In the late 1980s, after the NHS started going through its largest period of change, I began working for a women and children’s hospital, which was part of a larger group. At this time we were using a workflow system that was locally hosted on our site, however you could centrally report on all the individual hospitals. Despite being able to successfully administer our patients, manage our stock control, procedures and billing, we were missing the detailed patient notes – which were on paper.
Even at this time, the effects of an aging population were starting to show on the health service, with inaccessible paper-based patient information a major issue. Despite this being an acute hospital, it did not just cater for short stays; patients, particularly pediatrics and those in the special care baby units stayed for a long time, some for several years.
Silos and specialisms
It was in the mid-1990s when I started to focus on the clinical management of patients, with particular aspirations to assist with chronic diseases. I joined a small technology company specialising in the largest outpatient departments, such as rheumatology, oncology, and anticoagulation management (which was made up of around 150 diseases and types of conditions).
We started to support the management of patients and their conditions with the aim of achieving the best clinical outcomes possible and identifying the patients that needed the most urgent help – via an electronic process. In those days the clinical specialty was driving the information that was required and therefore we were not integrating our solutions with mainstream systems, and information remained pocketed in silos.
My point here is that the clinical requirements of assessing, diagnosing and treating patients have since change dramatically. Added to the NHS’ economic pressures, the modern patient expects clinicians to no longer treat them solely by specialty or condition; they now increasingly need a more holistic, person-centric approach. There are expectations, and rightly so, within the healthcare industry that IT systems should deliver more clinical and personal information at the point-of-care to support those with co-morbidities or long-term conditions and ultimately the patient journey. On top of that, we now have a paperless ambition set for 2018, which no one really knows quite how to deliver – all I know is that this simply cannot be achieved without collaboration.
From integration to collaboration
My story is over 25 years, a generation; I believe what we have the opportunity to lay the foundations, over the next 10 years, for the next generation. The shift from focusing on one specialty to supporting the complete patient workflow, with information from primary care, through Acute, onward to mental health and the community, starts with integrating our current systems, expanding and updating, replacement where helpful, but with the ultimate aim to integrate the wealth of silo, specialist systems.
This is something that 25 years ago should have been relatively easy to start by plugging the missing clinical information into the workflow system. However, all these years later there are still issues around integrating the care pathway in healthcare organisations.
But why is that? Is it because innovation was stifled due to the National Programme for IT? Lack of funding? Poor resource? Or could a significant factor really be that we simply are not sharing with our peers just how it could be achieved.
Travelling around the country and visiting numerous NHS organisations, I regularly find it startling how many trusts are unaware of what their neighbours are doing, the systems that they are implementing and the success or failures they are having. In fact, I’ve even seen mistakes made just months apart, which could have potentially been avoided by simply talking and learning from one another.
Beverly Bryant, director of strategic systems and technology at NHS England hit the nail on the head at EHI Live recently when she said that ‘everything we need actually works somewhere in the UK, right now’. We have layers of solutions, including portals, which can bring this information together, but more importantly, we need the information to be available digitally.
To plan for the future, we should reflect on the past and despite the loss of skills in some areas over the past decade, our healthcare service has seen the implementation of a lot of systems in the eighties and nineties, and the experience and knowledge that come with that activity is invaluable. Many organisations have good systems in place but we now not only have an opportunity to upgrade and enhance them, but to prepare for the next generation of healthcare, and that involves sharing and collaborating now.
Sharing could mean something as simple as sharing online or going over to the local or surrounding trusts, or even taking it a step beyond that like University Hospitals Birmingham NHS Foundation Trust and forming a partnership to impart IT wisdom with another organisation in need of informatics support.
On a grander scale, it could mean a central resource, a place where healthcare IT personnel past and present from a huge array of backgrounds can share best practice, experiences, and work towards a national standard. Here, healthcare providers can learn from each other and apply shared knowledge. While it is crucial for each individual trust to identify it’s own requirements and aims, having the opportunity to share and learn at any given time is vital.
This collective experience can importantly shape how the current level of government spend on technology is invested for the needs of future generations. It is obvious in my mind that we should all take responsibility to proactively manage the protracted £30 billion funding gap and this can be done, but it involves collaborating now for the greater needs of years to come.
This blog was first published on Last Witness. Last Witness provides open access for people to publish their personal stories of NHS IT Programmes over the years. http://www.lastwitness.co.uk/collaboration-is-the-future/