Smart Healthcare: North, Midlands & East | SmartHealthcare.com

Patient from Hell: Lies, damned lies and statistics

Wed, 10 Mar 2010 09:00:00 GMT

The failures of Mid Staffordshire show that mortality data is not the best way to judge a hospital, argues the The Patient from Hell Dick Vinegar

What worries me about Mid Staffordshire NHS Trust is that it was not complaints from patients' relatives that triggered the scandal, but the mortality statistics. And when Dr Foster, in 2007, first exposed these rates as being 25% above the national average, the chief executive tried to rubbish them, putting them down to coding errors and poor quality of data. It then took two years before the Health Commission finally exposed Mid Staffordshire in March 2009.

This reminded me of reading, just after I had had a thyroid operation in 2000, that my hospital topped the post-operative mortality league table. So count yourself lucky, dear reader, that I am still here to entertain you.

A year or so later, I found myself making a sick joke about this to an audience of hospital trust chief information officers, in Portcullis House in the heart of Westminster. The joke went down like a lead balloon, and in the coffee break, they all avoided eye-contact with me. Except one, who shuffled over to ask me whether the hospital in question was 'H' hospital. Indeed, it was.

He introduced himself as the IT manager, and explained that the hospital had presented the statistics all wrong. These were the early days of mortality statistics, but he had already learnt the hard way that massaging stats was an essential part of an NHS executive's management skills. The welfare of the patient is secondary.

So, when Richard Francis QC, in his report on Mid Staffordshire in February calls for a single hospital standard mortality ratio (HSMR) as an "impeccably independent and transparent source", he is crying for the moon. Hospital trusts have become expert in manipulating data, and will do so even if the most rigorous mortality standards are imposed, if they sense that their figures are bad.

And, even if they were scrupulously honest and not trying to massage the figures, different coders will interpret the rules differently. That is a law of nature. And the stats will vary between hospital and hospital.

I have an even more fundamental objection to mortality statistics as a way of judging whether a hospital is failing. They are always out of date, even without the delays caused by hospital administrators trying to rubbish them. The original Dr Foster alert in July 2007 covered the years 2003-06. Yet it was not taken seriously until March 2009. During those years, how many people died?

Even in a world with streamlined and accurate HSMRs, by the time they are published they will be at least two years late. That is inevitable. Hence, another law of nature: stats cannot be both timely and reliable.

And mortality stats are not the only criterion by which to judge a failing hospital. Patients may not die because they are left lying in their own faeces. They may not increase the mortality ratio. What matters more, as Richard Francis has twigged, is that the regulators paid no attention to the concerns of patients and relatives, but responded by referring "to data of a very generic type, such as star ratings, CNST (clinical negligence scheme for trusts) levels and so on". He concluded that "benchmarks, comparative trust ratings and foundation status do not in themselves bring to light serious and systemic failings".

Hitherto, statistical data has rooled OK in the NHS. Maybe Mid Staffordshire will be the turning point when the NHS turns away from computerised dodgy stats and tick lists, and turns to the evidence of patient complaints and the evidence of inspectors' eyes, ears and nose.

I apologise to you readers, who are mostly IT types, particularly coders who have sweated long hours producing all this stuff, for degrading the importance of the statistical data. But a lesson in humility never did anyone any harm. Computer systems are not the most important things in healthcare. Clinical skill, sympathy and common sense are.

It worries me though that the six month review of Mid Staffordshire in September 2009 found that it had not yet implemented an effective complaints system. Ingrained bad habits die hard in the NHS.

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."

Implementers claim benefits from mobile projects

Fri, 26 Feb 2010 16:05:51 GMT

Health providers can improve efficiency, reduce errors and improve patient outcomes through mobile technologies, according to those involved in such work

Kirklees Community Healthcare Services has calculated that its introduction of 600 Panasonic Toughbooks for community healthcare staff will save it between £9m and £10m a year from the third year of the project onwards. It reckons at least £4m of this will come from cashable savings.

The calculations, worked out with the project's provider BT, include just over £3m from saving clinicians travel time, £1.85m from avoiding unnecessary admissions and £1.64m from avoiding unnecessary referrals.

Tina Quinn, clinical and operational lead at Kirklees, told the SmartHealthcare.com Mobile and Wireless Healthcare conference in Birmingham on 24 February 2010 that saving money had not been the priority: "When we originally did the business case, it was around patient safety and patient care." Other benefits include improved productivity and better staff communications.

