Best practice is the key

The success of the National Programme will rely on the commitment and enthusiasm of the NHS staff who will ultimately be the ones using the systems.

Arguments in support of the plan are not hard to make in terms of its impact on health service modernisation. But they still need to be made and the message will not get out on its own.

A key point raised at the Computing-led NHS Monitoring Group meeting this summer was the need to make the most of existing best practice in NHS IT.

Little of the actual technology is new, it is just the scale that sets it apart. There is a clear need for success stories to be pubicised as widely as possible whether they be, in the future, parts of the National Programme, or projects going ahead now which will contribute in terms of technology, process re-engineering or staff commitment to IT-enabled change.

The National Programme needs more champions at the local level, Laurence Harrison, healthcare programme manager at supplier body Intellect, told the Monitoring Group.

'There are islands of success out there.

'This has been done before and these systems are in the ground now, working, with complete buy-in and architectural input from clinicians.

'NHS staff know how they've done it in the past and know how to put the message across,' he said.

Security expert and research fellow at the London School of Economics Peter Sommer said: 'The problem for people is visualising what the system will be like and what all the detail is.

'NHS staff are being asked for their views on something which at the moment is almost nothing - they are certainly not going to be looking at the technical specifications and visualising anything.'

Jim Norton, independent director and former head of the Cabinet Office Performance and Innovation Unit ecommerce team, said: 'We should pick some places with successful IT programmes and extract some clincians to go and sell that to their peers.

'Richard Granger should take a small part of his immense budget and use it to extract these people and give them every incentive and every support to go round and sell the change.'

Computing will be seeking out projects, either already underway now or going ahead locally as part of the National Programme implementation, with clear lessons that can benefit NHS IT in other areas.

Case study: North-East London Strategic Health Authority

The electronic patient records (EPR) project going ahead in North East London will have much to contribute to the National Programme.

The area's Strategic Health Authority (SHA) signed a multi-million pound nine-year deal with supplier Cerna in June. Once fully live the system will provide the area's Homerton and Newham Trusts with full electronic records, online ordering and booking systems, access and alerts on core data such as allergies and clinical knowledge and decision support.

Despite the rash of high-profile local projects made obsolete by the imminent National Programme (see Computing 23 April and 28 May), the NE London project is going ahead because of the overwhelming commitment of local staff to the modernisation plan.

It would have been counter-productive to put the plan on hold, says NE London SHA chief information office David Welbourn.

'With any change programme the engagement of the people, the willingness to change and the anticipation of being able to do things differently is what makes the difference between success and failure.

'Once you have got that head of steam, to interrupt it is an enormous de-motivation.

'The challenge was whether to allow this to go ahead with the danger of it becoming one of the last legacy systems, or halting the project and risking losing all that good will,' he said.

Because the project has only a few months head start, the project will have to have maximum consistency with the National Programme throughout its life, says Welbourn.

'The important thing is the way the system gets used, not the technology itself.

'We will be working very closely with the whole London cluster to make sure the care pathways, protocols and details of how clinicians work are programmed into this system in a similar way to the rest of London.

'It's a two-way thing - it's not 'us and them' - we've been in a position to take a decision early and now we have to be sure all of London benefits.'

The project will be phased over two years. The first stage, focussing on Patient Administration Systems and high priority modules including maternity and Accident and Emergency (A&E), will go live early next year.

'We want to get very early benefits so don't want more than year before first things come on stream,' said Welbourn.

A major focus nationwide is the government target that 90 per cent of people going to Casualty should be treated and released or diagnosed and admitted within four hours. Meeting the target is a major challenge in NE London - this year Homerton A&E will face 25 per cent more people than last year.

The A&E module of the EPR system will be significant in helping meet the target, says Welbourn.

It will mean effective data gathering and a better understanding of what is affecting patient numbers and hospital performance, he says.

'At the moment we don't know why there's a 25 per cent growth in attendance because we aren't able to do a detailed analysis and unpick where that community is coming from.'

Better information about A&E visits will help the hospital make best use of strategies for taking the pressure off, such as greater care in the community for patients with chronic diseases. This also benefits the patients themselves.

'If you have decent data you can identify where there is potential for more care in the community and avoid the increasing impact on A&E, but you need the data to understand what is happening,' said Welbourn.

The system will also allow better use of resources. In A&E the first contact with the patient needs to be a more senior clincian, for the initial diagnosis, but once treatment is decided it can be delegated to more junior staff.

'Knowledge-based systems and decision support give better clinical government around treatment episodes, so we can delegate with confidence,' said Welbourn.

Electronic records are simply more efficient.

'A significant number of treatment episodes are cancelled because the patient's records are not in the right place at the right time.

'The electronic hospital saves storage space, eliminates wasted episodes so theatres can be more effectively used, allows doctors to spend more time with patients and doesn't have to ask them the same questions twice.'