Smart Healthcare: Northern Ireland | SmartHealthcare.com

Scotland signs for patient info system

Mon, 01 Feb 2010 15:05:36 GMT

NHS National Services Scotland (NHS NSS) has struck a framework deal with InterSystems for the supply of a patient management system, but NI has opted out

In an initial round of contracts worth £44m, the company will provide its TrakCare product to a consortium of five health boards – Ayrshire and Arran, Borders, Grampian, Greater Glasgow and Clyde and Lanarkshire – to help manage acute and mental healthcare.

With NHS Lothian already using the system, it will now cover healthcare providers serving 70% of Scotland's population. NHS NSS said that other health boards are in discussions over use of the framework contract.

Health secretary Nicola Sturgeon said of the InterSystems deal: "This contract will enable health boards across Scotland to implement a single, nationally available patient management system that will play a major role in improving patient services.

"Clinicians and patients will both be winners from a system which will track patient journeys from referral to discharge. It means clinicians will have easier and quicker access to medical records and patients will benefit from having more time with healthcare professionals," she added.

The tender notice for the integrated patient management system, published in April 2008, put the deal's value at £30m to £120m, and said the agreement would also be open to healthcare providers in Northern Ireland. NSS said that 73 companies expressed an interest in the original tender.

The notice said the system would include "a core patient administration system (including mental health), complex scheduling, clinical notes, order communications, accident and emergency, theatres, mental health clinical, maternity, clinical support tools, neonatal and the management of drugs including prescribing and administration". However, users are able to choose which of these modules they wish to buy, rather than having to take them all.

The deal is one of several national contracts recently placed by NSS on behalf of the Scottish health service, reflecting the country's centralisation of its informatics work. In 2009, it awarded Lumension a deal covering information security and Sun Microsystems a £9.5m contract for an identity and access management system.

The organisation is also in the process of tendering for a national GP systems deal, which may also be used by other primary care providers, worth £10m to £50m.

* Update, 5 February: Northern Ireland has chosen not to take up services under this framework contract, an NSS spokesperson said.

Northern Ireland pilots care record system

Thu, 10 Dec 2009 12:52:49 GMT

Two of Northern Ireland's five health and social care trusts are to share information using a web based portal

The Belfast and South East trusts will test Orion Health's Concerto Portal to view data from more than 10 systems, including NI's Health and Care Index, GP systems and hospital data including laboratory, radiology, accident and emergency and patient administration systems (PAS).

The project will act as a one year pilot of a new Electronic Care Record for Northern Ireland, allowing GPs and hospital consultants to see each others' records on a patient. It will be used by the NI project team to evaluate requirements for developing shared medical records.

"The development of region-wide electronic health records has been a policy objective in Northern Ireland since 2005," said Brian McKeown, head of ICT planning, commissioning and performance management for the NI Health and Social Care Board. "We visited similar Orion Health integration projects in Canada before procuring this pilot and we learnt that it was essential for the project to be driven by doctors."

The system will be installed initially at Belfast City Hospital, Ulster Hospital and at some GP practices. The first users will go live in December, and the system will be fully operational by the end of March.

Ulster Hospital switches on PACS

Mon, 30 Nov 2009 11:14:30 GMT

A County Down hospital has become the latest to join Northern Ireland's picture archiving and communications system

The NIPACS service was launched in Ulster Hospital, part of the South Eastern Health and Social Care Trust, on 26 November 2009. Across Northern Ireland, the system will cost £31m over 10 years and link together picture and archiving systems throughout Northern Ireland.

Ulster Hospital's PACS system is supplied by Swedish company Setra, which has opened by a satellite office in Belfast.

"Over the course of next year, all health and social care trusts in Northern Ireland will have this state of the art equipment installed, which will improve efficiency and productivity within the health and social care sector," said health minister Michael McGimpsey at the opening of the system.

Kable senior analyst Victor Almeida, said: "This is a major step in the modernisation of the health system, but it is quite late compared to England where, despite some delays, PACS roll out has been completed."

England: big enough to fail

SA Mathieson — Wed, 25 Nov 2009 09:00:00 GMT

Provincial England's health service suffers from its size when trying to develop informatics

Last week's Queen's Speech included a pledge for further devolution from Westminster to Scotland and Wales. This was quickly dismissed as inadequate by the Scottish Nationalist Party, which plans to unveil its plans for a referendum on independence next week.

But the Scottish and Welsh health services have no need of further devolution: they have been independent of England for a decade. As a result of the significant differences between their political natures and Westminster's, significant gaps are starting to show – and in general, on informatics, they are doing better than England.

England is probably too big to run as a single health service. Elsewhere in Europe, health is usually run by regional government, or on an insurance basis with many organisations providing services. Only in England does one parliament – which currently has Scots in the two most important jobs – manage the public sector healthcare of 50m people.

