The National Health Service (NHS) is the United Kingdom’s primary healthcare organization, providing care to approximately 60 million citizens. While the NHS has a central IT agency that finances some technology purchases, each local Trust has its own IT department, resulting in a lack of centralized best practices. To ensure that the NHS gets the most from its IT investment, Microsoft Services helped the central IT agency produce a library of 50 technical documents and solution enablers covering business value, implementation details, and best practices for each of the Trusts to use. Using the Microsoft guidance materials, the NHS can rapidly deploy desktops, reduce build and configuration times by 75 percent, reduce unnecessary software costs, and improve patient care. As a result, one local Trust estimates that it is saving £50,000 (U.S.$72,000) per year in licensing costs alone.
Founded more than 60 years ago, the United Kingdom’s National Health Service (NHS) is one of the world’s largest publicly-funded health services. The NHS was founded on the ideal that good healthcare should be available to all—and that principle remains at its core. With few exceptions, the services that the NHS provides, from routine preventative care to emergency treatment, are free at the point of care for all 60 million U.K. residents.
||We are enabling our care providers to focus on the patient by giving them the tools they need to do their jobs more efficiently.
Head of IT Services, Humber Mental Health Trust, National Health Service
The NHS employs more than 1.4 million people, including 35,000 general practitioners, 90,000 specialists, 400,000 nurses, and 16,000 ambulance staff. On average, NHS employees serve 1 million patients every 36 hours. Each general practitioner sees an average of 140 patients each week.
While the NHS in England is funded centrally by the government, care is provided by more than 400 independent regional healthcare organizations known as Trusts. The Trusts are responsible for different services in various regions: acute Trusts, ambulance Trusts, mental health Trusts, and primary care Trusts.
NHS Connecting for Health is responsible for nationally-coordinated major IT programs across the NHS. Its mission is to use new technology to support the systems that give patients more choices and healthcare professionals better access to information that helps ensure quality patient care. As part of this mission, NHS Connecting for Health has a central Enterprise Agreement with Microsoft. It provides software licenses for core Microsoft® products and technologies for all desktop computers, laptop computers, and Tablet PCs throughout the NHS.
Though the software is purchased centrally through NHS Connecting for Health, each NHS Trust has its own IT department and is not governed by a central authority—each Trust makes its own IT decisions, resulting in a disparate set of systems. As a result, each of the Trusts has its own unique challenges. For example, at Humber Mental Health Trust, desktop deployment was time consuming and the IT staff spent much of its time troubleshooting and maintaining its Active Directory® services infrastructure. The IT department at NHS Sheffield would manually image new PCs because it lacked a standard operating system and an automated deployment system. Similarly, Leicestershire Health Informatics Services used a rudimentary software management system; it had to manually configure, deploy, and update its desktop computers, and once a desktop was deployed, IT staff had little control and no centralized console to monitor PC health. Furthermore, Leicestershire’s network environment was highly-dispersed and the IT department lacked centralized control of its server infrastructure.
Each of the Trusts experiences ever-increasing pressure to reduce costs and maximize the value and benefits that can be realized from their IT infrastructure and services. However, the individual IT departments approached problems reactively and in an ad-hoc manner, instead of proactively. IT was cost intensive, and IT staff at the Trusts were in constant “fire-fighting” mode, which resulted from the lack of centralized policies and best practices. Although the NHS structure—with each Trust run as its own business—does not allow for centralized IT management throughout the entire organization, the agency wanted a solution that would help individual Trusts increase the maturity of their IT infrastructure, with IT as a strategic asset and key productivity enabler.
||With Microsoft Deployment Toolkit for NHS, we got our build times down from one hour to 15 minutes—a 75 percent reduction.
Head of IT Services, Humber Mental Health Trust, National Health Service
“While the NHS had the software it needed through its Enterprise Agreement with Microsoft, it quickly became apparent that to accelerate deployment and maximize the value of the agreement, the Trusts would benefit from access to best practice advice and guidance,” explains Neil Slater, Enterprise Strategy Consultant at Microsoft Services. With hundreds of Trusts, enterprise-level knowledge sharing is difficult. To address this challenge, the NHS needed a solution that would enable the individual Trusts to effectively share knowledge and IT best practices. Solution
In 2005, Microsoft Services, in collaboration with NHS Connecting for Health and the NHS Trusts, began a program focused on increasing patient safety and clinician effectiveness by establishing a common user interface (CUI) for clinical applications. The NHS CUI Programme also began to develop a set of technical documents and solution enablers to help the NHS fully benefit from the software it purchased. Microsoft developed a version of this guidance that is available to healthcare organizations worldwide (www.microsoft.com/industry/healthcare/technology/hpo/silverfish.aspx). It includes product details and implementation guidance that aligns with an organization’s business value and IT strategy.
