The Microsoft CUI programme: introducing Solution Enablers

Microsoft’s Common User Interface team is working on ways to help the NHS to get the most out of its IT and to improve efficiency and patient safety.

Microsoft’s Common User Interface (CUI) team works with healthcare organisations, high-technology companies and standards bodies to design and promote IT systems that support the delivery of better healthcare and promote patient safety.

An often-used umbrella term is “knowledge-driven health” - and it’s worth reiterating what that means. Mark Bower, IM&T Tools Lead, says: “By knowledge-driven health, we mean the promotion of collaborative working, where patient information and the expertise of medical staff are shared usefully but securely to provide the best care possible.

“We want to empower clinicians and managers to make the best decisions, with the best data at their fingertips - and to be well connected with the support networks offered by their colleagues too.”

The IT delivery challenge

However, the vast datasets required by a 24-hour-a-day, 365 day-a-year healthcare operation have a complexity that gives any of the technology to be found in the private sector a run for its money. As a data user, the NHS really is out on its own.

That creates unique tensions: not only do IT systems in the NHS need to be massively scalable and resilient; but each new system places demands on a trust’s IT department. Managers are looking for infallible security, a watertight audit trail, and above all a deployment schedule with an end in sight.

That’s why the CUI team’s IM&T Tools Group is working on two projects:
 

• Information Management and Tools - Deployment Guidance: Over fifty pieces of step-by-step guidance for deploying best practice IT in trusts have been designed. These are intended to save time, maximise results and operational flexibility, and minimise the scope for error.
• Knowledge Worker Tools - Solution Enablers: These are software tools that are already customised for the NHS to solve specific management challenges. Solution Enablers are fast to deploy, and they use technologies already covered by the Miicrosoft/NHS Enterprise Agreement.

Neil Slater, Microsoft’s technical manager, IM&T Tools says: “All these developments have been produced in collaboration with NHS organisations every step of the way, thanks to pilot schemes in trusts around the UK.

Today, more than 80,000 PCs within the NHS are either live or involved in pilot schemes based on guidance produced by Microsoft’s IM&T Tools Group.”

Infomation and Management Tools team delivers deployment guidance and tools

The Information and Management Tools team is building guidance and tools to help NHS Trusts deliver a well-managed and secure desktop and server infrastructure.

Neil Slater adds: “The deployment guidance we offer allows trusts to migrate to an IT platform which reduces the support overhead and yet meets their ongoing needs. For example, we offer desktop deployment advice, which should make constant visits to far-flung corners of a trust’s estate a thing of the past.

“A judicious implementation of group policies (through Active Directory and Forefront) means every desktop machine can have the right software, security permissions, anti-virus protection and patch updates - all centrally administered from an intuitive dashboard.”

There are two business benefits here:

• The IT department’s time is better used, since less problem-solving and firefighting is required across the network
• In-house systems are more resilient, and therefore better equipped to deploy new technologies to solve real-world problems.

Knowledge Worker Tools team delivers Solution Enablers

Microsoft’s NHS Solution Enablers are designed to tackle the challenges faced by many trusts, with the minimum of new IT or bespoke development. There are three Solution Enablers available right now:
 

• Scorecards: The Scorecards Enabler pulls data from a wide variety of data sources and then presents it in ways that aid effective decision-making. Simple traffic-light metrics help trusts to focus resources towards meeting targets and to spot trends or anomalies. When these are identified, data can be further drilled to uncover the reasons: bed-by-bed if necessary.
• Managing Meetings: The Managing Meetings Enabler solves the perennial problem of organising meetings. Not only can meetings be scheduled in seconds (thanks to shared calendars), but each meeting has a workspace in which agendas, action points and any documentation can be stored as a permanent record for reference and compliance purposes.
• Collaboration Fundamentals: The Collaboration Fundamentals Enabler replicates all of the community-building tools found out on the Internet (like groups, discussion boards and forums) and executes them safely and securely within a trust’s firewall. Clinicians, nursing staff and managers can create universal (open) or invite-only (closed) groups of professional interest with minimum overhead to the IT department, and zero risk.

Designed to meet the needs of the NHS

Mark Bower, technical lead for Knowledge Worker Tools, says: “All the Solution Enablers stem from some fairly simple observations we’ve made about the specific needs of the NHS.

“We know trusts can ‘get by’ with existing technologies, but that leaves both clinicians and the IT staff who support them making less progress than they might towards greater efficiency.

“Meeting Manager is a good example - you can ‘get by’ with arranging meetings by email. But it’s time-consuming; indeed it’s the sort of thing a consultant’s secretary spends far too much time doing.

“As well as simplifying the process of scheduling meetings, we can now deliver a raft of extra benefits: secure document storage, reference materials for people who were unable to attend, lists of action points, and of course a clear audit trail, so nothing ever gets lost or forgotten.