Both Scotland (5m) and Wales (3m) face specific challenges. Scots suffer from high rates of heart attacks, Wales has to serve its people in two languages, and both countries have a legacy of older and retired manual workers with work related complaints, along with many patients living in remote locations.

But Scotland has made the greatest general progress in the UK in developing health informatics, with its Emergency Care Summary patient record system covering all but 1,400 refuseniks and celebrating four years of existence. It now plans to develop this system into new areas such as patients' end-of-life wishes. Wales is moving more slowly, but expects to have common systems running across the country by 2011.

Meanwhile, England's National Programme for IT is notorious for its failure to deliver. This reputation is somewhat unfair – it has established several national systems, such as the N3 high capacity network (shared by Scotland) and email. But on patient record and administration systems, progress has been slow.

England's progress has not just been hampered by scale. Tony Blair and his government mistakenly pursued a one-size approach for the National Programme, pushing all kinds of trusts to use the same systems to get economies of scale.

England also undermined public and professional trust in its Care Record Service patient records through making the scheme opt out, getting it bracketed with 'surveillance state' projects such as identity cards. (Scottish practitioners asks permission to access patients' records on every occasion, except if someone is unconscious or incapable.)

On both counts, policy has been softened, with more localisation and changes to policies on privacy.* But it takes a long time to turn around a supertanker.

Capital idea

It is notable that one part of England seems to be doing better than the rest. NHS London, the capital's strategic health authority, is taking a distinctive path for its 7m population. It has its own local service provider under the National Programme (BT), is planning a move to polyclinics and is going to introduce the Care Record Service across the capital. But such regional management looks unlikely to work outside the M25.

The answer for the rest of England might draw on the other part of the UK: Northern Ireland, where health and social care delivery are combined for the 2m residents. The last reconfiguration of England's NHS bodies left most primary care trusts contiguous with county and unitary authorities. Local authorities run social care, as well as other services complementary to health such as education.

The Conservatives, who look likely to win the next Westminster election, say they are keen on localism, and dominate England's local councils. So why not bring PCTs and councils closer together, or even merge them?

The (current) government's Total Place programme is already encouraging cooperation across the state sector in an area. Herefordshire Council's chief executive Chris Bull also runs the area's primary care trust, and the two are saving money by merging their offices and back office processes.

People in England often identify with their council area, particularly if it is a county or a city, far more than their region. Merging PCTs into councils could result in organisations with a holistic view of health and well-being in their areas. They could give provincial England health organisations big enough to function, but small enough to innovate – and with local democratic accountability.

* Illustrating how the NHS in England has moved on privacy of patient records, a Department of Health spokesperson emailed after publication with the following comments: "The consent model for Summary Care Records in England was revised in September 2008 so that permission is sought from patients when a clinician has a need to utilise records from outside their own organisation.

"Patients have the choice of saying they do not want to be asked in every situation in which the record might be viewed. Otherwise they will be asked for their consent in every situation. In cases of an emergency where a patient is unconscious or incapacitated, clinicians will access their record if safe treatment requires it."

SA Mathieson

NI health department awards £70m deal

Wed, 07 Oct 2009 10:23:20 GMT

Northern Ireland's Department of Health, Social Services and Public Safety has awarded HP a wide ranging ICT framework contract

The department's directorate of information systems signed the deal with HP, which will provide and support regional ICT projects, and will be available to health trusts and boards across the province. Some of these services are likely to be sub-contracted by the main supplier.

An award notice in the Official Journal of the European Union on 7 October 2009 says the framework will cover the supply and support of hardware, support and software, the last including a range of off the shelf products and bespoke application development.

Commenting on the award, Victor Almeida, senior analyst at Kable, said: "This is more than three times the average ICT budget of an integrated health trust in Northern Ireland, which we estimate to be between £4m-£5m a year."

IT spending will ride out NPfIT problems

Wed, 02 Sep 2009 09:08:23 GMT

Spending on UK healthcare IT is set to grow strongly over the next five years, despite doubts about the future of England's NHS National Programme for IT (NPfIT)

A new report from Kable, publisher of SmartHealthcare.com, shows that while there are major uncertainties over the direction of the programme, work on implementing the Care Record Service (CRS) is likely to proceed, fuelling a growth in the market for software systems. This will combine with an increase in remote and mobile working to support continued investment.

UK healthcare market profile 2013-14 forecasts that annual spending in the sector will rise from £2.34bn in 2007-08 to £3.48bn in 2013-14, representing a compound annual growth of 6.9%.

The growth is predicted to come largely from software revenues, associated with moves to begin using the central electronic patient record developed under NPfIT. Although the CRS has been delayed by two years, its development has now reached a tipping point and should prompt the signing of a large number of contracts over the next two years.

These will cover clinical, logistical and managerial applications, ranging from patient administration systems to more complex operations such as asset and contract management, risk assessment, remote telemetry and recording details to comply with the Mental Health Act. The market will also open up as NHS trusts are given the freedom to choose alternatives to the core systems – Cerner Millennium and iSoft's Lorenzo – previously specified within NpfIT.

