There are two camps when it comes to views about the future of Business Intelligence in the NHS.
One camp is despondent. The people in it point to a lack of large tenders from providers and wonder whether software vendors will survive.
Another camp is more upbeat, pointing to upcoming tenders from the commissioning support services that are being set up to support clinical commissioning groups, and a buoyant market for consultancy on developing BI in service transformation.
Drivers and inertia
On the face of it, it’s odd that the despondent camp exists. All the policy drivers would seem to indicate that NHS organisations need to improve their BI, and that this applies in spades to NHS trusts.
The move to a more commercial environment - with semi-autonomous foundation trusts, commercial providers taking over NHS services, and new demands from Monitor on service line reporting and, eventually, patient level information and costing - is one of them.
Martin Bell, a former NHS IT director who is now an independent consultant, says: “Any business in any other sector would want to know how it is doing and there should be more of a drive to BI that goes with this increasing commercial environment in the NHS.”
But BI suppliers report that all is quiet on the acute front. Those trusts that have BI systems are sticking with what they have got; those that are merging may at some stage down the line look at a new system; those trusts acquiring a new patient administration system are looking to develop a BI solution within the deployment.
Christine Whitehouse, managing director of Stalis says: “The problem is that if you already have something, it is very difficult to change and is there is no business imperative such as a merger or a new PAS, it is very hard to make the business case.”
It is a dynamic that Ardentia recognises. Darren Smith, head of marketing, says: “Traditional BI tools and solutions are not enough right now and we feel as a BI company that we have to be able to add context and demonstrate to the customer some added value.
“We are at the moment exploring a framework agreement with a PAS supplier that would enable the PAS supplier to provide a suite of BI tools as part of the package. I think this will be the direction of travel – helping trust to make best use of the data warehouse that comes with the PAS.”
One example of adding value and making better use of data from BI systems – and in particular PLICS – is patient cost benchmarking. There are now more than 40 trusts involved in a patient cost benchmarking project developed by King’s College Hospital and Albatross Financial Solutions.
It is helping trusts to understand their own costs as well as how they compare with others and explore where they are working above or below tariff. “These trusts were putting a lot of effort into patient level costing so they were asking ‘what is the next step?’ They were asking ‘what can we do with this information?’ and benchmarking is the logical next step,” explains Mike Hamilton, business development director at Albatross.
The tool is being used not just by trusts but also by national organisations, including Monitor, to gain a better understanding of how to set tariffs in the NHS that accurately reflect the cost of activity – in other words, to deliver some real business benefit from existing systems.
More activity on the commissioning front
The scenario in commissioning land is quite different. In August, the NHS Commissioning Board announced how networks of CSSs would be established to provide BI services such as data management and integration to CCGs.
Four consortia of CSSs are expected to collaborate to provide these services: North East and North Yorkshire and Humber CSS collaborative; South and West Yorkshire CSS collaborative, comprising the West Yorkshire and South Yorkshire and Bassetlaw CSSs; The London CSS collaborative, comprising North West London, North Central and East London, and South London CSSs; The South CSS collaborative, comprising Commissioning Support South, Surrey and Sussex, and Kent and Medway CSSs.
The North West London Cluster Board is tendering for a new BI system; a separate tender from Central South Commissioning Support Service envisages providing BI for the area around Oxfordshire and Gloucestershire.
“We are finding that BI is reasonably buoyant,” says Graham James, managing director of CACI. “These are large tenders looking for data integration, data warehousing, data quality, and analytics. They are very related to the patient pathway and are all about helping commissioners understand what they should be commissioning from providers.”
Nigel Slone, managing director of Sollis, paints the same picture, adding that requirements are going beyond a demand for dashboards and cubes. “They are stretching the term BI and asking for data hosting, data importing, data quality, data integration, data warehousing, data processing and analytics.
“They are in there to provide services at scale because there is a belief that clinical commissioning groups are just too small to do this alone.”
Turning the wheel
In theory, this new demand for information may feed back into the acute and provider sectors. Slone expects it to drive a demand for real-time data from providers that will support commissioners in service transformation.
“Traditionally, commissioners have had to rely on national systems such as the Secondary Uses Service to get their activity and cost data.
“The feedback we are getting from commissioners is that there is too much of a delay and there will be an increasing onus on acutes to present their information in a more timely way. The constant refrain from GPs is that they need better data and they need it in more real-time.
“So we would hope to see an increased spend on BI and more imaginative solutions although we are not naïve about the shrinking cash envelope.”
And indeed, this is what Paul Henderson at Ascribe reports seeing on the ground. The market is not so much for new systems but for consultancy about how to get existing investments to deliver, he says.
Most trusts have data warehouses; a few have struggled to get value out of new dashboards and other reporting solutions and taking a more sophisticated view, he says.
“The days when people said ‘I want a new BI solution’ are pretty much over,” says Henderson. “Increasingly it is bound up in transformation initiatives where it is a marginal piece of a larger programme.”
So, for example, a traditional BI solution in an emergency department will deliver information around four hour waits. “But the problem people are trying to solve is how to get people to choose the right kind of care so they need to integrate data from walk in centres and minor injuries. The BI is marginal on this.”
His sense is that directors of performance and directors of finance are commissioning the work – although usually on behalf of a single organisation in the hope of developing closer integration across the sectors rather than from a consortium of providers and commissioners who are already working together.
So for 2013, we are likely to see a picture of acutes making better use of what they have and asking not so much for new systems but for help to make the best of them, while commissioning support services become the more important new customers.
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