Inside e-health on (not) getting results out of the box

IT journalist Jon Hoeksma wonders why healthcare systems can’t be bought out of the box: and whether primary care might have something to teach the hospital sector. 



One of the abiding problems of healthcare IT systems is that you can’t easily buy them off the shelf. You can’t pick up a new hospital or GP information system from PC World, take it out of the box and start using it.

It’s not that there aren’t plenty of good systems out there. But having bought one – probably after a lengthy procurement – it will almost certainly require a lot of configuration and even bespoke code development before it meets an organisation’s needs, integrates with systems already in use and starts sharing data with them.

Licences are only the start

Few healthcare organisations can afford the cost and disruption of a wholesale “rip-and-replace” of all their existing systems. Unless they’ve got very deep pockets, very old systems or a very unusual appetite for high risk technology projects, it makes more sense to integrate new investments with old. “You can’t pick up a new hospital or GP information system from PC World, take it out of the box and start using it.”

However, the greater the level of local configuration and bespoke integration required, the more expensive the project will become and the longer it will take to implement. As project timescales start to stretch out, IT managers can expect to have to accommodate new requirements – the 18 week wait and Choose and Book being recent examples.

And because healthcare is highly complex, healthcare bodies rarely have identical ways of organising themselves and doing things - hospitals delivering ostensibly similar healthcare services have very different business and clinical processes. Adapting and configuring systems to match these local realities can help to make buying and installing a new clinical or management system prohibitively expensive.

Put another way, the lack of standardisation between healthcare services means that even standardised IT systems – such as those being provided under the NHS IT programme - require considerable local configuration to meet local requirements.

National systems: local requirements

These realities have helped to keep costs high and acted as a brake on the rate of adoption of modern IT in many health services, including the NHS. Only a handful of hospitals in England are fully digitised, with advanced electronic patient record systems, despite the clinical, management and patient benefits they can provide.

One of the core aims of England’s NHS IT programme has been to drive down costs by centrally awarding contracts for core, standardised systems. From a procurement perspective this has been hugely successful, delivering big savings in comparison to small groups of trusts carrying out their own, local procurements.

However, it has proved difficult to shoehorn these systems into a heterogeneous range of NHS trusts. As part of the shift to local ownership of the NHS IT programme, moves are underway – particularly in the South of England - to significantly increase the amount of local configuration provided to trusts.

The tricky balancing act will be to provide this local configuration without throwing away the strategic benefits of shared, common systems.

Primary care computing sets the standards

Standardised or single systems are not the only way to drive down costs and achieve interoperability. In the primary care sector, the NHS IT programme is pursuing a parallel track - one based on standards and accreditation of systems to core requirements - under a process known as GP Systems of Choice (GPSoC).

The idea is simple: as long as GP software meets a set of common standards, and is interoperable up to the point of being able to safely exchange patient records, the Department of Health will provide funding to primary care trusts who buy it for practices. “Standards mean primary care comes closest to delivering the kind of out of the box software you’d expect from PC World.”

This means they can choose from a range of innovative suppliers. A further key benefit is that prices have been driven down and costs are genuinely transparent. The same approach is being followed by NHS Wales. Intriguingly, Scotland - which opted for a national, centrally developed GP system - is now arguably lagging behind England and Wales.

GPSoC is the latest incarnation of accreditation in primary care, the successor to RFA 98 (Requirements for Accreditation 1998). Looked at over the medium term, the benefits of accreditation in the GP software market have been huge. Primary care in the UK is truly world class, with almost 100 per cent of practices computerised and many paperless.

Less than two decades ago, there were dozens of vendors - most tiny firms with a handful of customers, offering systems that were incapable of sharing data. Now, there are a small number of high quality firms offering rich systems that are increasingly interoperable. Standards mean primary care comes closest to delivering the kind of out of the box software you’d expect from PC World.

Hospitals are much more complex enterprises than GP practices; but there are lessons that can be learned from the primary care experience. Encouragingly, there are now signs that the NHS IT programme is keeping this option open with its Additional Systems and Supplier catalogue (ASSC) approach, set up to fill gaps its standardised solutions prove unable to meet.

About the author: Jon Hoeksma is technology journalist of the year, and co-founder and editor of the industry portal, e-Health Insider.