These factors should combine to boost spending in the field from £86.5m in 2007-08 to £364.4m in 2013-14.

The other main driving forces are the shift to telecare, which is encouraging the adoption of the relevant technology, and the growing use of mobility enablers such as smart cards, RFID tags, PDAs and BlackBerrys.

Among the other significant factors at work are the increasing use of outsourcing and shared services, and a move away from in-house software development towards turnkey applications from specialist providers. It is also significant that most NHS organisations do not have a specific budget for IT but tend to draw funds as needed from central budgets. This leads to a less settled investment approach and makes it harder to develop robust relationships with suppliers.

Report author Victor Almeida, a senior analyst at Kable, commented: "The health industry has the largest budget in the UK public sector and its modernisation is a paradigm not only for the rest of the UK government, but to health systems all across the world. For example, critics and supporters of 'universal healthcare' in the US often refer to the achievements and faults of the NHS in order to corroborate their arguments.

"Everyone in UK public sector and the rest of the world the has something to learn from the NHS."

* Read an extract from the report on the future of the National Programme for IT

Heart of England plans £10m record scan

SA Mathieson — Wed, 24 Jun 2009 08:00:00 GMT

May also saw multimillion pound contracts awarded by Scotland's health service for address management software and Northern Ireland for GP systems

A service to scan medical records, worth an estimated £5m-£10m, was the largest published tender in healthcare IT during May. It was posted by Heart of England NHS Foundation Trust, which wants to digitise its records for Documentum and Folding Space software, a job it says will take from three to 10 years. The paper records are currently stored in a number of the trust's locations in and around Birmingham.

Such projects are major undertakings for a trust, and are not covered by the National Programme for IT. May also saw St Helens and Knowsley Teaching Hospitals NHS Trust discussing its £1.2m deal with Eastman Kodak and OITUK, which involves scanning some 250m pages in 1m case files.

The only other technology related tender with an estimated seven figure value in May came from Nottinghamshire Healthcare NHS Trust, which provides mental health and learning disability services. It plans to spend around £1.2m on security systems, including CCTV cameras, a key control system, access control and a staff attack alarm system.

Scotland's National Information Systems Group awarded the month's largest contract, striking a £5.5m deal with QAS to provide address management software based on Scotland's national gazetteer. The system will be available to all health organisations in the country.

HSC Business Services Organisation, which buys on behalf of health and social care in Northern Ireland, agreed a deal worth just over £3m for GP clinical IT systems and services. The framework deal involves four companies, under which INPS will receive around £1.25m, Emis £900,000, iSoft £630,000 and Merlok Systems £270,000.

A parliamentary written answer published on 1 June threw more light on April's announcement that BT would take responsibility for Cerner Millennium at 12 acute trusts in the south of England and would deploy RiO software at 25 mental and community trusts in the same area. Ben Bradshaw – who has since been promoted from health minister to culture secretary – said that BT would get an extra £546m in 2004-05 prices for the work. In total, the firm will get £1.57bn for its local service provider work in London and the south.

Victor Almeida, Kable's senior health analyst, described the value of BT's southern work contract as an "oddity", pointing out that the 37 trusts represent a minority of the 93 in the region. Fujitsu's contract, which held the southern LSP deal until last year, was worth just £896m, but BT's contract covering just 37 trusts is worth 61% of that value.

Challenged on the size of the deal at Smart Healthcare Live on 10 June, Connecting for Health's outgoing head Martin Bellamy said that he was unable to discuss the negotiations with BT, but added: "We are confident that the contract extension represents value for money."

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

Government drops data sharing clause

Mon, 09 Mar 2009 17:35:00 GMT

Jack Straw has scrapped government proposals that could have allowed data including patients' medical records to be shared

The justice secretary bowed to public pressure over the data-sharing provisions in clause 152 of the forthcoming Coroners and Justice Bill, reports The Observer.

This would have allowed public bodies to exchange data without the knowledge or consent of individuals involved. Doctors and the Bar Council had joined privacy campaigners in warning of the potential risks to public trust.

The move will be seen as an olive branch to Labour MPs concerned about what they see as the erosion of civil liberties, and will raise eyebrows at Westminster where Straw is viewed as a potential future leadership contender.

"Absolutely no part of the purpose of this legislation was to extend a Big Brother society – quite the reverse – but I understand people's anxiety," Straw told the Observer. "I have never had a piece of legislation that was not improved by public debate during its passage through parliament."

He will now launch a fresh public consultation on how to implement more limited proposals from a review chaired by the information commissioner, Richard Thomas, which would allow government bodies to share information where there is clear benefit – for example, to ensure that bereaved families do not have to contact a string of official agencies to tell them someone has died.

The U-turn follows the Scottish government's decision late last week to withdraw support.