However, she added that the decision was taken more than a year ago, when there was more money available, and that financial savings have moved up the agenda.

John Wilson, a consultant gastroenterologist at NHS Fife, told the event that use of mobile technology can reduce medical errors, both improving efficiency and producing better outcomes for patients. This could include use of RFID tracking tags for the likes of sponges, to ensure they are not left inside patients during an operation, and for staff, to keep track of who took part in a procedure, something currently done manually. "Perhaps it would need to stretch out as far as golf courses" to track consultants, he joked.

He added that greater use of videoconferencing for telemedicine should be particularly beneficial for conditions that require "pattern recognition" for diagnosis, such as dermatology and rheumatology, with telediagnosis allowing radiology and other screening, such as of bowel samples, to be carried out by specialists at a remote location.

Wilson also thought that patients with chronic conditions including coronary heart disease, diabetes, respiratory conditions and mental health problems could benefit from remote monitoring, reducing the number of emergency admissions.

However, he warned that clinicians could be resistant to changes, and needed to be engaged to make such projects work. "I'd suggest a good place to start is one on one, not in a group," he said. "Start with their problems, not your solutions."

If an enthusiast can be persuaded to adopt the new technology and make it work to his or her advantage, "a combination of peer pressure and envy will do the rest for you," Wilson added.

Experts rubbish iPhone for health use

Thu, 25 Feb 2010 17:13:01 GMT

Two NHS mobile equipment specialists have said that the short battery life of Apple's iPhone makes it unsuitable for use in health work

Paul Curley, clinical director of IT and consultant surgeon for Mid-Yorkshire Hospitals NHS Trust, said that his organisation's tests had found that personal digital assistants were viable for use within hospitals, but that performances varied.

"With the BlackBerry, the battery life is superb. With the iPhone, it's rubbish," he said.

Tracy Andrew, head of information security and compliance for Berkshire Shared Services, made a similar comment about its tests of mobile devices for use in the community. "We have two iPhones on trial, and the first complaint is that the battery doesn't last a day," he said.

The two were speaking at the SmartHealthcare.com Mobile and Wireless Healthcare event in Birmingham on 24 February 2010.

Curley said it was more difficult to find a mobile device to work in a hospital than in the community, as it would generally have to connect to numerous software packages and handle high-resolution images of scans. When scans will be used for clinical diagnosis, "the smaller your screen resolution, the less safe it is," he claimed.

He said the trust has trailed Sony PSP mobile devices, with no keyboard but a good screen. It was possible to type using the screen, but the devices worked badly when they did not have connectivity.

The trust is currently building two new hospitals through the private finance initiative, at Pontefract and Wakefield, both of which will have wireless access throughout. However, existing hospitals, including Curley's, tend to have wireless available in just some areas, such as wards, offices and theatres.

"We have a very limited wireless environment," he said, and devices have to be able to cope with that.

Curley said the ideal mobile device for use in hospitals would need to allow for a "hot swap" of batteries, without the device closing while these were changed, session persistance and fast log-in and connection. It would also be "ultra portable", have a good battery life, not get too hot while in use and be "cheapish".

The aim was "bedside, non-wired access to all relevant information," he said.

Security leads NHS to avoid flashy mobiles

Thu, 25 Feb 2010 15:11:19 GMT

Healthcare officials have warned that service providers expose their community staff to security risks if they issue them with obtrusive mobile devices

Several speakers at the SmartHealthcare.com Mobile and Wireless Healthcare conference, held in Birmingham on 24 February 2010, said that their choices of mobile equipment for community use had been influenced by the need to make hardware easy to disguise.

Tracy Andrew, head of information security and compliance for Berkshire Shared Services, said his organisation had chosen Dell's smaller D and E series laptops for this reason. "If they can be small and unobtrusive, that's better," he told the audience.

He added that the service, which provides IT for Berkshire East and Berkshire West Primary Care Trusts and mental health foundation trust Berkshire Healthcare, has to take account of high levels of crime in Slough and Reading.

Andrew said that £32 Pacsafe bags, which can be locked to a luggage rack or the inside of a car's boot with a laptop inside, provide "a fantastic return on investment" for such workers.

