move from these systems we now have a tighter definition of what we will be able to migrate from these systems (including cost caps) and how. Our EPR, as Jack indicates, is based on i.CM but a lot of the data that makes it functionally rich sits in tables under the Trust's own control. Our expectation is that that will be the case with Wardware as well.


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Wardware, Kings, GSTT and KHP

Jack Barker 139 weeks ago

It's hard for me not to comment on some of this.

With respect to WardWare, we (KCH) aspire to get it context linked to our EPR - in fact that is one of the things that has delayed the roll out. Otherwise it seems a popular application, especially with the nurses, on the two wards that are piloting it.

As with all "best of breed" solutions we will need to define what is recorded and viewed in our core system and what is viewed in the sub-system (WardWare). We have integrated .Net and SSRS applications into our host EPR and much of the clinicians activity, including, 3 million bedside clinical notes, is undertaken in this environment. Therefore we may not use all the functionality in WardWare as we have other places to record and display important information. Similarly we probably will not use it to run ward rounds as much of the information relating to quality and safety is hosted and better presented from other systems. It will of course support ward rounds, just as the paper vital signs chart does now. We hope it will provide significant advantages in alerting us to patients who are getting sicker. We will definitely want instant access to the data as we may want to display it outside WardWare and communicate it to staff as part of more generalised messaging systems. We will probably want to present the early warning scores on TV based ward dashboards that we hope will replace the ubiquitous white boards.

With respect to GSTT, they have done brilliantly to extract promises of large amounts of money for IT from their executive. However, one of the biggest challenges we and GSTT face is that we are part of a large Academic Health Science Centre (AHSC), which also includes South London and the Maudsley Mental Health Trust (SLAM). It is likely that our IT strategies will need to be very closely aligned in the future.


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Thanks for the detail Jack

Rob Dyke 139 weeks ago

I too want deeper integration with context services, authentication and other systems and services. I'm really looking forward to working with KCH and others on the expansion of Wardware integration. As with lots of other software, the challenges are as much technical as they are political/social/economic &tc.

Take authentication for example: many Trusts have AD or LDAP, along with additional logins for a PAS/EMR and basic auth for other software. AD/LDAP could be integration with Wardware; can the auth mechanisms of EMRs be linked? Often not, as the provider has closed this down.

Your point about functionality is interesting. I imagine that there are just as many areas of overlap between systems as there are function gaps between systems. You've also given me some great examples as to what should be on the development roadmap for Wardware. The example electronic displays to replace whiteboards is great.

I am with you in applauding GSTT in securing funding for improved IT. There is another article on EHI which gives further examples of where some funds will be targeted. I look forward to seeing where GSST can 'connect all' through context, integration and interoperability for the care benefit of patients and the efficiency gain of staff.


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Wardware

Rob Dyke 139 weeks ago

For live bed state and electronic ward observations, G&T would do well to look at Wardware, an open source project from Kings.

Wardware captures bed side observations, calculates Early Warning Scores and improves ward rounds and handover through patient prioritisation.


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Best of Breed

Neelam Dugar 139 weeks ago

Wardware does look interesting, if a best of breed strategy was being considered.

Wardware deployment requires

1. HL7 integration with PAS for demographic & ADT

2. 1 click Context integration with ordercomms, e-prescribing, PACS etc.

3. Exit strategy--which elements of the information need to be kept, and thus will need to be migrated--temp charts, ward notes-medical, ward notes--nursing/allied etc. data that requires retention MUST be held in vendor neutral format--CDA & sent to a VNA. At the end of contract Trust can simply plug in a new ward management system & import data from VNA--data ownership through standards

3.


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Integration and exit...

Rob Dyke 139 weeks ago

1) Wardware supports HL7 integration using MirthConnect/MuleESB. We have integrated it at two acute hospitals in England.

2) This is in the road map for Wardware, however such one-click functions you propose are dependent on other systems supporting same integration (both technically and in terms of availability of features in the systems available at the site.

3) All the data is stored in MySQL and exit is supported through structured metadata. Additionally the basic output is Text/HTML in a table or with a simple graph.

Neelam, drop me a line and I'll arrange a demo for you.


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End of Contract Exit Strategy

Neelam Dugar 139 weeks ago

Pleased to hear Trust is spending on IT.

1. EPR must have vendor neutral content---CDA doc, DICOM images & XDS for indexing.--so the Trust can move to another vendor after 7 years with ease (no no expensive data migration)---XDS based VNA is reccomended as EPR strategy.

2. Clinical Portal Must be vendor neutral--Clinical Portal that is XDS consumer will access all EPR/XDS based documents. There is NO lock-in by your Portal or VNA vendor.


