Come on up: A view of Microsoft’s NHS chief information officers’ summit
Microsoft held its annual summit for NHS chief information officers at its UK headquarters in Reading on 15 January 2008. Lyn Whitfield reports on some of the key themes of the day.
It may be little consolation to those who feel that the only NHS constant is change, but the pressures it faces are being faced by healthcare systems around the world.
Dr Bill Crounse, Microsoft Corporation’s senior director, worldwide health, said healthcare everywhere faced “significant challenges” from an aging population, labour shortages, rising costs and rising patient expectations.
He also told the NHS CIO summit that they would need to make more innovative use of IT and, in particular, systems and services built around cheap, “commodity” products, to meet them.
On a positive note, he argued that the healthcare systems leading the way in using the web and mobile technologies to deliver new forms of care were those that combined payer and provider functions – such as Kaiser Permanente in the US or Group Health Co-operative in Seattle.
“In 2008, it is just wrong to tell people that the only way to get healthcare is to take time off work and drive someplace to wait and wait to see somebody [when often all they want is] a check up or some information.”
He felt this boded well for the NHS since “it is a big example of those kind of services.” “I think [the NHS] has a great opportunity to come up with a new paradigm for healthcare,” Dr Crounse concluded.
“In 2008, it is just wrong to tell people that the only way to get healthcare is to take time off work and drive someplace to wait and wait to see somebody [when often all they want is] a check up or some information. And just think of the resources that could be freed up.”
A review of reviews
Dr Crounse’s list of pressures was echoed by Matthew Swindells, director general, information and programme integration, at the Department of Health, who also said they made further “reform” inevitable.
“The path of reform has been putting money into capacity and then looking at the technical levers of reform,” he said. “Now, we need to bring investment and those levers together, and to move from monolithic providers of services to many providers that are more patient centric.”
Against this background, he added, the health service would also need to accommodate Lord Ara Darzi’s review of the NHS, with its focus on creating “gold standard” patient pathways to ensure high quality services.
“That is a challenge for IT, because at the moment we know what happens at the start of the pathway and what happens at the end, but we don’t know much about what happens in the middle,” he said.
Indeed, Mr Swindells said several times that the “vision” for the NHS emerging from the review “depends on IT”, which was why the review of informatics in the health service that had been announced shortly before Lord Darzi started work had been aligned with it.
The review is looking at how all the different audiences that require data in the NHS – from researchers through auditors and managers to patients – can be served.
Meanwhile, the National Programme for IT in the NHS is also under review. Mr Swindells said this was to make sure its vision was still relevant and deliverable and that it would meet the requirements of the modern NHS and the Darzi review.
However, he told his audience there was no point in saying “I would not start from here” and “we need to build on the best of what we have.” On the other hand, he acknowledged there was a need to align new policy announcements and IT requirements more closely, and to “make sure that the role of the centre and local organisations is correct.”
Infrastructure is key
At a local level, the key theme of the day was the need for NHS organisations to address infrastructure issues and to derive better value from their IT spend. “NIMM is a set of tools for assessing infrastructure and planning co-ordinated improvements in a systematic way.”
Dr Mark Ferrar, director for infrastructure at NHS Connecting for Health, said Gartner research suggested that 70 per cent of NHS It spend went on infrastructure and staff, and there were efficiencies to be made by improving its robustness, security and management.
He described NHS Connecting for Health’s national infrastructure maturity model (NIMM), which has been developed to enable trusts to assess their infrastructures and plan improvements. “A consistent infrastructure and desk-top is key to the NPfIT Local Ownership Programme (NLOP),” he said.
“Yet we still see trusts using technology when they are not ready for it. I see hospitals investing in Wi-Fi networks, when nobody has laptops. That sort of thing erodes the value of our IT spend. NIMM is a set of tools for assessing infrastructure and planning co-ordinated improvements in a systematic way.”
He also said NIMM would control access to some of the high-value technologies in the NHS’ Enterprise Agreement (EA) with Microsoft; which has developed its own Infrastructure Optimisation (IO) tool that maps closely to the NIMM model.
Philip Graham, head of IM&T at Blackpool, Fylde and Wyre foundation trust, told fellow IT directors that it had used a version of this tool with consultants to review its infrastructure. “We wanted to do the things that NIMM is supposed to do; we wanted to target our future investment,” he said.
CUI guidance and NHSMail
Both NIMM and Microsoft’s IO tool measure infrastructure maturity against a number of levels. Neil Slater, a programme lead for Microsoft’s common user interface (CUI) programme, said it had developed guidance and tools that could help trusts move up these levels.
“We went to ten trusts and did [some infrastructure maturity modelling] and then sent in consultants with a pile of CUI guidance and got trusts to work through it,” he said.
“Then we did a second assessment of where they had got to and we found that [all of them] had taken the leap from [the] ‘basic’ [level] to ‘standardised’. So if you want to do that, look at the CUI help that is available.”
The CUI programme started when Microsoft signed its first EA with the NHS three years ago, and began its second phase when the deal was renegotiated last summer. It now has a number of strands looking at how to make healthcare IT interfaces more consistent, safer and easier to use, as well as how to make IT easier to deploy and maintain.
One new project is the “technology refresh” of NHSMail, which will move the NHS’ email service off its current platform and onto Microsoft Exchange 2007. Dr Ferrar said the move would deliver new features and allow NHSMail to run across new mobile platforms.
“We are looking to make NHSMail the centre of the NHS’ unified communications structure,” he said, adding that the first phase of the refresh was almost complete and “detailed testing” was underway. Migration may start towards the end of this year.
Although the tech refresh has attracted a lot of interest in the NHS, several speakers stressed the importance of the CUI programme to the NHS and to healthcare more widely.
Dr Crounse said it had a part to play in two areas: delivering better information tools to healthcare workers and making the systems they used more intuitive. “There are a lot of systems out there and nobody could be expected to learn them all,” he said. “That is why I am a big fan of the CUI programme.”
Further Reading:
Presentations from the event (please right click on the links and save each one to view as the files are very large):
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Tags: CIO Summit presentations, common user interface, CUI, Dr Bill Crounse, Dr Mark Ferrar, EA, infrastructure optimisation, licensing, Mark Bower, Matthew Swindells, Neil Slater, NHS CIO Summit, NIMM