Smart Healthcare: London | SmartHealthcare.com

Liberty and Patients Association join SCR protest

Mon, 08 Mar 2010 10:57:40 GMT

Campaigners for civil liberties and patients' rights have joined the British Medical Association in attacking England's opt-out requirement for electronic patient records

The NHS in England is introducing Summary Care Records using a policy of "implied consent" – patients are assumed to agree to the creation of a record unless they refuse, reports The Guardian. The BMA wanted these to include an opt-out form. But Connecting for Health (CfH), the NHS body running the scheme, refused.

Instead, patients who do not want to participate have to get an opt-out form from their GP or request one by letter, helpline or website. Some 1.24m records have already been created and another 8.9 million patients have received a letter about the programme, according to the Department of Health. A record will be automatically created for each patient after 12 weeks unless they specifically withhold their consent.

Isabella Sankey, director of policy at Liberty, the human rights organisation, voiced serious concern about the summary records. "There would have been very good arguments for clear public information and an opt-in policy for this scheme," she said.

"But the worst of all worlds is to alleviate political criticism by providing a so-called opt-out which is inaccessible and virtually meaningless. How do you expect people to trust you with their most sensitive and private information if they can't even trust you to be honest in trying to gain their consent?"

Katherine Murphy, director of the Patients Association, said summary records could improve the care patients receive, but that they should all be given an opt-out form. There should also have been a national advertising campaign so people could start thinking whether to participate or not, she said.

Some doctors accuse the NHS of trying to scare patients into agreeing by claiming that future medical care could be impeded if they refuse. The opt-out form asks the patient to acknowledge that any future treatment may suffer if they do not have a summary record. "There is no evidence to say that is the case. It is scaremongering," one London doctor said.

Some GPs are refusing to release their patients' details until each one has specifically agreed. "We will not upload anyone's records without their explicit consent," said Dr Neil Bhatia of Yateley, Hampshire. "We control the data records and we are responsible for its release. No one can force us to upload it without a court order."

Wirral primary care trust in Cheshire was recently warned that pursuing summary records could be illegal. Despite these reservations, it accepted almost £70,000 from the NHS to pay for packs to be sent to patients.

Prof Ross Anderson, a security expert at Cambridge University, said there was no guarantee that only NHS staff treating someone could access their records. Hundreds of thousands of health service personnel would have a swipecard to enter the system.

"You just can't keep a secret if 300,000 people have access to it. All celebrities should definitely opt out," he said. "The sort of things you can find on SCRs, such as prescriptions for anti-retroviral drugs, can also be highly stigmatising."

The BMA is writing to Andy Burnham, the health secretary, to say that while it supports the idea in principle, it has serious concerns. Dr David Wrigley, the BMA council member for Lancashire and Cumbria, said: "How do we know that people have received the material in the post? Doctors in my area wanted a tear-off strip to be included at the bottom of the letter for patients to fill in and hand in to their GP's surgery to say no they didn't want a SCR, but CfH told us we couldn't do that."

A Department of Health spokeswoman said that the model of implied consent being used was adopted in accordance with national information governance good practice and was supported by the Information Commissioner's Office.

BMA criticises SCR enrolment process

Fri, 05 Mar 2010 15:33:38 GMT

It should be easier for patients in England to opt-out of having Summary Care Records, according to the British Medical Association

The BMA has criticised the fact that there is no opt-out form included with the information sent to patients about SCRs. Instead, patients have to request the form online, through calling an 0845 phone number or by informing their GP.

If patients take no action, the NHS will automatically generate a centrally-held record from their healthcare data. However, as in Scotland healthcare practitioners will have to ask patients for permission to view records on each occasion.

The association also said that patients are inadequately informed about whether or not to opt-out, citing a 2008 evaluation of the records' introduction by academics from University College London, which found that seven in 10 patients in early adopting areas were unaware that their records would be added to a national database.

The criticism comes as five of England's strategic health authorities are moving ahead with introducing SCRs across their areas: the north west, north east, Yorkshire and Humber, London and east of England.