“We’re also keenly aware that NHS staff span the whole breadth of IT literacy; from IT experts to people with no computing experience whatsoever. The Solution Enablers have therefore been designed with the benefit of all our user interface know-how, to make them easy to use for staff at all levels.”

Above all they are easy to switch on. Mr Bower continues: “All the Solution Enablers use a SharePoint architecture, so they integrate with Office tools on the desktop and are readily administered for security and access rights.

“Workspaces, forms and groups can all be created on-the-fly and both the setup and ongoing administrative workload on the IT department is minimised.

“All the Solution Enablers also come with master templates, designed specifically for the NHS – so, for example, the Scorecard Enabler includes fiscal-oriented examples for managers and clinical-based examples for medical staff.

“With these templates to work from, both clinical and IT staff will not only find it easy to get started, but they will also quickly see value in their day-to-day work.”

Coming soon

Many more Solution Enablers are in the pipeline - including an Enabler to simplify creating and filling in the many forms associated with patient care pathways and one for creating reference policies and procedures for all manner of trust administrative processes.

In all these cases, Solution Enablers are designed to help trusts push towards a real execution of “knowledge-driven health” through quick wins which deliver fast results without adding to the IT workload.

 

In Depth: The Scorecards Enabler

One of the subjects that made national press headlines when it was discussed at the 2008 Royal College of Nursing Congress was the administrative burden that is now placed on nursing staff.

There are certainly some outdated processes within trusts that call for the repeated copying of information. However, even trusts that have strategies to reduce the amount of form-filling can get complaints about the admin effort.

These might be vastly reduced if there was clear evidence that the data collected was more effectively used – to achieve beneficial clinical outcomes. The fact is that at the moment, there is plenty of data entry, and not enough strategic output. That’s where the Scorecards Enabler can deliver value.

The Scorecards Enabler has been designed to:

• Extract data from multiple sources

• Present that data usefully in clear and concise “dashboards” to support real-time decision-making

• Apply the data to evaluate performance against trust targets

• Provide value both to managers and clinical staff

• All in a simple package, which allows for a quick start without burdening the IT team with a new set of deployment challenges.

As with all of Microsoft’s NHS-specific Solution Enablers, costs are reduced because the Scorecards Enabler operates on standard SharePoint software - covered by the NHS’ Enterprise Agreement with the company.

Standard templates

The Scorecards Enabler comes fully equipped with three standard templates - for GP practices, Clinical Services (the template replicates a cardiology department) and Management Services.

As you would expect, the clinical services example demonstrates the extraction of clinical data (patient status, medication administered, clinical outcomes and so on); while the Management Services module extracts financial and resource management information.

Uses and advantages

There are two main uses for the Scorecards Enabler. The first is to the track performance of a trust against statutory targets.

One of the advantages of the Scorecards Enabler is that even very complicated datasets can be interrogated and then presented in simple executive summaries. Bed by bed, intervention by intervention, each clinical process can be classified and shown in real time.

Simple traffic-light displays present a trust’s progress against targets to board-level managers, who can then make effective decisions to prioritise resources.

Just as useful, however, is the capacity to drill down from summary target information to find the underlying reasons for an operational target not being met (or indeed what lessons can be learned from an area in which one is being consistently achieved).

Steve Ledbury, Technical Program Manager, says: “To take the cardiology example, a clinical services manager might be presented with statistics demonstrating that the target for administering anti-platelet drugs was not being met.

“This would appear as a “red light” in the dashboard summary. A simple click will call up a list of patients in an Excel spreadsheet, and identify which of them has been given the medication. If the Enabler has been connected to other data sources, it may also be possible to find out under what circumstances each patient was, or was not, prescribed the drugs.

“This allows a manager to make a useful decision: is the target not being met because of administrative shortcomings, or simply because of medical circumstances specific to the patients?”

There are plenty more examples of where accurate data can lead to better resource management. In order to meet the 18-weeks total waiting time target, for example, a manager can assess current waiting times, and then drill down to the waiting time data for each individual patient.

By finding out the reasons for the delays that characterise long waits, targeted measures can be applied to overcome them, without disrupting other departments that are working entirely effectively.

For any trust looking to take the first steps towards enterprise-grade business intelligence applications, the Scorecards Enabler is an ideal start.

Operating on a standard SharePoint architecture, and coming pre-programmed with NHS-specific examples, deployment demands on the IT department are minimised. Users also need nothing more than an Internet browser to access even the Excel-enabled reports, so there is no additional cost per desktop user.

Yet the system is also scalable - new data sources, even from legacy systems, can be used to put ever more powerful data at the fingertips of the clinicians and managers who need it most.

In Depth: The Managing Meetings Enabler

Like many of Microsoft’s NHS Solution Enablers, Managing Meetings Enabler was born out of the sneaking suspicion that a lot of administrative effort was being wasted on unnecessarily repetitive tasks.