Northern Ireland integrates organisations and IT

Wed, 18 Feb 2009 09:00:00 GMT

Northern Ireland is merging many of its health and social services organisations, continuing a pattern of rationalisation that includes computing

Northern Ireland's health service has been substantially reformed in the last two years, under the direction first of Peter Hain and his team of direct rule ministers, and now by the devolved health minister, Ulster Unionist Michael McGimpsey. The common driving factor has been to streamline a wastefully bureaucratic system and allocate more resources to front line services.

The structure of services in Northern Ireland is significantly different from that in Great Britain: social services, public health and the fire service are responsibilities of the Department of Health, Social Services and Public Safety (DHSSPS) rather than local government. Until last year, there were 19 health trusts but now there are just six.

The next stage of reform in April will be the replacement of four health and social services boards by a single Health and Social Services Authority; 15 local health and social care groups become seven local care groups; and four health and social services councils merge into a Patient and Client Council.

Other quangos will merge into four new agencies, one of which – the Business Services Organisation for back office operations – is under review.

Overall responsibility for health IT lies with the Directorate of Information Systems within the DHSSPS. Until recently the department ran a distributed server infrastructure, using 105 servers. This has now been replaced by an IBM system using two data servers. The centralised data warehouse is used by DHSSPS to monitor individual trusts' performance outcomes, such as in the reduction of waiting lists, and is intended as the basis for an integrated electronic patient record system.

A limited electronic patient record system was installed last year in Northern Ireland's hospitals, with BT contracted to deploy the Sapphire Theatre software produced by Newgate Technology. The system was designed to provide theatre staff with immediate access to information on patients and to improve the administration and management of operations and theatres.

Celtic cooperation

Although it has not yet committed itself, the Northern Ireland health service has also given itself the option of adopting a patient management system jointly procured with Scotland. The Scottish government published the tender early last year.

In 2003, Steria won a 10 year contract worth £26.7m to provide the linkage between the health and social care trusts and agencies, including the 350 general practices. Its Health and Care Number system now shares patient information across all health bodies.

The contract required Steria to update the email, internet and electronic inter-system services for all surgeries. Steria had responsibility for all aspects of design, build and managed services, which runs through the IBM hardware platform and uses iSoft software.

iSoft's software recognises all patients using their Northern Ireland health care number, with a central index that cross-references and confirms identities. All the province's hospitals use iSoft's Clinicom patient administration system, which is also the basis for the sharing of electronic imaging.

A contract was awarded in October last year to Sectra to provide the technology for managing radiology information, picture archiving and sending RIS/PACS images across Northern Ireland. The 10 year contract was valued at £30m.

US corporation Partners HealthCare was awarded another technology contract last year to improve healthcare management practices. It covers remote monitoring of patients, reflecting the devolved government's ambition of telemonitoring 5,000 patients by 2011. The contract is also tied into the creation of the European Centre for Connected Health, which is intended to bring together public and private sector health and bioscience professionals and boost the telehealthcare sector in Northern Ireland.

Dr Jimmy Courtney, of the British Medical Association, says that despite the investments, there remains a heavy reliance in the hospital trusts on old legacy systems. "A clinician will often have to look-up a record from a legacy system and have to log onto five or six different systems," he says.

Nor, he says, are patient records effectively integrated. "If the patient is from a different trust, you may not be able to access the patient details," says Dr Courtney. "The patient administration has been around for 15 years or so. It does need to be replaced, but there is nothing around to replace it. There is a lack of compatibility between systems. You can't access information from other trusts at present."

Dr Courtney adds: "It is still work in progress on the amalgamations [of trusts] from last year on IT systems."

BT removes 0870 and 0845 charges

Fri, 09 Jan 2009 17:10:00 GMT

The UK's largest telco is to cut the cost of calls to specialised numbers used by many government bodies, including NHS Direct and some GP surgeries

BT has announced that from 16 January it will include calls from 0845 and 0870 numbers within its inclusive calling plans. This will make the calls to such numbers free for some or all of the day to the company's 14m residential customers.

It has claimed to be the first UK telecoms provider to make such a move.

People on BT's basic calling plans will pay nothing extra for 0845 and 0870 calls at times when geographic calls are free, either at weekends, at weekends and after 6pm on weekdays for those on a 12 month contract, or at any time for those who pay extra for free daytime calls.

Ofcom, the telecoms regulator, last year issued a consultation on forcing telcos to include calls to 0870 numbers, for which BT now charges about 6p a minute during peak times, in inclusive calling packages. A spokesperson said an announcement on this is due shortly. It has not proposed that 0845 calls, which BT charges at about 2p a minute at peak, be moved within packages.

If other telcos follow suit, BT's move could make government plans to move away from 0845 and 0870 numbers less urgent. 0845 numbers are used by parts of the NHS, including doctors' surgeries and NHS Direct.