"The Summary Care Record roll-out is now happening too hastily," said Dr Grant Ingrams, chair of the BMA's GP IT committee. "While we believe it has the potential to improve both the quality and safety of patient care, we are concerned at the speed because it means patients are very unlikely to be aware of what they are automatically being enrolled into."

The Department of Health replied that it has changed the process to make it easier for patients to opt-out. "Patients are given at least 12 weeks to decide if they want to have a Summary Care Record and are provided with full information about how to opt out if they wish to," said a spokesperson.

"We have a coordinated information programme aimed at increasing patient awareness of the initiative across the country. However, this aims to alert and inform patients, rather than speed up the process by which they take a decision."

Another hospital stricken with Conficker virus

Fri, 19 Feb 2010 15:31:39 GMT

West Middlesex University Hospital NHS Trust has been infected by the virus, leaving hospital staff unable to book appointments via computer

The outbreak has been contained but some hospital IT systems remain unavailable, resulting in ongoing delays to patients and affecting the smooth running of the medical facility, reports The Register.

A hospital spokesperson said that the malware infection, identified as the Conficker-A, struck on the afternoon of 12 February 2010. "Most of the computers had to be cleaned, so we've had to rely on a pen and paper system to book appointments. Technicians worked over the weekend to clean up systems. Priority systems are running but the clean-up is likely to last until the end of the week."

The Hounslow Chronicle reported on 16 February that email and internet access was affected by the outbreak but net connections since largely been restored.

A notice on the Trust's website warns patients to expect delays. "We are currently isolating the virus and cleaning the system," it said. "This is causing some operational issues. We have implemented our business continuity plan and are operating manual systems as part of our standard procedure. We do have a number of computers working in several priority areas such as A&E, ITU, theatres and some out-patient departments.

"We have contacted all our partner organisations and are doing everything we can to get back to normal. We apologise for the inconvenience that has been caused so far but do ask the local community to refrain from contacting the hospital for non-urgent requests. A&E is open and accepting patients. If it is not an emergency, we would encourage the local community to contact their GP, visit their local pharmacy and use walk-in centres such as The Heart of Hounslow and Teddington Memorial Hospital where possible."

The hospital has 400 beds and employs 1,900 staff to serve the needs of 400,000 residents in the London boroughs of Hounslow and Richmond-upon-Thames.

It's unclear how the infection occurred at West Middlesex but recent UK public sector Conficker infections have been blamed on either infected USB drives or external laptops.

Victims of the malware in the last month alone have included Greater Manchester Police, Mid Cheshire NHS Trust and NHS Leeds. The malware infection at GMP had severe operational consequences after senior officers decided to disconnect force systems from the Police National Computer and court systems for five days while a clean-up operation took place.

David Harley, director of malware intelligence at net security firm Eset, and an NHS IT manager for five years, said that continued problems with Conficker were far from confined to the public sector, despite the number of outbreaks in hospitals and government facilities since the start of the year.

It could be that hospital and other public sector systems include servers running NT4 and PCs running very old versions of Windows. Security software packages no longer support these systems and this may well be a contributing factor in recent outbreaks of Conficker, Harley added.

"I wouldn't like to bet that there are no PCs at all sitting in medical centres and police stations that aren't running anti-virus because they run an OS that's no long supported by the organisation's scanner of choice, or hardware that can't take the extra load from an on-access scanner, or because there's inadequate system support to ensure that local security is maintained," he said.

Bureaucratic factors may be at work against the application strong security policies, according to Harley. "In the NHS, which is really an umbrella organisation comprising many semi-autonomous sites clustered around some common networking services, NHS Connecting for Health decided it wasn't in the business of network and end-point security, so it focused on confidentiality and the services it supplied nationally," he said.

Emis sells shares for patient record push

Mon, 15 Feb 2010 12:08:47 GMT

The dominant supplier of GP systems plans to float 25% of its shares before it launches a web product launch later this year

Emis, which is currently privately owned, hopes to raise around £50m through its share placement on London's Alternative Investment Market. It said it plans to launch Emis Web, a service for shared electronic health records held at its own data centres, later this year.