Tina Quinn, clinical and operational lead for Kirklees Community Healthcare Services, said unobtrusiveness was among the reasons that led her organisation to order 600 Panasonic Toughbooks for mobile working. "It's small enough to fit in a normal workbag. It goes into the workbag, and no-one's the wiser that they have the kit on them," she said. A low weight and long battery life were among Kirklees' other reasons for choosing the laptops.

Richard Sargent, ICT change control specialist at Portsmouth Hospitals NHS Trust, said that the trust's trial of BlackBerrys and Anoto digital pens for midwives followed the same logic. "There are some undesirable areas in Portsmouth. We didn't want to show they were carrying a laptop," he said.

The Portsmouth scheme, which allows midwives to record information on mothers to be both on paper and digitally at the same time, also includes an alarm function – if a midwife scores through the trust's logo on a form, the microphone on the BlackBerry is activated and an email sent to the senior midwife, who can listen and contact the police if necessary.

The project is about to go live, following a trial and a training period during which 130 midwives have been getting used to the system.

SCRs have friends in the north

Wed, 24 Feb 2010 09:00:00 GMT

Summary Care Records have become something of a political football nationally, but their their northern early adopters are making good progress

Since SmartHealthcare.com examined the use of Summary Care Records (SCRs) in Bury and Bolton in January 2009, the rollout of the the system – designed to ensure that essential patient details are available for out-of-hours and emergency treatment – has continued apace.

The north of England continues to host many of the early users, although the system is now being extended to patients in London. NHS Tees has just begun a mass mailing to all patients in its region over the aged of 15 years and 9 months, with details of the SCR programme and how to opt out.

Carl Parker, chairman of the Professional Executive Committee for NHS Stockton and NHS Hartlepool, is very upbeat about the scheme, which should be operational this coming summer in the NHS Tees region.

"Errors can occur where patients move from one service to another, particularly when general practice is closed or the patient is unable to communicate due to severe illness or trauma," he says, adding that the SCR will help eliminate this.

NHS Bolton, which was one of the first primary care trusts to start introducing SCRs, had two of the three GP platforms enabled for access in early 2009. Since then, a project manager has joined to develop the scheme and a DVD produced – involving pupils form a local school – to promote the programme to interested parties.

According to spokesperson Claire Wightman, approximately half of all NHS patients in the trust's area now have their SCRs uploaded to Connecting for Health's national data spine. This equates to 21 Bolton GP practices having created more than 130,000 records, with further practices expected to confirm and come online over the next year.

At the other end of the SCR connection – the clinical side – Wightman says that the records are now accessible by several teams within the PCT and at the Royal Bolton Hospital. "Now that so many records have been uploaded, clinicians who are accessing the system to read the SCRs are finding the system extremely useful," says Wightman.

Darren Mansfield, NHS Bolton's clinical lead for urgent care and patient safety, is equally upbeat about the scheme. "The doctors working in out of hours care have seen real benefits through using SCR in their patient consultations," he says.

"SCR is enabling out of hours care to be delivered more safely and effectively. Further plans are in place for the next 12 months to allow other clinical departments in both primary care and acute care settings to begin using the SCR application," he adds.

Recording wishes

Wightman adds that considerable work has recently been undertaken on patient's end of life details and care wishes using SCRs. This, she told SmartHealthcare.com, has ensured that many palliative care patients have experienced a more dignified death than they may have experienced had the out-of-hours service not had access to their SCR.

"An example of which was when Petrina Wood recently lost her mother Olive Mitchell due to cancer. As Olive had her end of life details on her SCR, the out of hours service were informed of her wishes and therefore were able to contact her GP who was able to issue the death certificate immediately," she says.

The good news about this, she explained, is that this avoided the need for the police to become involved.

Petrina Wood added: "The information within the Summary Care Record meant that my Mum's death was treated in a dignified and respectful manner. If the out of hours service had not had access to the end of life information, it would have made the already painful experience of her death more traumatic for me and my family."

Across at NHS Bury, the primary care trust had planned to have around 140,000 SCRs online by spring of last year, with the data accessible to Fairfield Hospital's A&E department, the town's walk-in centre and the GP doctors on call service. These targets were achieved and, in November last year, the trust went live with the Lorenzo electronic health record system from iSoft.

