4-page Case Study - Posted 11/27/2006
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Hospital Trust Increases Efficiency by Standardising Communications Infrastructure
Employees at Southend University Hospital NHS Foundation Trust provide medical services to 330,000 people in Essex, United Kingdom (U.K.). As with many hospital trusts, IT investment at the organisation became disjointed in recent years and failed to adhere to common technology standards. The U.K. government’s new Connecting For Health (CFH) programme aims to rectify that problem by requiring healthcare organisations to procure standard systems from authorised vendors. This requirement presents a considerable challenge to many hospitals, which must now migrate to a standardised host network and desktop environment. Many are struggling to implement and maintain the infrastructure required to support new CFH clinical systems. Southend University Hospital Trust was particularly concerned that the requirements—coupled with the need to support existing systems—would increase IT support costs.
Situation
Southend University Hospital NHS Foundation Trust is a university teaching hospital in Essex, United Kingdom. It has 840 in-patient beds and nearly 4,000 employees serving a population of 330,000. Employees at the hospital, which has an annual budget of £182 million, provide a comprehensive range of services, including acute medical and surgical specialties. In June 2006, the hospital was awarded foundation status, giving it increased power at a local level and greater financial independence.
In 2002, having reviewed its existing technology base, the hospital concluded that it needed to launch a future-proof infrastructure if it wanted to accommodate new information and business systems and offer patients the best possible service.
The hospital was running a mixture of Microsoft Windows NT® 4.0 domains and Novell Netware servers with no centralised control. It also had a number of incompatible local database systems. Because there was no desktop management, the IT team had to sort out problems, deploy updates, and install new applications almost constantly. Worse still, they often had to spend several hours out of the office on each visit.
Nick Fernandez, IT Director at Southend Hospital University NHS Foundation Trust, says: “The Trust environment had grown organically over many years. This inevitably resulted in a disjointed infrastructure with isolated departmental data silos only accessible from certain dedicated computers. Employees were unable to search across the organisation and access critical patient data whenever and wherever required.”
At the same time, managers at the Trust were under increasing pressure from the government to provide more detailed activity reporting and auditing of patient care. This created demand for new user-friendly IT systems that could support timely data capture and analysis.
Because existing IT systems were unreliable or difficult to access, employees were reluctant to make use of them. Fernandez estimates that only 30 per cent of employees were using computers regularly, which led to unnecessary use of paper and delays in accessing critical patient data.
In 2002, the Trust initiated its Infrastructure Development Programme to address these issues. The main goal was to introduce a corporate-style Enterprise Architecture based on standardised, interoperable technologies and establish a secure and stable environment for management and clinical employees alike. Above all, the technology had to be user-friendly and familiar so employees could rely less on paper-based processes.
Solution
Between 2002 and 2004, Fernandez and his team deployed a completely new IT environment based on Microsoft technology. The underlying infrastructure was built on Windows Server® 2000 and later updated to Windows Server 2003.
Other technologies included:
- Active Directory®: sets permissions and security levels for different groups, ensuring everyone from porters to clinicians can access different levels of information.
- Microsoft SharePoint® Portal Server: an Internet portal that helps create a greater flow of information and collaboration across the organisation.
- Microsoft Systems Management Server (SMS): desktop management software that allows applications to be deployed remotely to all desktops in the network. This was introduced along with Microsoft Operations Manager 2005, which monitors all critical servers for disc space, load balancing, and network failures.
- Microsoft BizTalk® Server: a “translation” server that allows different, often incompatible, systems to “talk” with each other and share information.
- Microsoft Exchange Server 2003: provides both internal and external e-mail communications.
- Microsoft Content Management Server: Trust departments can authorise and publish information specific to their area or specialty on the hospital Web site.
- Microsoft Live Communications Server 2005: allows IT team to communicate across multiple sites.
- Microsoft Virtual Server 2005: tests applications in a virtual environment.
Although the IT team could have chosen alternative tools, the hospital opted for Microsoft products because of their ease of integration and reliability, Fernandez says.
"The problem was that, even where alternative solutions were competitive in terms of price and functionality, the case would break down because of the need for specialists and training,” he says. “Standardising on Microsoft also ensures we have a highly accountable single point of contact and support with a vendor that is stable and has a long-term software roadmap.”
Benefits
The changes in the IT systems have had a dramatic effect. Employees are using IT far more frequently and can share information in a way that was previously impossible. This has improved communications and patient care across the hospital.
Employees Gain Better Access to Information
The number of employees using electronic communications has increased dramatically, with a six-fold rise in the use of e-mail. Fernandez estimates the proportion of workers using computers has increased by as much as 75 per cent over the last four years.
Will Fensom, IT Infrastructure Manager, Southend University Hospital NHS Foundation Trust, says: “Busy clinical employees will only use computers if they are easily available and offer a clear benefit. There is clear evidence that, with the incredible growth in e-mail, people are moving away from a paper-based environment and are more comfortable using electronic applications.”
Employees also receive up-to-the-minute information through a sophisticated Intranet called STAFFnet. Instead of a monthly hard-copy newsletter, for example, Southend University Hospital now sends out a weekly e-mail containing a link to a single version of the document stored on STAFFnet. It also delivers updates on key issues at a moment’s notice and provides a virtual forum where employees can post and discuss their views.