The move will see the firm competing with suppliers of patient record systems outside its speciality of GP practices, where it dominates the market, counting 52% of GPs with 34m patient records as clients. The product could also fit with Conservative plans to allow patients in England to control their own online health records.

The firm is already introducing Emis Web in Tower Hamlets in London, Liverpool and Gateshead. The company said that this has helped reduce waiting times for minor surgery from an average of nine months to, in some cases, same day appointments. The company wants to sell the product to primary care and multidisciplinary teams.

"In the UK, we see Emis Web as a key component in the future of NHS IT because it enables healthcare practitioners to deliver quicker, better patient care through the sharing of key patient information between different healthcare teams," said chief executive Sean Riddell.

"Emis Web is a core part of our strategy and will provide us with both organic growth and acquisition opportunities as we continue to develop its potential across the whole healthcare spectrum – including primary, secondary and community care settings."

"This shows Emis' desire to cement its position within the software sector of the health care market," said Chris Pennell, a senior analyst at Kable, adding that the funds raised would give it the ability to develop its current products and provide staff incentives through shares and share options.

"There is clearly an opportunity for suppliers who can fill the gaps between the differing service delivery channels within the health sector in a cost-effective manner, something the Emis is trying to achieve through its Emis Web offering," Pennell added.

First southern trust turns on RiO

Wed, 16 Dec 2009 12:06:05 GMT

Surrey and Borders has gone live with BT's patient record system for mental and community health trusts

Surrey and Borders Partnership NHS Foundation Trust is the first in the south of England to install CSE Healthcare Systems' RiO electronic patient record system, as part of the extension to BT's National Programme for IT contract agreed in April. It connects the trust to the NHS Care Records Service, including the Spine database.

BT will be paid £546m to install RiO in 25 mental and community health sites and Cerner's Millennium system in four acute trusts, and to manage existing Cerner installations in eight it has taken over from Fujitsu Services.

The RiO software will in time be used by some 3,000 staff at Surrey and Borders at 125 locations. Chief executive Fiona Edwards said: "RiO will enable us to offer better care to the people we serve. Our staff work across multiple care settings and geographically dispersed sites, but we will now have accurate, up to date information that is quickly and securely accessible."

RiO is replacing some paper based systems, and will cover clinical and administrative work including case records, caseload management and treatment records. It includes a single sign-on system using smart cards, and provides users with access to national systems including patient demographics and Choose and Book.

BT said that it is more than 80% through its RiO implementation programme in London, where it is the programme's local service provider.

RiO has also been adopted by the Isle of Man government, which recently went live with the software. It used System C Healthcare to implement it for its mental health and social services staff.

Cerner just beats deadline at Kingston

Wed, 02 Dec 2009 14:09:23 GMT

Kingston Hospital NHS Trust has confirmed that it went live with its Care Record Service software days before a government target date

The move from the London trust's old patient administration system (PAS) began on Friday 27 November 2009, with the move to the new Care Record Service (CRS) software, part of the NHS National Programme for IT, taking place over the weekend.

Out-patients was the last area to be connected on the morning of 30 November, the trust said – the government's deadline for suppliers to make "significant progress".

Kate Grimes, Kingston's chief executive, said she was pleased with progress so far. "Our CRS command centre is a hive of activity, with the teams there solving minor technical glitches with the transfer of data between our old PAS and CRS," she said.

She also said that patients had responded well to the new system. "We've taken time to ensure that they know we are doing something new, and explaining that it might take us a little longer to get to grips with the new system," Grimes said. "We've had staff out talking to patients, handing out letters and flyers with information on them – and a free cup of tea!"

"This is good timing, just three days before NHS chief information officer Christine Connelly's end of November deadline for suppliers to make 'significant progress' with the CRS," said Victor Almeida, a senior analyst at Kable.

Kingston is the first trust to successfully launch the CRS system since Royal Free Hampstead's delayed implementation in June last year.

Introduction of CRS, to enable NHS professionals to access patient records across England, has suffered a number of setbacks. It was due to start in 2004, along with other elements of the programme.