Organisations including the Identity and Passport Service have followed Central Office of Information advice to move enquiry lines to the new 03 code, which always costs callers the same as 01 and 02 geographic calls, but others including the Driver and Vehicle Licensing Agency continue to use 0870 numbers.

BT said that its rivals charged from 10p to 75p for a 10 minute 0845 call on a Saturday morning, and 20p to £1.07 for the same call to an 0870 number.

DNA database campaigners win European judgement

Thu, 04 Dec 2008 11:44:00 GMT

Police forces could be forced to destroy the DNA details of hundreds of thousands of people with no criminal convictions, after a European court judgement

The European court of human rights in Strasbourg ruled that keeping innocent people's DNA records on a criminal register breached the right to respect for private life, safeguarded by the Human Rights Convention, reports The Guardian.

The decision could oblige the government to order the destruction of DNA data belonging to those without criminal convictions among the approximately 4.5m records on the England, Wales and Northern Ireland database.

The home secretary, Jacqui Smith, said existing laws would remain in place while ministers considered the judgment.

"DNA and fingerprinting is vital to the fight against crime, providing the police with more than 3,500 matches a month, and I am disappointed by the European court of human rights' decision," she said.

"The government mounted a robust defence before the court and I strongly believe DNA and fingerprints play an invaluable role in fighting crime and bringing people to justice."

Liberal Democrat leader Nick Clegg described Smith's consideration of the ruling as "an insult".

"The judgment is totally clear, innocent people should not be made to feel like they are guilty," he said. "This demolishes the government's view that the way to fight crime is to blur the distinction between innocence and guilt.

"It is a measure of this Government's disregard for civil liberties that a European court has to fight to protect traditional British freedoms from an Orwellian database."Scotland already destroys DNA samples taken during criminal investigations from people, who are eventually not charged or who are later acquitted.

The court decision follows a lengthy legal challenge by two British men. Michael Marper, 45, was arrested in March 2001 and charged with harassing his partner, but the case was later dropped.

Separately, a 19-year-old named in court only as "S" was arrested and charged with attempted robbery in January 2001, when he was 12, but he was cleared five months later.

The men, both from Sheffield, asked that their fingerprints, DNA samples and profiles be destroyed. South Yorkshire police refused, saying the details would be retained "to aid criminal investigation".

They applied to the European court after their case was turned down by the House of Lords, which ruled that keeping the information did not breach human rights.

Public sector to increase ICT outsourcing

Thu, 20 Nov 2008 00:01:00 GMT

New approaches to procurement and a wave of contract renewals will provide a boost to the public sector market for business process and ICT outsourcing over the next five years

Many small organisations will aggregate their demand to enter a market that they have so far neglected, leading schools, colleges and community services to take advantage of outsourcing. This will combine with organic growth in established government markets and the demands of transformation programmes to lift spending in the sector from £7.5bn in 2008 to £10bn in 2013, according to a new report on the subject.

ICT and business process outsourcing in the UK public sector: to 2013 and beyond, published by Kable, points out that following a slow period, over the next couple of years a number of high value outsourcing contracts will be up for renewal. This will spark a fresh burst of activity in the market, providing for about £8bn of business over the next two years.

While the central government market is saturated, the momentum for growth will be sustained by the entry of more local authorities, education and healthcare organisations and even third sector bodies into the market. A crucial factor in this will be the trend to bring them together in partnerships that will help them to share the costs and make the business more attractive for suppliers. The development of local education partnerships to implement the Building Schools for the Future programme is providing a model for this approach.

The demand to produce 3% per year efficiency savings and the government's transformation strategy will lead many organisations that have not yet considered business process and ICT outsourcing to regard them as serious options. The move towards shared services and new methods of procuring communications services will also contribute to the trend.

Another notable development will be that the large organisations that have already outsourced many of their functions will require more flexible business support than they currently receive. This will lead them to move away from large scale deals towards a portfolio of smaller, more specialised contracts that run for shorter terms.

These factors will combine to ensure that, compared with other markets, the public sector will be relatively stable and provide more scope for growth. It will, however, face some cultural resistance among the organisations that have not previously chosen to go down the outsourcing route.

Report author Peter Reed said: "Organisations that have rejected outsourcing solutions for the last 10 years are unlikely to be won over by the same old arguments, no matter how much pressure they are under. The challenge for suppliers is to attract new clients from outside today's core market.

"The area of untapped opportunity is in small to medium public sector bodies, most of which are operating at a local level. That means that suppliers will need to find ways to engage profitably with smaller customers, and deliver more than just efficient ICT services."

Anyone interested in obtaining a copy of report should contact Brett Mitchell on brett.mitchell@kable.co.uk or +44 (0)20 3353 4448

A paler shade of green

SA Mathieson — Wed, 02 Apr 2008 17:55:00 GMT

Health service organisations have been slow to explore options to reduce the energy consumption of their IT, but there is plenty of potential

Some of the most convincing reasons to be concerned about global warming are linked to health. In April, the World Health Organisation said high temperatures in western Europe in 2003 were associated with 70,000 more deaths than in previous summers, and that deaths from asthma are expected to climb by nearly a fifth over the next decade as a result of climate change increasing levels of airborne particles.