Lorenzo now supports approach 600 community-based clinical and administrative users working across two wards and 1,200 clinics in the trust's area. In parallel with the switch-on of the system on 3 November 2009, NHS Bury sent a letter to all of its adult patients formally requesting permission for the trust to allow staff access to the patients' SCRs.

The letter included specific example, such as "If the healthcare worker treating you is not able to ask for your permission – for example if you were unconscious or unable to answer questions – they can access your record in your best interests."

In the letter, Stephen Mills, NHS Bury's chief executive, said that the trust believes that SCRs "will improve the quality and safety of your care," noting that, if the patient did not respond to the letter by 7 December 2009, an SCR would be created automatically.

So, have SCRs been a success? Judging from the rollouts in Bolton and Bury PCTs, most definitely, and in the case of NHS Tees, things are also looking good.

Nationally, however, the situation is less rosy. There is considerable opposition from privacy groups such as NO2ID and a number of lobbying groups seem unhappy with the government being able to shuttle patient records around PCTs electronically.

Given the ultimate aim of the CfH programme is to have SCRs available to emergency and out of hours staff nationally, this opposition could prove a stumbling block. The Conservative Party has discussed alternative approaches, and the Liberal Democrats want to scrap the records altogether.

As the case of the Bolton patient and her daughter above clearly illustrates, however, SCRs can make a considerable difference to terminally ill patients' experience of the NHS – something which politicians may wish to take into account.

iSoft plans iPhone app for Lorenzo

Wed, 17 Feb 2010 09:47:53 GMT

One of the main suppliers to the National Programme for IT is planning to launch software for Apple's mobile later this year

iSoft said the prototype iPhone application will allow medical professionals to access scans, X-rays and patient records, as well as recording basic patient data such as pulse and temperature.

The firm said this could be used in conjuction with Lorenzo Regional Care, the version of the suite which is being designed specifically for use within the National Programme in the North, Midlands and East region of England.

"We need to bring the patient into the consumer space," said iSoft's chief medical officer Dr Michael Dahlweid. "At the same time we need to ensure we extend the richness of electronic health records to the finger tips of medical professionals in a hospital or surgery, or on call, so that they can track a patient's condition in real time."

Some public sector organisations, including the Department of Health, Met Office and the Highways Agency, have released iPhone apps for the public, but this would be among the first for professionals.

However, several NHS organisations already make use of other mobile devices, both within hospitals and in patients' homes. Hospitals have tended to use special hardware such as mobile clinical assistants, which are robust and can be cleaned easily. This may not be the case with a device designed for consumers.

At home with the upwardly mobile: using mobile technology in patients' homes

Wed, 17 Feb 2010 09:00:00 GMT

Treating patients at home requires mobile access to data. A few trusts are learning how to make this work

Home-based care could save the NHS more than £1bn a year, according to a report by Dr Foster Intelligence for Healthcare at Home. But effective community healthcare depends on wider availability of the clinical information used by practitioners in hospital.

For health service organisations, this means providing mobile access to clinical and patient information. Early adopters in the NHS are using mobile devices ranging from smartphones to ruggedised laptops to near field communications (NFC) enabled mobile phones for monitoring, time and location recording.

"In my experience, the use across the UK of technologies to support mobile working among nursing staff is patchy," says Nicholas Hardiker, eHealth adviser to the Royal College of Nursing. "While there are excellent isolated examples, it is frustrating that the majority of front line community staff still do not have the basic technology they need to do their jobs."

Portsmouth Hospitals NHS Trust, with funding from South Central strategic health authority, is introducing BlackBerrys with pen input across its midwifery service from the beginning of March, following a pilot. The so-called 'digipen' technology transmits handwritten patient notes to electronic hospital files.

Deputy head of midwifery Jayne Jempson says: "Our service has 6,000 births a year, about a quarter of which occur in the community, which is very unusual for a maternity service. It could easily be expected that a woman may have between 15 and 20 contacts during the course of her pregnancy and postnatal period so it is those that we are really trying to capture with the digipen.

"We would anticipate that this would really improve patients' experience by giving midwives time to be with them," she adds. "Also, we can better capture the activity that the midwives are doing for payment by results for which maternity services get their funding."

Previously, midwives were required to make multiple copies of patient notes. The project aims to eradicate duplication of data entry and errors, as well as providing real time mobile access to patient data.