Sheffield and Wandsworth buy iSoft PAS

Tue, 24 Nov 2009 14:06:42 GMT

A foundation acute trust and a primary care trust have agreed contracts for patient administration systems, as southern trusts meet alternative suppliers

Sheffield Teaching Hospitals NHS Foundation Trust will pay iSoft £2.04m to move to a single PAS. It currently uses iSoft at the Northern General Hospital, and McKesson's Totalcare at its Central Campus, which includes the Royal Hallamshire Hospital.

The six year contract includes a payment of £570,000 for licences and implementation, and £1.4m for support and maintenance, iSoft said. The firm will move both sites to the latest version of its PAS and provide new hardware from HP.

Primary care trust NHS Wandsworth will pay £965,000 to iSoft for the latest version of its PAS at Queen Mary's Hospital in Roehampton, which provides services including outpatient facilities, a minor injuries unit and wards for the elderly and intermediate care. It will pay £182,000 for licensing and £580,000 for support over three years.

The announcements have come as the Department of Health holds a market awareness event for alternative suppliers to trusts in the south of England, which have been without a local service provider since Fujitsu's departure from the National Programme for IT last year. iSoft said in October that it plans to sell directly to trusts in the region.

The event, held in London on 24 November 2009, allows suppliers accredited to the Additional Supply Capability and Capacity (ASCC) scheme to exhibit to trusts in the South West, South Central and South East Coast strategic health authority areas, in advance of a series of procurements starting in January.

"The market awareness event open to all ASCC suppliers in the acute, community and child health service categories demonstrates that we plan to move ahead with ASCC framework procurements in the south," said a spokesperson for the department.

Kingston plans flu into care records launch

Thu, 19 Nov 2009 12:22:49 GMT

A London acute trust has considered the impact of swine flu in adopting Cerner Millennium at the end of November

Kingston Hospital NHS Trust said that it has trained its staff ready for the launch the National Programme for IT approved Cerner's patient record system on 30 November 2009. If successful, it will be the first trust in London to go live with the NHS Care Records Service (CRS) system since Royal Free Hampstead's troubled adoption in June 2008.

"Trials and practices have taught us some valuable lessons and have, as always expected, indicated some additional work which needed to be done on the technical side," said a trust spokesperson. "This work is being carried out and further technical rehearsals are scheduled."

He added, however, that "as a result of the Department of Health's warnings on the rise of swine flu, the trust has taken the responsible action of modelling the trajectory of swine flu and its affect on staff, and how that would impact on the introduction of CRS during this predicted period".

Introduction of CRS, which will eventually enable NHS professionals to access patient records across England, was expected to start in 2004, along with other elements of the national programme, such as the N3 broadband network and picture archiving and communications systems.

Delays have been attributed to problems with software packages and a lack of definition about access levels and security standards.

Cerner says that Millennium has more than 29,000 unique users across the NHS at 17 live sites.

London to introduce Summary Care Records

Mon, 16 Nov 2009 10:22:43 GMT

The Department of Health says that the NHS in London will implement England's national patient record system over the next year

The first records will be uploaded by the Princess Street Group Practice in Southwark on 19 November 2009.

The department said that all residents in the capital will receive a letter outlining the initiative, offering them the choice to opt out of having a SCR. The record includes core health information including prescriptions, allergies and adverse reactions gathered initially from GP records.

Ruth Carnall, chief executive of NHS London, said: "Getting hold of health records for London's highly mobile population often presents real challenges to doctors and nurses when patients need out-of-hours and emergency care.

"The Summary Care Record has demonstrated clear benefits elsewhere in the country and NHS London is keen to bring these to the capital."

Introduction of the SCR has been heavily delayed. It was originally expected to start in 2004, along with other elements of the national programme.

But it was only this year that the project began to show significant progress, with six primary care trust areas, including Bury and Bolton, having started implementation.

London polyclinics 'critically dependent' on IT

Thu, 12 Nov 2009 09:00:00 GMT

The capital's move to offering primary care through polyclinics will require significant IT work, according to NHS London's chief information officer

Kevin Jarrold said the plan to establish 130 polyclinics across the city is "the kind of radical transformation of services that is critically dependent on IT".

