Mooving with the times

“Cows in the Isle of Man have better ‘electronic patient records’ than patients in the NHS,” consultant Sean Brennan joked at the NHS North West ISD Network event in Manchester.

As the managing director of Clinical Matrix – and long-standing observer of the NHS IT scene – observed, there has been a long-standing desire in the NHS to create a single, fully-integrated electronic patient record.

But he argued it was “time to face facts” and admit this might never happen. The North West is one of the areas that has been waiting for local service provider CSC to deploy the Lorenzo electronic patient record that still in use at just three ‘early adopter’ trusts.

A slowly growing number of acute and community trusts are now devising their own IT strategies, and going out to tender for their own systems.

In doing this, Brennan said they should try and avoid constantly redoing work that had been done elsewhere. “If you see a good idea, just go and bloody knick it,” he said. “I have lost count of the amount of times I have done it. You don’t have to reinvent the wheel.”

Lorenzo – working and going mobile

Not that Lorenzo is dead yet. At another session at the event, which was organised by the Informatics Skills Development Network in the North West to spread ideas for improving patient care through technology, Steve Fairclough insisted that the system “works.”

The head of health informatics at University Hospitals of Morecambe Bay NHS Foundation Trust, which was the first acute – and most high profile – early adopter of the electronic patient record – admitted that “we had a bumpy ride for three or four months.”

But he said the system was now providing his trust with the “flexibility to do things, such as mobile working Apple iPad tablets”, which is being piloted across four wards at the Royal Lancaster Infirmary.

This was met with some scepticism from delegates in the room, but Marc Hadwin, EPR programme manager at the trust, said the project was using a “mobile application version of Lorenzo”; and that other developments are planned.

For example, he said electronic whiteboards that “plugged into” Lorenzo would be rolled out at the trust next month, to help staff track the progress of patients. And the trust is using the system for electronic discharges and to share information with local GPs using EMIS Web and the Medical Information Gateway.

Toughbooks and iPads

One of the themes of the event, which attracted around 80 representatives of trusts in the North West, also outlined other successful projects in the region.

Indeed, Alan Spours, chief information officer for NHS North West, opened the event by saying that it wanted to be “a celebration of success stories”; many of which focused on mobile working.

Ben Ryan, clinical IT trainer at North Tees and Hartlepool NHS Foundation Trust, explained how it is using Panasonic Toughbooks to give community staff offline access to information held in TPP’s SystmOne, which its community provider arm has used since 2008.

“We received the Toughbooks as part of a Department of Health initiative; [we were] one of 11 early adopter sites for the [Mobile Health Worker Project],” he said.

“As part of this, we were provided with 50 devices which were split across four services and the first year of revenue costs were covered by the DH.” The second phase of the initiative saw a further 95 devices deployed.

Ryan said the project had reduced the amount of time that staff spent travelling, since they now had access to their schedules and emails, improved the amount of they could spend with patients by 22% and cut duplication of data-entry.

He also said there was some evidence that the Mobile Health Worker Project had reduced hospital admissions. However, he also faced some sceptical questions.

A representative from Liverpool Heart and Chest Hospital NHS Foundation Trust, which has rolled out a secure network to allow staff to use their own devices, including iPads and other tablets, said: “Doesn’t this defeat the purpose of mobile working?

“[The Toughbooks] are very clunky and really should be used for the battlefield; which to all intents and purposes they were built for.” Ian Curr, assistant director of information at Stockport NHS Trust, also said “the problem is; they are not iPads.”

Making the most of reform

The event also discussed some of the pitfalls of implementing good practice effectively. Joe Rafferty, director of commissioning development for the North West, said organisations sometimes tried to transport a “success story” into their organisations – but failed to do it effectively.

He said one reason for this was the understandable desire to “comprehensively make it your own”, but that in the process of doing this there was a danger of reinventing the wheel. “Just pinch it and contextualise it your needs,” he advised.

Rafferty is heavily involved in the development of the government’s commissioning reforms in England, working closely with Dame Barbara Hakin, and the business development unit of the new NHS Commissioning Board.

He acknowledged that those attending the event were often working against an uncertain background, and one in which money was tight.

But he said that to make the reforms work, NHS managers needed to understand that they were about moving from “the rhetoric of putting clinicians in charge to actually putting clinicians in charge.” He also emphasised that IT and information services would have a key role.

“There is the potential for IT and information to inform new ways of thinking about workflow and innovation, and to help the reforms address the very profound problems that the NHS faces as it goes ahead,” he said.

The Manchester event suggested that in looking to make the most of that potential, trusts look to good ideas elsewhere. Also, that much of the future will be mobile – and not just because it has four legs and goes moo.