In the run-up to its full introduction, 130 clinical staff are training on the new system. "The majority of these will be midwives but there will be some obstetric colleagues, because there are obstetric clinics that take place that need to be recorded, as well as some of the support staff," says Jempson. "People are looking to see what results we get, how it works and take it from there."

Lincs to the community

As director of informatics at NHS North Lincolnshire, Trevor Wright was responsible for deploying mobile technology to support service transformation of community services. He implemented ruggedised laptops developed in conjunction with Panasonic and based on a BT mobile contract that includes special arrangements with other mobile service providers.

This model of mobile working is being developed nationally according to Wright, who adds: "It is fair to say that Yorkshire and Humber have led the way."

Wright now works for NHS Yorkshire and Humber, the local strategic health authority. It has expanded the use of mobile technologies in the community into other primary care trusts including NHS Calderdale, NHS Kirklees and NHS Sheffield.

"North Lincolnshire uses about 600 devices for community based treatment, accessing clinical records while out in the community. It was the first full scale deployment and we have learned lessons from that," says Wright.

The lessons mainly revolve around transformational change and technology: "The transformational change issues are primarily about ensuring that the organisation owns the deployment and the deployment is service-led rather than technology led."

"Initially in North Lincs we put it straight in – give the equipment to the staff and it will deliver," he says, but adds: "That is not the case. The need for a transformational change programme is the first serious lesson."

"With training there was an expectation that staff were well versed in IT," Wright continues. "They were using IT but the introduction of mobile devices and the use of IT in different settings brought with it different challenges so there is certainly a significant need to increase support both in terms of training and technical support.

"Secondly there was a need to review business process and ways of working so rather than just doing the things they used to with the aid of technology there was a need to spend the time reviewing the way they do things to optimise the use of technology."

The biggest technical problem was network availability. "A certain amount of effort in every deployment now goes into testing different service providers and you cannot guarantee good coverage anywhere. What we now advocate is to only assume that this will work 75% of the time," says Wright. "We are now working with suppliers to develop their applications so that they will work in a disconnected way."

He cautions: "Mobile access to clinical systems is very helpful, however you must have robust clinical systems to access to make it worthwhile."

* Portsmouth Hospitals is among the trusts presenting its work at Kable's Mobile and Wireless Healthcare event next week, on 24 February in Birmingham. For more information, click here.

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.

South Manchester awards dictation deal

Mon, 08 Feb 2010 16:36:07 GMT

SRC has won a contract to provide a digital dictation system to hundreds of staff at an acute trust in Manchester

University Hospital of South Manchester NHS Foundation Trust will introduce the WinScribe digital dictation system, along with workflow technology and speech recognition.

The system will be integrated with the trust's IPM patient administration system, which will insert patient and hospital information to Word templates, saving further time for typists transcribing recordings.

The trust looked at each of the six systems offered under Yorkshire and Humber Commercial Procurement Collaborative's framework agreement for digital dictation services, awarded last August, which is open to 40% of trusts in England, and which was used for this deal.

SRC said it was not disclosing the value of the contract, but said that the new system will be used by hundreds of staff.

Digital dictation: cost-saver or efficiency-gainer?

Wed, 03 Feb 2010 09:00:00 GMT

Many trusts have replaced tapes with digital systems to save money, but can such systems also help healthcare professionals

Digital dictation is taking off in the NHS, largely because at the press of a button the files can be sent to a transcription service on the other side of the world. But digital dictation (DD) systems have gained a reputation for involving big upfront costs, for both software licences and hardware, and such capital spending requires specific managerial approval.

To tackle this, a number of suppliers are offering DD facilities on a software-as-a-service basis across the internet. This means that trusts no longer have to tap scarce capital funding and can instead pay for the service as they use it out of operating budgets.

NHS Salford is one trust using DD on this basis. It uses WinScribe's service at its Walkden Gateway Clinic, a health centre which is jointly maintained and serviced by the local council and the NHS. The web-based dictation system has been active since the centre opened in September 2008.

Where analogue tapes were used previously - taking up to three weeks to transcribe patient notes and relay the printed words to the patient's GP - WinScribe's OnDemand technology means that the notes often come back, fully transcribed, during the same half-day session.

"It's a web-based system that allows our staff to dictate the notes into the computer and send them off securely to a transcription centre in the US, where it is transcribed and sent back," says consultant physiotherapist Victoria Dickens.