He told the e-Health Insider conference in Birmingham on 9 November 2009 that NHS London has started two "very modest" pilots in existing polyclinics, to provide a single system for reception desks which links to GPs, secondary and mental health services within the building.

The polyclinics would not see the wholesale replacement of existing IT, he said. "I think there was an assumption that existing GP solutions would be replaced. We moved away from that some time ago," he said.

But he added: "There is a challenge for both the NHS and suppliers as to what the IT for polyclinics may look like."

NHS London, the city's strategic health authority, is also hoping for a city-wide implementation of the NHS Summary Care Record. It is running a pilot of using records for end-of-life care with the London Ambulance Service.

Jarrold said that the English NHS had been wrong previously to insist on the same systems for everyone. "We made a mistake in trying to drive through a standard one size fits all solution," he said.

Jarrold said that four hospitals in London are using Cerner's Milllennium suite of software, each tailored to their circumstances. He said that Kingston Hospital NHS Trust will go live at the end of November, while St George's Healthcare NHS Trust will follow in the following weeks.

London is using difference software for different sectors of the capital's health organisations. All of London's primary care trusts bar one have installed, or are installing, RiO software for their community based services.

The exception is what Jarrold described as "the People's Republic of Croydon," although he did not expand on why the south London borough had avoided RiO.

Dealpulse: Trusts unleash robo-pharmacists

SA Mathieson — Wed, 14 Oct 2009 08:00:00 GMT

September saw three English hospital trusts sign deals for automated pharmacy dispensing systems, with more in the pipeline

Oxford Radcliffe Hospitals NHS Trust gave Mach4 Pharma Systems a deal worth £150,000 to provide such a system at the Churchill Hospital, although it said that orders may also follow for other sites. The tender said the system will dispense medication in its original packaging, and use barcodes or other automated entry.

"ORH would also like to consider using the Robot remotely outside of hours to deliver medication to a specified location," it added.

Meanwhile, West Suffolk Hospital NHS Trust and Harrogate and District NHS Foundation Trust both awarded contracts to Arx to provide similar systems, each paying £160,000.

The three trusts are not alone: Western Sussex Hospitals issued a tender for an automated pharmacy dispensing system during September; Bradford Teaching Hospitals, North Middlesex University Hospital and Mid Yorkshire Hospitals all published similar tenders in August; while that month also saw Arx win a £214,000 deal from Medway NHS Foundation Trust.

The biggest health ICT deal of September was a framework, worth up to £10m, awarded by the NHS North West Collaborative Commercial Agency to a number of suppliers for patient and non-patient communication systems.

The suppliers joining the two year deal, which may be extended for a further two years, are 360 CRM, Cable & Wireless, Capita Group, Data Lateral, Direct Data Services, Experian, Healthcare Communications and X-On.

Capita is also the likely winner of a £100m, seven year deal to process claims made by dentists, to be awarded by the NHS Business Services Authority. The firm said it had "entered into exclusive dialogue" with the authority during September.

On a smaller scale, South West London and St George's Mental Health NHS Trust awarded TecTrade a £553,000 contract for a data storage system, including hardware and software, to upgrade the trust's storage area network.

South London and Maudsley NHS Foundation Trust issued a £1m tender for software and related implementation, support and maintenance. The month also saw NHS National Services Scotland publishing a £800,000 tender for a replacement quality management and analysis system, covering software, the transition of data and support.

On the research front, Kable predicted that healthcare ICT spending will rise from £2.34bn in 2007-08 to £3.48bn in 2013-14, representing a compound annual growth of 6.9%, with the growth mainly due to spending on software.

Information is drawn from notices published in the Official Journal of the European Union. These, along with a monthly analysis of ICT tenders in all government sectors, are available to customers of KableDIRECT.

SA Mathieson

Computing problems lengthen Barts' waiting list

Fri, 02 Oct 2009 11:28:44 GMT

Cerner user Barts and The London NHS Trust has said its attempts to meet the government's 18 week waiting list target have been 'compromised' by IT weaknesses

It has issued a statement that: "It has been a frustration for everyone at Barts and The London NHS Trust that our desire to meet the 18 week national target has been compromised by previous weaknesses in our information management and administration systems."