So it is surprising that there is relatively little green computing work going on within health, compared with other parts of the state sector. Only one of the entries in the green IT category in this year's GC Awards for Innovation (run by Smart Healthcare's sister magazine) came from health: North Mersey Health Informatics Service. All the others were from local authorities and national government departments.

North Mersey HIS provides the IT services for eight trusts in and around Liverpool, put forward its work reducing printer cartridge use through use of special software. It has used the Print Green and Save print management and toner optimisation solution from Team Logic Systems to reduce the usage of consumables - paper and toner - and get a picture of the true cost of its printing.

It has said the return on investment should exceed 35% of the costs, and projected that implemented across the NHS it scould provide savings of up to £10m per year.

Dinah McLeod, head of BT's recently established sustainability practice, says that of the six external clients her practice has gained so far, there are three each from local government and the private sector. Although the unit is working with other parts of BT to talk to health service organisations - and despite the firm's major contracts with the health service - it does not have any NHS customers.

"Green issues are not a top item on the NHS agenda," says Victor Almeida, a senior analyst for Kable, who adds that he has not come across any large initiatives in this area.

"Perhaps it is because people are not pointing fingers at the NHS - it's not a big polluter. Local authorities have a lot of responsibility at community and citizen level which the NHS doesn't have, and if you look at the main items on the green agenda, it's recycling at home and congestion. The NHS plays a limited role in these."

Given their environmental responsibilities, it may make sense that local authorities are leading on green IT work, but the same techniques could easily be applied to the health service.

The most obvious method - and the one being pushed by many vendors - is to install more efficient equipment. Leeds Partnerships NHS Foundation trust reduced its number of servers from 32 to nine through use of virtualisation technology: the software, provided by VMware and installed by CSA Waverley, allows one server to do the job of many.

However, although the mental health trust saw energy efficiency as one reason for the move, it cited improved disaster recovery as the main justification for the work.

Tim Dawes of Socitm Consulting, author of a recent report on green ICT in the public sector, says new equipment should be seen as one option among several. "It's not just about greener stuff, it may be about procuring less often," he says, as it requires energy to manufacture the equipment. "IT people may get really into (buying more efficient equipment), it's the nerdy thing to do. The greener thing to do may be not to buy anything, which is terribly hard for IT people."

He suggests low tech options for reducing power consumption. Of the organisations he researched, "the ones that seem most effective are explaining to people and getting them to turn off at the plug," he says.
A good example is Chesterfield Borough Council, which has lengthened its replacement cycle from three years to five, and run a campaign asking staff to turn computers off at the plug, which has the same effect as physically unplugging it.

Warwick Andrew, the council's head of e-government and ICT, says the latter is worthwhile: a personal computer turned off but plugged in uses 13w, as its power transformer is still on. The council has reduced the number of computers left plugged in from 60 to fewer than 25.
"We've had to invest no money, except in terms of time wandering around the building seeing which PCs are turned off," he says - a flashing light on a network card betrays a plugged in machine.

Cheapskate

As a working computer uses around 130w, the final 10% may seem like small change. But Andrew points out that most computers are on for less than a quarter of the time. As a result, a computer's switched off but plugged in state can account for around a quarter of its power use. "It's a belt and braces approach, and quite a cheapskate one," he says.

Socitm's Dawes believes that measurement should be the priority for IT departments seeking to save energy, as it justifies the work. But he warns against relying on manufacturers' estimates, as models change often and power consumption depends partly on usage: "There's quite a big variation between what they actually do and what they say. You have to test it."

Such testing of existing equipment has been a key part of work by Fujitsu, one of the biggest NHS suppliers, in its preparation to move the Cabinet Office to a greener computing model. The department is joining the Flex framework agreement that it runs with the vendor, which is designed to be shared by other public sector organisations.

Phil Brown, technical project manager for the Flex framework, says the Cabinet Office will cut its IT energy use by 20% when it has completed its move from desktop computers to thin clients, with a few exceptions for those staff requiring specialist software. Other organisations moving to Flex could see comparable savings, he adds, although much depends on whether most staff can use a standard suite of software.

"The headline figures were that by the end of 2011, the Cabinet Office would have saved in excess of 300 tonnes of carbon dioxide," he says, for its 2,000 users. This is primarily due to moving computing power from desktops to a data centre, where it can be allocated more efficiently.

Although a bigger data centre and a higher bandwidth network requires more energy, Brown says this is overshadowed by more efficient desktop equipment. In moderate to heavy use, Fujitsu's thin client draws 23w, compared with an average of 115w for the Cabinet Office's desktop computers.