So why not simply get the staff to keyboard-enter the data themselves at the point of clinical care? According to Dickens, there's just too much data to enter and, in any case, it's not a good use of NHS funds for a trained physio to perform secretarial duties.

Staff at Colchester General Hospital tell a similar story. The Essex hospital has five secretaries, more than 30 patient-facing staff, as well as ultrasound technicians, radiographers and consultants spanning five sites. This made the physical handling of audio cassettes - including shuttling them between sites - a logistical nightmare.

Switching to DD was a logical move, especially after the hospital's IT systems crashed for nine days in March 2005, making analogue transcription impossible. Radiology services manager Sue Maughn worked with the hospital's clinical director Martin Gould to commission a system from G2 Speech, whose system is based on Philips DD technology.

According to Maughn, switching to DD has allows secretarial staff to prioritise which tasks needs to be done and in which order through the software. "You can even dictate and use Windows applications at the same time," she says, describing the ergonomics of DD technology as perfect.

A national conversation

While staff at Walkden and Colchester are keen adopters of DD, what about the national view? Are trusts adopting the technology because of the clinical care advantages, or are the economic benefits alone driving its adoption?

Chris Hart, chief executive of DD specialist SRC, argues that both ongoing cost and clinical advantages are apparent. Hart, whose company has signed technology agreements with a number of NHS procurement hubs, says that most consultants and medical staff are well used to dictating their notes, so it does not matter whether the technology is analogue tape or DD.

"The main advantage we see stems from the use of the technology in acute departments, where you get a lot of patient throughput and there is lot of human contact involved," he says. "The last thing you want is a doctor typing between patients."

He adds that SRC is also starting to see trusts integrating DD technology with their electronic health records (EHR) systems, including West Sussex and Chichester hospitals.

It is possible to improve efficiency at the same time as improving patient care, he argues. "Take the example of Brighton and Sussex University Hospitals Trust - they use barcoded capture and DD to speed the transcription process. Once the transcribed text comes back, the admin staff can load up a patient letter template and populate the letter with data from the transcribed text," he says. "Using this approach means that the letter file can then be checked and approved by the doctor - and off it goes."

Legacy systems can be accommodated by using software modules that interface between the SRC dictation platform and specific third party applications or - where the modules have not been developed for a given legacy package - using standard open database connectivity protocols.

But James Kippenberger, healthcare director of rival DD vendor BigHand, says that integration with EHR and other systems is far from universal, however, although some trusts including Mid-Yorkshire have integrated the technology,

"What they have done is to create an intermediate step between the file being dictated and typed. If a member of staff accesses the patient's record in the interim, they can click on the audio file and listen to it," he says.

Kippenberger is also seeing trusts starting to move away from the need for text based EHRs and notes, and an increasing interest in digital streaming. Young staff coming into the NHS are comfortable with audio-visual files being streamed on the internet, so medical staff are starting to append the spoken words of the patient to their medical files.

"GPs know that their patients can describe their type of pain far more effectively using the spoken word rather than text based notes. Moving to audio attachments to patient notes makes a lot of sense in these situations," he says.

South Tees tenders for £5m radiology system

Tue, 02 Feb 2010 13:22:33 GMT

A foundation trust in the north-east of England is planning to buy a fully integrated radiology information system and PACS

The systems, which will cost an estimated £5m, should provide full desktop integration and voice recognition, South Tees Hospitals NHS Foundation Trust said. Its current picture and archiving communications system (PACS) is available to around 3,000 service users across acute and primary care sites.

According to the notice published in the Official Journal of the European Union on 30 January 2010, the supplier will provide full data migration from old to new systems with business continuity services as a costed option. The contract will also include elements of standard X-ray technology.

The chosen technology will interface with external and internal systems to allow the sharing of information and images between computers. The contractor will supply diagnostic workstations, a facility for hospital clinicians to view images on existing trust PCs, and a comprehensive management reporting tool.

The notice said that provision of a cardiology image storage system, which will include technology to support catheter labs and echo cardiograms, should be considered as a costed option. It added that storage of other digital media may also be required.

Wirral places clinical trials at its core

Gill Hitchcock — Wed, 27 Jan 2010 09:00:00 GMT

A north-west foundation trust will make clinical trials easier to run through specific software integrated with its patient record system

Wirral University Teaching Hospital NHS Foundation Trust is aiming for two firsts. If all goes to plan, in May 2010 it will be the first trust in the UK to implement Cerner's PowerTrials clinical research module.