It added that the 26,640 patients concerned have all been seen by a consultant as outpatients within 13 weeks, adding: "There is no evidence that any patient has come to clinical harm because of the backlog."

The trust also said that the number of patients whose main treatment has not started within 18 weeks has been reduced and the trend is continuing. "We are committed to meeting the target by the end of the calendar year," it added.

The trust, which runs hospitals in central and east London including St Bartholomew's and The Royal London, is one of the few that has implemented the Cerner Millennium platform as part of the National Programme for IT.

"Barts and The London are working to address a potential backlog of around 23,000 patient records to determine those who have been treated within 18 weeks and those who have breached this standard," said a spokesperson for NHS London, the capital's strategic health authority. "The SHA is meeting monthly with the trust and its commissioning primary care trust to ensure that this backlog is addressed and extra support is being provided to make sure the trust validates these records quickly and accurately."

Problems with Barts' Cerner implementation were acknowledged in May by then health minister Ben Bradshaw. It was one of three acute trusts in London to go live with the first phase of the National Programme approved Millennium software.

In a parliamentary written answer on NPfIT patient record systems, Bradshaw told shadow health minister Stephen O'Brien: "At the Barts and The London NHS Trust some unresolved issues are being tackled as part of a wider comprehensive improvement programme that is addressing identified weaknesses in the trust's information management and administration systems."

Dealpulse August: Procurement hubs sign digital dictation framework

SA Mathieson — Wed, 16 Sep 2009 08:00:00 GMT

More than 200 trusts have access to a digital dictation and speech recognition framework deal established by Yorkshire and Humber's procurement hub

In August, the organisation completed a two part framework agreement to supply such services, used extensively by hospital departments such as radiology and by consultants.

Six suppliers won a place on the first, involving the lots for digital dictation and speech recognition systems: BigHand, Dictate.it, G2 Speech, Softech Global, SRC and Voice Technologies. The second, for transcription services, involves Dictate.it, Dict8 and Scribetech.

Apart from Yorkshire and Humber Commercial Procurement Collaborative, the other hubs involved cover the East of England, South East Coast and the North West, as well as the Health Purchasing Consortium representing trusts in the West Midlands, Luton and London and Pro-Cure, which covers the South Central strategic health authority.

When the tender was first published in January, by Yorkshire and Humber on its own, it estimated that it might be worth £500,000 to £5m over four years, although on a framework agreement no work is guaranteed.

On the award of the deal, suppliers said that with six hubs involved the deal could be worth as much as £20m, as it covers 40% of English trusts.

The month also saw Dorset County Hospital NHS Foundation Trust award one of the framework suppliers, G2 Speech, a £234,000 contract to provide a digital dictation and voice recognition system for use by both clinical and non-clinical departments.

Health facilities were also included within a Building Schools for the Future tender published by the councils of Halton and Warrington, worth between £167m and £500m.

The main aim of this deal, which may last for as long as 15 years, is to set up a local education partnership to renovate or rebuild the area's schools. This would include the provision of ICT services, although Halton and Warrington have said that in their case the partnership may be extended to construct primary health buildings, including GP surgeries, pharmacies and polyclinics.

Telemedicine for stroke patients is the aim of a £750,000 tender published by Solent Supplies Team, on behalf of 16 hospitals in and around the South Central strategic health authority area. The hardware purchased under the resulting framework contract will allow those suffering serious strokes to have round-the-clock access to thrombolysis treatment involving clot-dissolving drugs, through remote assessment by a stroke consultant.

This equipment will include video cameras, screens, access to picture archiving and communication systems (Pacs) and mobile workstations. The three year tender will enable hospitals in the South Central area to implement the National Stroke Strategy.

Other deals saw the Royal Marsden NHS Foundation Trust in London award Philips Healthcare a £982,000, 10 year deal to provide an electronic charting and critical care monitoring system, to be used in critical care units, theatres, anaesthetics and interventional radiology, and the Royal Wolverhampton Hospitals NHS Trust pay £321,000 to BioMerieux for a computer controlled system to automate microbiology processes.

