Life on Marsland asks: Where can I find a decent OBS nowadays?

The National Programme for IT in the NHS is supposed to be delivering “strategic” care record systems to health communities. However, this key part of its work is delayed.

As the delays get longer, some trusts are looking for “interim” systems to deliver core clinical functions and improve quality and efficiency. Where are they going to get their output based specification from? asks Iain Marsland.

Trusts needing to buy an electronic patient record (EPR) today may be hard-pushed to find a current specification for their procurement. Ten years ago, the NHS was awash with output based specifications (OBS) for EPRs.

Following the Information for Health IM&T strategy, many trusts set about procuring an EPR using capital or public finance initiative (PFI) funding mechanisms. Kettering, South Manchester, Royal Berkshire and Southmead in Bristol were just a few who developed an OBS in support of their procurements.

From local to national and back

Since then, the National Programme for IT in the NHS has offered to deliver these solutions, so few trusts have needed - or at least felt the need - to set out their local clinical IT requirements in a formal OBS. 

However, following last year’s Health Informatics Review, which set out an opportunity to implement interim care records services (CRS), a number of trusts have embarked on independent procurements for EPR systems.

They have been prompted, no doubt, by the ongoing delay in the national programme and the increasing need for clinical IT in support of quality care. Rotherham and Wirral have announced their intentions; others are proceeding along similar tracks.

But where do these trusts look to find a decent OBS that reflects their local clinical needs and addresses their response to the vision for the NHS set out by Lord Darzi in his report, High Quality Care for All?

Powerful and important

The OBS is a powerful mechanism for engaging clinicians, enabling them to express their requirements and increase their understanding of the many facets and benefits of an electronic patient record.

It defines in detail a trust’s mandatory and discretionary requirements to potential suppliers. It then becomes the reference document underpinning its selection of both supplier and solution.

The OBS develops into the key contract schedule with the supplier; its importance cannot be underestimated when you remember that these can be ten year contracts worth many millions of taxpayers’ pounds. Finally, the OBS enables a trust to know when it has been successful in achieving the defined outputs from the procurement.

Not to be undertaken lightly

The local service providers (LSPs) appointed by NHS Connecting for Health to run the national programme’s five clusters have a Schedule 1.1 within their contracts with the agency. This sets out each LSP’s requirements for the CRS it is supposed to deliver to trusts and other organisations in its cluster.

This schedule is used to manage the supplier and hold them to account to deliver a trust’s requirements (which are defined, remember, by its clinicians).

So an OBS is not something you go into lightly. Just one part of the national CRS OBS was over 600 pages long. Trusts looking to purchase their own ‘clinical 5’ systems (patient administration system, results reporting and order processing, clinical correspondence, scheduling and e-prescribing), should be aware that e-prescribing alone can have over 150 requirements.

All these need to be expressed clearly and without jargon to enable a fair and equitable procurement and eventual supplier selection.  And the use of clinicians in developing an OBS is critical.

An EPR has two fundamental functions, to support a transaction between two clinicians (scheduling, order processing, medication administration) and to enable data to be processed in support of that transaction (results reporting, clinical correspondence, e-prescribing).

The OBS must therefore set the framework for how a trust’s clinicians practice. Actual practice will be reflected at the configuration of the EPR and embedded into care pathways. The OBS must therefore reflect the views of pathologists and radiologists as well as physicians and surgeons, of nurses and junior doctors as well as allied health professionals and pharmacists.

Building on what exists

So where do you find help?  Most OBS documents are built on the most recent OBS developed elsewhere in the NHS. This plagiarism enables trusts to add to, enhance, update and localise each OBS.

The CRS OBS was founded on the major EPR procurements of the early millennium; the South West EPR, the West Midlands Blackberd project and UCLH’s EPR procurement. Elements of these OBSs can be found in earlier and later versions, rather like an evolutionary record.

It’s worth noting that the core elements of an EPR specification do not change significantly year on year. Recent initiatives such as Choose and Book, Payment by Results and 18 weeks have resulted in changes to the specification of legacy systems such as PAS and pathology, rather than clinical functions such as e-prescribing and documentation. Referencing historical EPR specifications is therefore still relevant for interim solutions.

One sadness is that the 2003 CRS OBS is no longer available on the NHS CFH site. This would be the most recent iteration of EPR OBS and a useful starting point for anyone considering procuring an interim EPR. The crop of recent EPR procurements will of course mean that, somewhere in the NHS, modern OBSs are being built and, with agreement, may provide the basis for future specifications.