The NHS CUI guidance consists of more than 50 documents that cover strategy, technical product information, implementation, and administrative guidance. In addition, it includes solution enablers that are packaged for quick deployment and give Trusts the flexibility they need to implement the most relevant pieces of any solution. The NHS CUI guidance includes documentation on:
- Infrastructure security
- Systems management
- Configuration management
- Desktop deployment
- Desktop build
- Server deployment
The NHS-specific guidance is available to all Trusts, though several Trusts are participating in an early adopter program, including Humber Mental Health Trust, NHS Sheffield, and Leicestershire Health Informatics Service. These NHS Trusts work closely with Microsoft Services to offer valuable feedback during the delivery cycle, helping to ensure that the published guidance is suited for the entire organization. Humber Mental Health Trust: Automating Desktop Deployment
At Humber Mental Health Trust, 19 IT staff support 7,500 users across 287 sites. It has 5,000 client computers—3,000 in clinical use and 2,000 in support use—running the Windows® XP operating system and Microsoft Office 2003. The IT staff spends much of its time troubleshooting and maintaining its Active Directory services infrastructure. “We have changed focus, system delivery, and hardware over the years, and now we have an Active Directory infrastructure that limits what we can do and requires extensive support time,” explains Adrian Purcell, Head of IT Services at Humber Mental Health Trust, NHS.
|Humber Mental Health
|Leicestershire Health Informatics
To address its limiting Active Directory infrastructure, Humber is using NHS CUI guidance to help implement the Windows Server® 2008 operating system and a new Active Directory forest. It plans to roll out the new environment by the end of March 2009. Humber also has a significant hardware refresh planned for 2009, and will use the NHS-specific guidance in the Microsoft Deployment Toolkit 2008 for NHS to help automate its manual desktop-build process and consolidate its 27 desktop images. It plans to upgrade all computers at its 287 sites to the Windows Vista® operating system and the 2007 Microsoft Office system by March 2010. The Trust is also implementing Microsoft Office SharePoint® Server 2007 for its collaboration solution.NHS Sheffield: Standardizing the Desktop
The 12 employees in the IT department at NHS Sheffield support 3,000 users across 180 general practitioner and primary care physician sites with 3,000 client computers running various operating systems—Windows 95, Windows 98, Windows 2000, and Windows XP. It did not have a formal operating system image or an automated deployment system, so the IT department would manually image new PCs. What’s more, the Trust could not easily update existing images. To upgrade its operating system, it had to manually rebuild each computer. For support issues, IT staff would often drive out to Sheffield sites—often longer than a 30-minute drive.
The IT team at Sheffield is using guidance from the Microsoft Deployment Toolkit 2008 for NHS to help consolidate its images and create an image that is hardware independent. In addition, using the guidance enabled Sheffield to develop and document its own formal build process—ensuring a consistent desktop across the Trust. Its standard image now includes Windows XP, Microsoft Office 2003, and standard clinical applications. The Trust is also using NHS CUI guidance on the Windows User State Migration Tool to help simplify the process of migrating users’ settings to new computers during upgrades. Leicestershire HIS: Centrally Managing a Dispersed Environment
The Leicestershire Health Informatics Service (HIS) is a shared IT service for multiple Trusts that supports 300 locations throughout the city of Leicester and Leicestershire County. It has 100 IT staff who manage 8,000 desktop computers running the Windows XP operating system with Service Pack 3. The HIS used a rudimentary software management system; it had to manually configure, deploy, and update desktops. Once a desktop was deployed, IT staff had little control and no centralized console to monitor PC health, so the staff relied on reports from end users in the case of an IT security risk. The highly dispersed server environment is composed of more than 200 servers running the Windows Server 2003 R2 operating system, so the IT department lacked centralized control. Managing backups and maintaining a sound disaster recovery plan involved a time-consuming and costly process—requiring the IT department to spend resources ensuring that back-up tapes and drives were installed and working.