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Surely this is not a race to spend money?

AdeByrne 139 weeks ago

The comments, many of which I have seen before, urge us to spend more money on IT. I'll be honest, I wish I could. However, cases have to be well made, and it may be that G&T have done this. However, I am currently working on this for my own trust and it is clear that those benefits in efficiency not yet achieved are usually related to better recording for income purposes. This does not help my organization, as any proof of "extra owed" would certainly fall on deaf ears.

Therefore as a part of follow up on this if anyone has any genuine reason preferably by reference how for example "full pathway support" will yield tangible and proven benefit I would very much appreciate a post. Needless to say, anything as evidence that would cause a board to release the kind of sums talked of here would be interesting indeed. Will this deliver if we are not (as we were under the national programme) delivering a full community programme? Do we need to think of full community wide implementation to gain these benefits?

I tend to think that high cost technology deployments without the associated clinical [and other] business applications are highly likely not to yield results as quickly as hoped, and in fact are therefore highly likely to be obsolete by the time the users and software are ready.

This is not a call by the way for purveyors snake oil to contact me with their latest wares. You know who you are.


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Race to spend money

george385 139 weeks ago

I'm not sure I'm following this last comment accurately - perhaps I'm not? But are we suggesting that we are having trouble justifying spending money on IT to improve patient safety (as an example).

Thousands continue to be harmed under the care of the NHS each year in relation to drug related errors - perhaps focus on patient safety improvements rather than improvements to income recognition streams could justify spending?

The case for ePrescribing is well documented - if you don't already use it then perhaps investing money there is something to consider? The take up of ePrescribing in the acute sector is still woefully low - despite proven benefits (financial and safety)?


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Explained

AdeByrne 139 weeks ago

Thanks, what I was talking about was a large investment in things such as mobility technology without the correspondent software and use cases etc. If for example I "mobilize" the community midwives in theory they should access their system and work in real time. If I deploy laptops I have the well understood network issues and the software does not support off-line working. If I go to tablets I have the same problems plus an application that will not run native on the OS i.e. it's just a browser presentation. It could therefore be years before I can extract the benefits of the mobility investment.

I have no problem designing business cases to support better outcomes and safety, and ePrescribing (yes we are doing this) is one of those as you mention.

The hospital in pocket and paperless ward ideas presented are certainly where we are all trying to get to.

I suppose my point is £200m spent on one thing is £200m not being spent on something else.


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Not entirely the point

stan 10 139 weeks ago

Percentage spend on IT is not a key factor for the Board but what level of service transformation and improved effectiveness is going to be achieved by the investment. On the face of it this looks a good and ambitious plan and I wonder if the rest of the iSoft7 will look to get benefits on the coat tails....or whether GSTT are now going it alone.


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EHI Intelligence income/spend data

JBhatt 139 weeks ago

According to data collected by EHI Intelligence, in 2010-11 the trust had income of 992m whilst its IT spend was 26m. IT investment in 2010-11 worked out at 2.6%.


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Trust IT investment as a percentage of turnover

ehealthsolutions 139 weeks ago

Assuming Guy's & St Thomas' total annual income/turnover is in the region of 400 million (educated guess) then they are prepared to spend 10% of their income on IT modernisation.

But, many other Trusts seem to struggle to spend up to 5% of their income on IT? Is there not some sort of central guidance from the D of H on this issue.

Should the D of H not be closely monitoring how much each Trust is spending on healthcare IT and what they are getting out of their investment in the form of improved patient care?

My own personal view is that most acute Trusts are spending too little on IT and this is why most acute care clinicians have relatively poor software to support them in their high pressure and high risk working environment.


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Wanless

Lyn from eHealth Insider 139 weeks ago

It's hard to believe but it's ten years since Derek Wanless called for NHS IT spending to increase to around 3% a year to improve efficiency and tackle demand. Pretty much exactly ten years...

http://www.ehi.co.uk/news/ehi/162/nhs-needs-to-double-it-spending-%E2%80%93-wanless


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Nor productivity gains, nor public health

Lyn from eHealth Insider 139 weeks ago

Oh well, if we're going to talk key things that we haven't got since Wanless... how about:

NHS productivity gains of 3% a year, in part delivered by a more integrated, non-competitive service.

Big cuts in smoking and obseity.

Big cuts in socio-economic and health inequality.

Big increases in years of healthy life...


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Neither money nor standards

timbenson 139 weeks ago

The other half of that key sentence also said "stringent standards should be set from the centre to ensure that systems across the UK are fully compatible with one another". We don't have that either.


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GSTT turnover

E. L. Wistey 139 weeks ago

Last year the Trust turned over just under £1bn, so the investment looks less generous than that at about 4.7%


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