The department's existing flat screens, which are likely to be retained as they are fairly efficient, each use 30w. As a laptop experiencing similar use draws 70w, the thin client plus screen remains more efficient, although Brown says laptops can use less power than thin clients and screens if lightly used.

And the thin clients can be switched to the most power efficient settings, such as blank screen savers: "If you have swirly things on your screen, that costs 30 watts. If you have nothing, you are burning virtually nothing," says Brown.

Cautious calculation

Brown adds that the calculation of energy savings "erred on the side of caution," and did not include saving fuel on travel, through the system enabling home working and collaborative working.

BT's Dinah McLeod says these broader savings should be added into organisations' calculations, to help justify efficiency work. Her practice has created a carbon impact assessment tool, which looks at a wide range of sources of emissions. "There's huge emphasis on the kit," she says of most calculations. "It's part of the equation, but only part."

The BT assessment includes commuting: McLeod says that even for data centres, staff travel to work is responsible for 7% of emissions, according to research at four BT facilities. But when the firm looked at one of its offices in a Welsh city centre, where many employees used public transport to commute, it found that home working would make little difference to carbon emissions: staff at home use power and heating they would not otherwise. "We have found a magic number of 25 miles to and from work (by car)," says McLeod, above which home working is a clear energy saver.

ICT makes possible other savings on transport, such as by allowing teleconferencing. BT's conferencing division says it saved NHS customers from emitting 4,500 tonnes of carbon dioxide (and £2.7m in travel expenses) through the 33,000 virtual meetings health service employees held through its facilities last year, which include teleconferences and broadcast streaming to up to 2,500 computers.

So far the NHS has apparently been slow to exploit the potential offered by the various technologies to reduce the environmental impact of its IT. But given the increasing focus on the subject it is unlikely to be long before its organisations begin to learn some of the relevant lessons from other parts of the public sector.

SA Mathieson

Comment: It's not easy being green

Mark Say — Wed, 02 Apr 2008 17:00:00 GMT

"Green" - in the environmentally friendly context - has become one of the most widely used words in our society without its implications being fully understood

Everyone understands the intent of green initiatives, but we are still struggling to comprehend the knock-on effects and how these could undermine the efforts.

The NHS, like most organisations, is grappling with the issue without yet getting on top of it. Our feature on energy consumption by IT suggests that a limited amount has been done so far to cut it in the health service, but it would be a surprise if IT chiefs are not at least giving it some serious thought by now. A look at the Assist website shows that, through its association with the BCS, it is providing a forum for ideas on the subject.

The green agenda is often tied up with the efficiency drive in the public sector, but at times there can be a tension between the two. For example, a move to more home working for some staff could help to reduce the demand for space and energy in the office, but would push up electricity and heating costs for the worker. It would be good for the organisation's bank balance, but the green audit could show that energy consumption was just dispersed, even increased, compared with the existing situation.

Similarly, the drive to reduce the volume of printing is increasing the production of PDF documents. A lot of people don't like reading anything beyond a couple of hundred words on screen, so they print the whole document, of which two or three pages may be relevant to the them. It burns up power and uses paper in the office. How much, if anything, does that gain?

There are lot of pitfalls and we're still finding our way, but progress is being made with a combination of hi-tech solutions - such as more energy efficient data centres - and common sense - like switching off PCs at the end of the day. The culture is changing in a way that will demand that IT departments have to get their collective heads around the issue over the next couple of years.

It's likely to lay the ground for a trend over the next couple of years where we see organisations appointing a member of staff, or maybe a consultant, to lead their work in the field. That's when "green" becomes more than a buzzword.

Mark Say

A standard for Europe

Mark Say — Wed, 02 Jan 2008 14:44:00 GMT

The European Commission is aiming to carve out a route towards EU-wide interoperability of healthcare systems

We've all heard plenty about the number of people coming from other EU countries to work in the UK, less about Brits going to work on the continent, and a lot about the temptations of retiring to Provence or the Algarve. At some time, almost anyone involved in these migrations are going to need healthcare, and the clinicians will be eager to tap into information on the patient's history.

So far it has been a fringe issue, but the interoperability of healthcare systems around the EU is likely to take on a much higher profile over the next few years. It has been on the European Commission's agenda for some time, but now it has begun to gather the momentum that could make it a big challenge for Europe over the next few years.

Many of the problems in achieving interoperability revolve around the nature of the data rather than the ability of systems to exchange information. In healthcare it is critical that data is properly understood, but in the past there has been no guarantee that the person at the receiving end will interpret it in the same way as intended by the sender.

The College of American Pathologists began to address this problem 40 years ago when it began work on the Systemised Nomenclature of Medicine (Snomed) to provide a structure for clinical information. But standards have not been developed to a sufficient extent to make systems truly interoperable within national boundaries, let alone across a continent.