Leicestershire HIS is using guidance from the Microsoft Deployment Toolkit 2008 for NHS to implement a range of technologies. It is using the NHS MDT 2008 guidance to speed its desktop deployment. It plans to implement Microsoft System Center Configuration Manager 2007 in July 2009 to help automate updates to its client computers and servers across the distributed organization and to manage its software inventory. For unified virus and spyware protection across its desktops, the Trust is using Microsoft Forefront™ Client Security. Benefits
With NHS CUI guidance, the NHS Trusts can access tailored information for implementing the technology that they have available through NHS Connecting for Health. As a result, the Trusts have been able to make critical improvements to their IT infrastructures to address each of their unique challenges. The Trusts have realized a variety of benefits: reduced deployment and configuration time, reduced time to migrate user settings, easier backup and data recovery processes, cost savings, and improved patient care.
Reduced Time to Deploy and Configure Client Computers
||Not only is Forefront Client Security a better security solution, but it will save us £50,000 each year in licensing costs—that’s huge.
Systems Engineer, Leicestershire HIS, National Health Service
Prior to using the Microsoft Deployment Toolkit 2008 for NHS, Humber Mental Health Trust had to build client computers manually. Its operating system image was out of date, and engineers would spend valuable time adding to the outdated image—each build was customized for each user, taking an hour to build each desktop. As a result, the Trust managed 27 operating system images. In addition, it did not have the ability to remotely build desktops.
By using the Microsoft Deployment Toolkit for NHS, Humber reduced its operating system images from 27 to 1 single image. The IT department no longer has to manually build client computers and can configure them remotely, resulting in significant time savings. “With the Microsoft Deployment Toolkit for NHS, we got our build times down from one hour to 15 minutes—a 75 percent reduction,” says Purcell.
With a range of hardware in its client computing environment and a manual desktop-build process, NHS Sheffield used to spend up to three hours to configure a single computer. “Now we can configure and deploy 20 computers per hour,” explains Martin Lane, Infrastructure Manager at Sheffield, NHS. “This would have been impossible prior to the NHS CUI Programme.”
Leicestershire HIS is also able to save valuable IT resources on building and deploying client computers. It has reduced the size of its operating system image by storing applications on the network and has automated the deployment process using Lite Touch Deployment—saving two hours for each of the 100 or more computers it builds each week. Reduced Time to Migrate User Settings
Prior to implementing the Windows User State Migration Tool with the help of the NHS CUI guidance, it would take most of an entire day for IT staff at Sheffield to migrate user settings in the event of a computer upgrade. IT staff would first have to back up the old computer, run through a long checklist of tasks, and then manually build a new desktop and implement the previous settings. Now, the process is automated. Using the tool, the IT staff can capture files and settings from the source computer and then migrate them to a new Windows installation.
“With the Windows User State Migration Tool that we learned through the NHS CUI guidance, we can migrate more than 50 computers each day,” says Lane. Lower Licensing Costs
With the NHS CUI Guidance, the Trusts are able to use the software that the NHS has already licensed through its Enterprise Agreement—enabling them to reduce their need for third-party solutions. Specifically, Leicestershire HIS was able to eliminate other security solutions it was paying for thanks to NHS guidance for implementing Forefront Client Security. “Not only is Forefront Client Security a better security solution, but it will save us £50,000 (U.S.$72,000) each year in licensing costs—that’s huge,” explains Townes. Improved Quality of Patient Care
As a result of NHS CUI guidance and the IT improvements that the solution helped foster, all three Trusts are able to meet a critical business goal: improve the quality of care they deliver to patients.
At Humber, an intranet that is difficult to navigate and that lacks easy access to information is being replaced by Office SharePoint Server 2007 meeting spaces and document libraries. Now, multidisciplinary healthcare teams in various locations can use meeting spaces for collaboration, and employees can easily find critical documents. “We are enabling our care providers to focus on the patient by giving them the tools they need to do their jobs more efficiently,” says Purcell.
A consistent desktop environment helps the Trusts improve patient care. With a single image tailored to each Trust’s needs, the IT departments have helped ensure that all healthcare professionals have access to the required applications. In addition, with the improvements to desktop build and deploy time, the Trusts are able to improve their response times for their users. “We can get fixes deployed to any of our sites in less than 45 minutes,” says Townes. “Doctors and nurses don’t worry that their PC will be out of commission for a long period of time, so they can focus on patient care.”
Microsoft Solutions for the Healthcare Industry
Healthcare and life sciences organizations are under tremendous pressure to meet regulatory requirements, improve patient care, and reduce the time it takes to develop drugs and take them to market. To meet this challenge, Microsoft and its partners have developed cost-effective solutions that enable healthcare organizations to streamline and automate daily processes that improve productivity and deliver information whenever and wherever it is needed. The result is enhanced productivity, safety, and quality.
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