Life on Marsland on revisiting the value of IM&T to healthcare
The NHS is partially insulated from the credit crunch for another year. But even it is being told to prepare for tougher times ahead and to play its part in getting the government’s budget back on track.
To do so, it will need to make savings and to innovate. Iain Marsland considers some of the resources that the NHS has at its disposal for bringing about change. He concludes that Information Management and Technology (IM&T) is the best resource that the health service has for doing things more efficiently while improving care for patients.
“Few resources offer the opportunity to continuously add value to healthcare in the way that IM&T can.”
As the credit crunch deepens, the NHS in England will be looking to make efficient use of its £96 billion a year. In October, I looked at how NHS organisations could make savings by managing and investing in modern technology infrastructure. This month, I’d like to argue that effective utilisation of IM&T will have a significant impact on both efficiency and effectiveness.
Tougher financial times ahead
The NHS continues to have the benefit of year on year above-inflation funding. However, there is no guarantee that the present level of above-inflation funding will continue after March 2011, when the health service’s current three-year settlement with the Treasury ends.
The NHS is already required to find an annual 3 per cent efficiency saving from ‘recoverable savings’. In addition, the Operating Framework for the NHS in England 2009-10 says that to support the government’s management of the economic downturn, the NHS will need to contribute to the cross-Government Operational Efficiency Programme and find “substantial public sector efficiency savings in 2010-11.”
The Operating Framework sets out four themes to be explored for efficiency savings. These are increased use of shared services, collaborative procurements, efficient property usage and local innovations. It also notes that prioritising the most effective treatments, reducing errors and waste and keeping people healthy and independent will contribute to a more efficient and productive health service.
It would be difficult to argue with these points, especially as they are a central tenet of the final report of Lord Darzi’s year long Next Stage Review of the NHS, High Quality Care for All. Sadly, however, the Operating Framework does not identify IM&T as a key contributor to efficiency and innovation.
Resources for change
The dictionary definition of innovation is the act of doing something differently. In the NHS, as elsewhere, there are a number of resources that can be used to do things differently.
“The dictionary definition of innovation is the act of doing something differently.”
Clinical Technology: new diagnostic and treatment equipment – including drugs - often leads to a step change in clinical services. Dialysis, electrocardiograms, antibiotics and anaesthetics are examples of powerful technology innovations that led to significant improvements in patient care.
Buildings: new layouts can enable much greater efficiencies in patient flows. Recent reorganisations of Accident and Emergency departments have enabled patients to receive better focused care. Polyclinics are intended to be a local, one-stop provider of care for ambulatory patients, who would traditionally be shunted between GP surgeries and hospital outpatient and diagnostic departments.
People / skills: change happens when people do things differently, so every innovation involves people, often requiring new skills.
Money: it is difficult to think of any change that can happen without some initial investment.
Information technology: I think IT has two capabilities. The first is information processing; getting the right information to the right person at the right time. In the NHS, that means supporting clinical decision making at the point of care; for example, enabling urgent care clinicians (GPs, A&E consultants, minor injury nurses or ambulance paramedics) to have access to the patient’s latest pathology and drug history. This will both speed up treatment and improve outcomes.
The second is transaction processing (for example, order communications, prescribing and scheduling). The NHS already uses basic scheduling in outpatients and radiology. The NHS Care Record Service will deliver complex scheduling across multiple ‘resources’ (whether they’re a theatre, an ultrasound machine or a radiographer).
Transaction processing ensures that the right clinical resources are in the right place at the right time. This will transform patient flows by delivering services in the most appropriate sequence. Such a patient-focused service will have a significant impact on outcomes.
Making the best use of resources
So which of these resources is the most powerful in driving change and innovation? Let’s take two dimensions; flexibility and sustainability. Money is probably the most flexible resource; however it cannot be used twice and so is the least sustainable.
Buildings are the most sustainable; outlasting most other resources. However they are also the least flexible, requiring major planning to implement any change. Clinical technologies are also fairly inflexible, since they usually have single functions and a variable life (a one to three-year warranty or sell by date).
People are limited in both their flexibility and sustainability. Although individuals continue to develop and learn, formally re-skilling a clinician will be dependent upon the Royal Colleges and professional bodies. Also, people cannot operate 24x7.
Only IM&T can demonstrate both flexibility and sustainability. IM&T’s capacity for knowledge is effectively infinite. The growth in accredited online clinical information sources is now being matched with smart browsers and focused resources, such as Microsoft’s Health Vault.
The flexibility inherent with IM&T data is also exhibited by IM&T hardware and software. Computers can be reprogrammed at marginal cost and time to support new transactions and processes. A simple computer can access a diverse and growing wealth of information and support many pathways of care - and it does so 24x7x365.
Few resources offer the opportunity to continuously add value to healthcare in the way that IM&T can. It is a powerful agent for innovation and efficiency and should be at the forefront of thinking by chief executives when considering how to manage their Darzi agenda in the economic downturn.
About the author: Iain Marsland has been in the NHS for 34 years, most recently as chief information officer for Essex Strategic Health Authority and previously as director of IM&T for acute trusts in Brighton, Sussex and Bristol. He is now an independent consultant.