The European Commission implicitly acknowledged this in 2004 when it adopted the eHealth Action Plan. This is a roadmap for the increased use of technologies in areas such as electronic prescriptions and computerised health records, with a series of targets lined up.

It has now trying to move forward. Last year the Commission's ICT for Health Unit produced the Connected Health report, outlining the steps needed to create a framework for interoperability, and it is aiming to publish a set of guidelines early next year.

The steps include standardised services related to identification and authentication, and moves towards semantic interoperability, the latter made more urgent by the development of automatic language processing and intelligent information retrieval. Alongside this is a need for standardisation in areas such as technical interfaces, protocols, messages, documents and even clinical processes, all of which would work better if defined at an international level. This could be supported by a certification process, which could work in a centralised manner or through a network of certifiers.

One of the measures outlined was for an ad hoc expert group on interoperability to compile advice on the necessary requirements. A spokesperson for the ICT for Health Unit says that during the summer it completed a document, Recommendation on eHealth Interoperability, which during consultation received 20 comments from industry and user group representatives, and was discussed at three meetings organised by the Commission.

Some of its main features seem to reiterate the basic aims: starting a dialogue on achieving a European health information space by 2015: indicating where there needs to be agreement and engagement for interoperability; and forming a framework within which all members states could find an appropriate role. But it also calls for a common terminology framework to improve semantic interoperability, and further developing the limited range of applications among which information can already be shared.

The next steps for the ICT for Health Unit involve launching a large scale pilot, under the EU's Competitiveness and Innovation Programme. This will aim to provide a federated solution, which would work across borders, for patient summaries and medication data. It is also working on proposals for conformity testing and accreditation schemes of e-health systems based on international best practice, and on the legal framework for the protection of personal data when information is exchanged.

The spokesperson says its more general aims are "to successfully launch a 'lead market initiative on e-health' in cooperation with DG Enterprise". In effect, it wants to promote plenty of innovation in the field.

One of the recurring features of the EU's plans is an assertion of the need for standardisation. This is encouraging it to work with HL7, the international organisation formed by healthcare professionals and software specialists to develop and implement standards for interoperability.

Martin Whittaker, a director of its national affiliate HL7 UK, welcomes the work the EU is doing in the field.

Standards benefits

"It's good that the EU is encouraging the use of international standards," he says. "It will drive down the cost of software development and the integration of links between systems.

"The risk has been that it would produce unnecessary standards that are not supported by the industry, but because of the current collaboration we think it will choose the right standards."

He says, however, that there are stiff barriers to interoperability on a European scale. There have been efforts within the UK over a number of years with limited success, and there is still a question mark over whether it is technically possible to achieve it across the continent.

He cites the experience of the Veterans Administration in the USA, one of the country's largest healthcare providers.

"It has a huge and complex hospital network, and at least has the same systems in all its hospitals, but it is finding it very hard to transfer information between them. It's even harder to do this just within the UK where there are a variety of systems."

The ICT for Health Unit acknowledges that the barriers are significant. Along with the lack of common standards, its spokesperson says the main obstacles to interoperability are the absence of common certification, market fragmentation and uncertainty - among patients and in a legal sense - around issues such as the protection of personal data and cross-border reimbursement.

There is a starting point, however, in providing a structure for the coding of information. Snomed has laid the basis for this by providing a code structure for clinical terminology. It is the only coding system to be used internationally, and is independent of national languages and their potential for interfering with the exchange of information.

"If we can get to the stage where we can structure and code clinical information the language problem disappears," Whittaker says. "But if there is no code you cannot structure the information."

He says another important element is that HL7 is working with the ISO in the US on a set of relevant standards, some of which have already been published.

The efforts have attracted some attention in the European Parliament. John Bowis, MEP for London, has been one of the leading advocates for action in the EU to support patient mobility. He acknowledges the significance of the interoperability effort in ensuring that patients who have moved from one member state to another, or may even be visiting for medical treatment, get the best possible service by making their information available.

Need for action

"I welcome anything done to improve patient information, particularly on the sharing options and to put security into the exchange of patient records," he says. But there is a need for swift action to maintain the momentum for the guidelines.

"I believe they need to get their skates on because this Commission will run out of time when the European Parliament expires in 2009. They need the proposals to land this year (2007) to have a chance of legislation going through next year."

Bowis says, however, that interoperability of systems has to be supported by other measures to support the aim of responding to patient mobility around the EU. These include providing patients with legal certainty on their opportuntities to go abroad for treatment, an understanding of the relevant procedures if something goes wrong in the treatment - which would have to be dealt with in the country where it took place - and provisions for patient safety.

This takes us to the verge of a separate debate, and it could be argued that the priority is to establish the technical conditions for interoperability. Martin Whittaker suggests that the EU's willingness to work with the specialists who have already laid the ground bodes well for the future.

"The key thing about the European initiative is that we are now working together," he says. "Without that it would be impossible."

Mark Say