The following arrived in my inbox a few days ago. As the writer needs to keep his job I am publishing it anonymously – but with his explicit written permission. I am sure you will enjoy what he has to say!
I am currently work on the NHS IM and T programme for one of the Local Service Providers assisting NHS organisations in putting new systems in. I'm sure you are probably aware of the e-health insider website -
- which reports on the trials and tribulations of the NHS IT programme. It offers relatively fair and balanced view of what we are going through here in the UK in IT health with the reader comments on articles expressing a range of passionate views. I draw your attention to it as while PACS get a good response issues continue to abound on many other systems deployments and overall strategy. The website provides a good view of what is going on not just from the Connecting for Health view point.
I read with interest your article in November on Why Hospital IT is so Hard. Your thoughts on the engagement of clinical staff were spot on. Having been involved in two deployments in London acute hospitals in the past couple of years I can relate to that.
Briefly as I see it in the UK is that the initial IT strategy to replace patient administration systems dealing with Outpatient appointment scheduling and admission and discharge was misplaced. A strategy that focused more on improving clinical decision making - PACS, ordering and receiving test results, patient medical history recording and ease of access to it - would have been more successful and would have improved the level of clinical engagement. Some of these issues have been partly addressed through the 3 or 4 years of the NHS project and the success of PACs there is an increasing focus in some of the LSPs on improving clinical decision making and health recording which will lead to improved patient outcomes.
There is also an increasing trend here to use "organisational change management" techniques to try and improve the success of putting IT systems in the NHS which is what I am involved with. These techniques from the private sector management consulting around benefits management, communications and stakeholder planning plus system process redesign. As a non-practicing nurse I think that these require a bit more of a clinical and health sector bent to them but this is developing as people from a non-health back ground brought in to improve the success of the IT implementation get to know and understand the NHS clinical and managerial culture
As an ex-pat Australian I have only been recently following what is going on in Australia in health IT and information. It seems from your articles that the former government set up an organisation largely based on bringing non health and private sector techniques and management styles to IM and T planning. It can't be done this way alone. You need to join this with insider health knowledge particularly an understanding of the way clinicians (particularly doctors) make decisions, practice and deliver care. They have to be 100% sure that something is viable and safe of they will opt out. I believe this comes from the way clinicians practice and are taught to make individual decisions about their practice.
You also need detailed process knowledge of how hospitals and health systems are run, managed and administrated. How patients are referred through the system, how costs are monitored and funded or paid. And the organisational and political public and private players Gaining this understanding is not easy and needs experience too. It’s not easy but all needs to be accounted for in successful IM and T health deployments.
Sorry your probably a busy man and this is going on too long. Let’s hope that the new Government and advisors adopt an strategic approach to systems that gets clinicians excited, involved and will improve practice. It’s not easy and can't satisfy everyone. But I also hope that strategies are also planned and developed around how to engage clinicians, other staff and patients on how new IT systems will change the way they deliver and receive care. This will make the introduction and the use of the systems easier too. Again from experience you can’t everyone but you have to try very hard.
I think there are some excellent hard won perspectives that entities such as NEHTA should work hard to absorb.
I look forward to any other insights our new UK Correspondent can offer!