Clinicians can access the Intranet from any desktop and pick up the latest guidance or information on drugs, treatments, and procedures. Cardiologists can even observe live demonstrations of heart procedures from their computers. The Intranet is also an effective vehicle for internal recruitment.
Using STAFFnet, employees can now access previously inaccessible databases. Ward clerks, for instance, can now log on to discover exactly when patients will receive their prescriptions. A more efficient discharge process also frees up beds and helps improve occupancy.
Solution Encourages Employee Innovation
The new technology environment also encourages employees to embrace change and be more innovative, Fensom says.
Future plans include setting up a new telecommunications system where all porters are equipped with mobile devices. This would allow managers to track porter activity and direct them to work remotely. The hospital also intends to scan all existing paper-based medical records and reduce the cost of managing large paper files. This reduces the risk of appointments being cancelled or treatment disrupted when patient notes go missing.
Clinicians are also starting to link up with specialists from across the country to discuss the treatment of patients. In the past, they used dedicated video conferencing suites. Fernandez now expects most people to start using miniature video cameras and streaming software included in most standard computers and networks.
Solution Ensures Safer Use of Patient Data
The treatment of patients is also enhanced by standardising messages across hospitals. It is now possible to “translate” clinical information for a patient moving through different treatment areas into common databases, which ensures the information is up to date and consistent.
With the previous system, there was always the possibility errors would enter medical records, which could ultimately put patients at risk, Fernandez says. “Integration of the respective databases allows us to share demographic outputs with all our core clinical and administrative systems,” he says. “It avoids the costs of inputting the same data twice.”
It also ensures that all pathology results are secure and free of transmission errors. The hospital has two lab systems with different suppliers, which raises the risk of misrouted or false test results if not carefully coordinated. Now, all lab test data can be converted into a common set of results viewable using a Web browser.
Theatre Monitoring Reduces Cancellations
Clinicians and patients benefit from a reduction in the number of cancelled operations. “Operations can be cancelled if you don’t have the right medical equipment, consultants, and anaesthetists in the right place,” Fernandez says. “This theatre-management system brings all that together and links in with the sterile services.”
Furthermore, employees can now track all stages of the cleaning process for instruments used in theatre operations to ensure they remain completely sterile. The electronic theatre-management system can also record the history of each instrument over the past five years as part of the strategy to protect patients from the theoretical risk of variant CJD.
IT Support Team Works More Efficiently
The Southend University Hospital Trust IT team consists of three helpline operators, six second-line support engineers, and two third-line support engineers. They look after 4,000 employees who use 1,800 desktop systems and 170 servers. The new remote control repair and deployment facility has allowed the team to keep on top of an ever-expanding IT agenda. And with the reduction of helpdesk inquiries and call-outs, the team can now support the service more proactively.
Fensom says: “It means we can view what we’re doing and deliver that without going anywhere. We can also roll out applications to these machines without having to visit.” Without these tools, the IT team could not have kept up with demand.
The Trust was an early adopter of the electronic booking system Choose and Book, which requires extensive updates and close monitoring. Fensom says: “At one stage, we were doing weekly updates, and these machines are all over the Trust. Without central management, my technicians would be running around week in and week out, and we’d have been unable to keep up to date.
“With RIS, it is far easier to deploy and redeploy desktop systems. Although the scripted builds take around 40 minutes to deploy, the total investment of engineers’ time is around five minutes to start the process off. They can then walk away confident the system will finish its installation and automatically reboot ready for use.”
Another clear benefit is the ability to use SMS to gain remote access to desktops, which supports a significant time reduction in issue resolution. IT workers can look at most desktop technical issues remotely, without time-consuming desk visits.
Employees are also very positive about the IT team’s support. One of the most common responses in a recent satisfaction survey was that users were impressed to “see the computer fix itself.”
Solution Provides a Secure Environment
Employees and the public now can access only the information appropriate to them, which increases the security of the whole network dramatically. This, in turn, helps ensure compliance with patient-confidentiality and data-protection legislation.
It has also substantially reduced the danger of virus infection and malicious interference. Fensom says: “The biggest advantage is that none of our users can install anything we don’t want them to install, and that in itself resolves half of the viruses out there. We have got greater built-in resilience.”
What’s more, the ability to virtualise 10 interface computers has been a revenue-neutral method of increasing resilience and recoverability of Trust interface systems. Entire system configurations can now be backed up and restored by backing up the Virtual Hard Disk files. By hosting multiple virtual machines on a single server, the Trust can spread the cost of resilient hardware across several systems while benefiting from increased uptime.
For More Information
For further information about Microsoft products and services please visit
www.microsoft.com/uk
or call 0870 60 10 100*
For hearing impaired customers with a Minicom contact: 0870 50 30 400*
*Lines are open 8am-6pm Monday to Friday. Please note Numbers prefixed 0870 will be charged at national call rates. For details of national call rate charges please contact your telecoms provider
For more information about Southend University Hospital Foundation Trust products and services, visit the Web site at: http://www.southend.nhs.uk/
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This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.
Document published October 2006