SA Mathieson

Patient from Hell: Administration & Emergency

Wed, 09 Sep 2009 08:00:00 GMT

When appointments can be booked online, why does a London hospital force terminally ill patients to walk between departments to book tests, asks the Patient from Hell

Further to the slow diagnosis and bad communication that my friend Charles* had to endure in his last weeks with terminal cancer – see previous column – two more aspects of his treatment enraged his family.

One was that after a hospital consultation about six weeks before his death, he was sent off to trail along endless corridors to book a CT scan. Then he had to find his way to another department to book another test. And I can tell you, even for somebody relatively fit, the distances in his hospital are immense. I sometimes wonder why they didn't install travelators, as at Heathrow or Gatwick.

Why couldn't these bookings be done from the consultant's surgery? If Choose and Book is supposed to get hospital referrals done remotely from the GP's desktop, why can't an internal hospital system cope with centralised booking of tests? To make terminally ill patients do the booking physically themselves seems a bit 19th century to me.

But what would I know: I am not a hospital administrator or chief information officer. I am just a patient who thanks his lucky stars that he is being treated at a specialist hospital that is small enough not inflict these cruel and unnatural punishments on its inmates.

When the hospital at last realised the seriousness of Charles' condition, the consultant called him in as an emergency admission early one morning. Rather to Charles' surprise, he was asked to present himself not directly to the consultant's ward but to A&E. He arrived there at 10am, passed through endless bureaucratic hoops and finally got a bed in the appropriate ward at tea-time – seven long hours later.

Why couldn't he go straight to the ward? After all, some lord high panjandrum of a consultant had deemed him worthy of an emergency admission. So why did he not receive emergency treatment?

I can hear hospital administrators reading this article, shrugging their shoulders and saying "what a plonker, not to realise that to have two admission streams, A&E and emergencies of existing patients, would cause chaos". Sorry; I insist. Clearly it is administratively easier to have just one admission stream, through A&E. But, is it in the interests of patients like Charles to go through the A&E bureaucracy – for no purpose, and with great distress?

It seems to me that, in the NHS, administrative convenience is still more important than patient care, whatever the rhetoric claims.

Ah, I hear you say, beds are scarce, and Charles should have been content to wait his turn. This is an argument I might accept, except that a week or two later, Charles was left blocking a bed for five days waiting for the cardio-thoracic wing to find a theatre slot to clear fluid from his lungs. In his hospital, the left hand did not appear to know what the right hand was doing. And beds were being blocked for no purpose.

Again, Charles's experience is so different from mine at 'Fastrack Hospital'. At an outpatients' clinic, a few months ago, the doctor reckoned that the wound of my operation had become infected. Within two hours, I was in a hospital bed being pumped full of antibiotic, and stayed there for the following four days until the infection cleared.

What is the difference between Charles' hospital and Fastrack? Size is one thing. Fastrack is small. Charles' is monstrous. Fastrack specialises in one family of diseases, and was only created about 50 years ago. Charles' is general – and has a long history of being one of the premier teaching hospitals in London. Maybe this is a lesson for the NHS as a whole.

* Not his real name

MCAs under the microscope

Wed, 26 Aug 2009 08:00:00 GMT

Mobile Clinical Assistants are starting to be used at patients' bedsides across the UK

Health service organisations in England, Scotland and Wales are starting to see the arrival of customised notebook personal computers known as mobile clinical assistants, or MCAs, arriving on the wards. Underpinning them is another relatively new technology for hospitals, the wireless network.

The Princess of Wales Hospital in Bridgend in south Wales, has installed one of the largest wireless networks of its kind in Europe to revolutionise patient care. The technology allows consultants and doctors to spend more time with patients because they can access reams of electronic information about a patient from their bedside.

Carl Mustad, assistant director of IT with Abertawe Bro Mogannwg University NHS Trust, says this means patients' latest test results are now available at the touch of a button, and staff no longer have to leave the hospital bed to view X-rays and other scans.

In place of the traditional paper notes found at the end of each patient's bed at the Princess of Wales unit is a tablet-style MCA. There are 57 MCAs in wireless carts in active use across the hospital, which can display virtually all of the patient's notes and tests.