The software, which aims to integrate research processes, will also be the first phase of a slightly delayed trust-wide programme to introduce Cerner's Millennium suite of clinical information software.

In February 2009 the trust, which runs Arrowe Park and Clatterbridge hospitals, exploited purchasing freedoms associated with its foundation status and signed an 'out of cluster' contract with Cerner, rather than opting for Lorenzo as part of the NHS National Programme for IT.

Luke Readman, director of information at the trust, says that Cerner Millennium will replace existing software, including systems to support patient administration and clinical tests, which have been in place for about 17 years.

"We are running about 50 clinical trials, mostly drug trials across a range of specialities, and the biggest problem is identifying patients for recruitment," Readman says.

"It might be something as simple as, does the patient have a certain condition and do they have any other illnesses, say diabetes as well. What we have to do now is to manually trawl records and rely on individuals to identify patients.

"But because PowerTrials is an integral part of the clinical system, all that information is contained within it and so we will be able to identify patients who meet the criteria for the clinical trials much more easily."

In addition to increasing the participation of patients and clinicians in clinical trials, the new system is expected to streamline clinical trial screening and enrolment, and integrate the collection of research data into research systems. It will also include rigorous metrics for study feasibility, research prioritisation and oversight.

Chief operating officer and deputy chief executive for the trust Gary Doherty says: "The collaboration with Cerner will allow our organisation to more effectively manage the clinical trials process and reduce the time and cost associated with conducting research."

Readman expects the benefits of the new clinical trials system to be apparent within six months to a year after implementation. "And we will be assessing it to check that we do, bearing in mind that as an organisation we do get some income associated with conducting trials."

The trust is keen to expand its research base and the new clinical trials system could help achieve this, he says. "There is a large and complicated set of mechanisms around research in health in the UK. There is the Department of Health, which sponsors research through biomedical research centres, research collaborations through the National Institute of Health and some directly funded through commercial organisations, such as drug companies.

"The new system gives us an advantage compared with other organisations, because you have to compete to win the clinical trials work. If you are better at it and are able to recruit more patients to it you are more likely to be successful."

Wirral had been due to go live with Cerner Millennium, which in addition to PowerTrials includes modules for outpatients, accident and emergency, operating theatres and patient administration, in November 2009. In preparation it implemented a new data centre and computers to support the new software. Readman says the decision to postpone was made because of safety considerations.

"We put in place a process to check that we transferred all the data from the old systems as safely as possible," he says. "During that process, we decided that it was sensible to give ourselves a bit more time to see how it works, rather than proceed to the original timetable, ensuring confidence in the safety and completeness of the replacement."

"Our trust has a rich history of developing IT to support the way patients are treated and to improve clinical safety and it will give us a platform to continue to develop the expertise and deliver the best for patients that we can do into the future," he adds.

Gill Hitchcock

Oxfordshire puts out-of-hours GPs on GPS

Tue, 26 Jan 2010 17:06:52 GMT

A south-eastern primary care trust is paying CSC £728,000 for a system which will allocate out-of-hours doctors' visits through satellite tracking

CSC said that Oxfordshire PCT will be the first NHS user of its OmniLocation system, which is used to allocate mobile staff based on their location then track them as they travel.

"It makes the reporting easier, and makes the allocation of staff easier," said Andrew Spence, CSC's UK director of healthcare strategy. The system is already used in other sectors, such as mobile engineers working for utility firms.

As part of the deal, CSC will also provide the PCT with its SystmOne electronic patient record system to record treatment carried out by GP out of hours services, as well as emergency dental services, minor injury units and first aid centres.

The firm will start installing its systems in April as part of a three year contract with the trust, which has an option to renew for a further three years. The deal covers installation, project management and maintenance of the system.

Spence said CSC is exploring how it can offer other systems and services it provides to other sectors to the NHS, including server virtualisation and mobile working using dynamic desktops.

The firm recently said it will introduce new healthcare systems to NHS customers, including its clinical information portal, joining up data on a trust; its electronic patient folder, for digitising patient records; and self-service kiosks, allowing patients to 'check in' saving receptionists' time.

The firm acts as local service provider to the North, Midlands and East area of the NHS, covering 60% of England.