When a patient is discharged, an electronic transfer of care (eTOC) plan is sent to their GPs. The eTOCs generated by the MCA-based IT system at the Princess of Wales unit are actually created when patients are first admitted and material is added throughout their stay. As staff add data on the patient through the MCA at the bedside, so information on diagnosis, procedures, test results and changes to medication is added to the eTOC.

Such has been the success of the MCA-based wireless network at the Princess of Wales that the technology has been copied at the nearby Neath Port Talbot Hospital.

Novel on campus

MCAs are also being progressively introduced across all wards at NHS Grampian, whose Aberdeen group of hospitals - the Royal Infirmary, Children's Hospital and Maternity Unit - use a campus-wide wireless network.

Paul Allen, head of ICT for Grampian, says the project to equip the wards and allied patient care departments at the three units, known as the Forresterhill campus, started earlier this year when Carillion IT Services was contracted to supply the five-year installation and rollout.

The first stages of the campus wireless network are due to go live in October, and early indications are that the Panasonic MCAs are being well received by staff. "It's still early days with the MCAs, but we are also looking at extending the project to include personal digital assistants and even smartphones," says Allen.

Allen says that access to patient records through the Panasonic MCAs is not going to be wholly wireless as there will always be a need for cable-connected units, such as in offices and other sites where higher speed network access is required.

St Bartholomew's Hospital (Barts), England's oldest hospital and part of Barts and The London NHS Trust, has just completed a year-long trial of MCAs and wireless network technology in the hospital's accident and emergency ward.

The Philips notebook PCs are connected using a wireless network in a project that cost £300,000 during its 12-month trial. The plan now is extend the trial to the opening of Barts' new 300 bed unit, which is due to open next year.

Doug Howe, the trust's head of client services for ICT, says that he and his IT services team are due to gain access to the new unit during September, at which stage they will install a wireless network to support the use of MCAs, as well as RFID-based asset tracking and a Star Trek-style badge-to-badge and badge-to-desktop PC voice communications system.

The longer term plan is for Barts to extend the use of MCAs to its new Royal London hospital site, which opens on a phased basis between 2012 and 2016. The site will include three towers, each of which will be 16 storeys high.

"One advantage of having a new unit is that we can install the IT system from scratch, which means we can go all-wireless and support the use of portable devices at the bedside with ease," he says.

However, Howe says that clinical staff have tended to shy away from using MCAs on their rounds, as they found the laptops were too cumbersome to carry around with them. "Conversely, pharmacy staff love them to bits, as they allow staff to prescribe at the patient's bedside, which is a real advantage," he adds. "They like the ability to be able to pull up the Millennium (pharmacy system) software and prescribe right there at the patient's bedside. Pharmacy staff have taken to the MCAs like a duck to water," he says.

Seeking approval

The use of MCAs in hospitals is not all plain sailing, however. Jean-Louis Evans, managing director of TUV Product Systems, a 'notified body' that approves IT equipment for use under different conditions, says there are a lot of standards approvals required before a laptop can be allowed on wards.

Evans says that the MCAs have to be certified as safe for use in a clinical environment. "This is on top of the RF emissions tests and other checks that are required under the Radio & Telecommunications Terminal Equipment (R&TTE) directive," he adds, adding that, because modern laptops are effectively now radio transmitters on multiple wavebands, they have to be tested with all their systems operating at the same time.

"That is the essence of why we test on the RT&TTE front, to check that, with WiFi, cellular and Bluetooth systems operating, the laptop is perfectly safe for use in a hospital ward, as well as anywhere else," he explains.

Before an MCA can be approved for use in a hospital, Evans adds, it must meet the stringent safety terms of the European Medical Devices directive. "It all comes down to the electromagnetic output of the MCA - it must not, for example, generate any RF interference as, if it does, it could interfere with other medical equipment in use on the wards," he says.

The strict standards requirements imposed on MCAs for use in a hospital environment start to explain why, even though you can buy a portable PC for under £300 these days, a specialised MCA - even without any software installed - can run into four figures.