Microsoft SharePoint Consultant James Kemp takes up the story: “We noticed how much admin time in trusts was being spent simply on arranging meetings - a challenge Microsoft has already solved in many large businesses with SharePoint and Outlook.

“We wanted to be able to adapt what we had learned with these private sector clients to the NHS, which has particular demands, such as impeccable security.

“We also found that arranging meetings wasn’t the only challenge. We realised that lots of documents were regularly being created unnecessarily from scratch, such as agenda forms and PowerPoint templates.

“And because email was being used as the main way to communicate, any documents associated with the meeting would be distributed in an unstructured way. After a meeting, for example, there was no central place to tick off action items achieved, or to refer to relevant paperwork.”

The solution

The Managing Meetings Enabler is designed to minimise the administrative effort of arranging meetings, while also using IT to make every meeting more productive. Here are some of the highlights:

• The Managing Meetings Enabler begins with the secure sharing of calendars for all staff. Don’t worry - you don’t have to publicly explain every item in your calendar! But if people block out times they are not available, the system will automatically find a free space and schedule a meeting to suit all attendees.

• Every meeting has a Workspace. It’s ideal for storing all the documents associated with a meeting in advance - meaning that nobody should turn up unprepared. Managing Meetings Enabler also comes equipped with templates for common documents, for example agendas and minutes.

• The Workspace remains “live” for as long as you want after the meeting. This means it can act as an ongoing central repository for relevant documents and progress tracking. Templates have also been pre-designed for Objectives, Tasks, and Decisions, so everyone can see what further actions are required.

• Data security remains a top priority, and every attendee, document or administrative operation can be assigned a security policy. Information can therefore always be shared with those who need it, and never with those who do not.

• Similarly, approval checklists are built in as well - if a more senior member of staff is required to sign off a process, for example, the enabler has the facilities to do it.

Use and advantages

Mr Kemp says: “One of the great advantages of Managing Meetings Enabler is that it is entirely suited to the dispersed nature of NHS estates. You don’t have to be located within, say, the trust’s main hospital to use the system.

“A secretary in a doctor’s surgery or a consultant logging on at home through Outlook Web Access can both use all these functions as easily as if they were at trust HQ.

“The enabler is also fully compatible with Microsoft Outlook, so admin staff using Outlook every day won’t have to learn anything new: the Workspace for a meeting will simply pop up on-screen right next to the meeting request.”

The Managing Meetings Enabler has been designed to make deployment easy for IT departments (it uses a standard SharePoint and Outlook architecture, all covered by the terms of the Microsoft/NHS Enterprise Agreement). And it is full of NHS-specific examples and templates to help busy clinical support staff get started quickly.

An example meeting is provided as an educational work-through, and user guidance is also provided every step of the way (much like the Wizards found on desktop software). In no time at all, staff at all levels will easily be creating and managing meetings - and getting more productive results out of those meetings, too.

In Depth: The Collaboration Fundamentals Enabler

One of the problems endemic in any large organisation is that valuable information becomes locked away: in departments, in offices, and in individuals’ heads.

Organisations don’t come any larger than the NHS, and here the communication challenge is even more acute: knowledge can be required at any hour of the day and from innumerable disciplines. It’s no surprise that collaboration is high on the NHS IT agenda.

Mark Bower, IM&T Tools Lead says: “Clinicians were among the first groups of practitioners to see the value in sharing their knowledge, because of their shared professional status.

“We have found plenty of instances of clinicians congregating in online forums and discussion groups, collaborating to further their professional knowledge. These groups seem like an ideal way to break out of the one-to-one relationship of email and to build vibrant communities of expertise.

“The challenge for trusts, though, is that these online groups simply don’t offer enough security for business-critical sharing of intelligence. The NHS demands a level of data protection simply unavailable on the open Internet.

“No trust would be comfortable with case-data or company confidential information living in an online forum. Furthermore, there is a big question mark over the issue of who ‘owns’ any of the information found on many of these sites.”

The ideal solution, of course, would be to encourage the sharing of professional excellence by replicating the functions of online forums within a trust firewall. Indeed, the tools to do this have been around for some time – they’re called an intranet.

However, intranets need management, and with IT staff engrossed in day-to-day administrative challenges, “nice-to-have” functions like intranets come low down the list of deployment priorities.

Microsoft has therefore created the Collaboration Fundamentals Enabler, a turnkey solution based on a “plain-vanilla” execution of SharePoint which offers all the functionality of online collaborative forums and workspaces with a minimum IT overhead.

Mr Bower says “At the centre of the Collaboration Fundamentals Enabler is the idea of a single ‘communities co-ordinator’- the IT is simple enough to deploy that a single representative of the IT department can manage the security, permissions and access rights to what is otherwise a very free and open collaborative platform.”

Uses and benefits

Once implemented, the Enabler allows authorised staff to:

• Set up their own communities (for example, “cardiothoracic specialists”)

• Search for existing communities to join

• Set communities to be open to all, or private and accessible by invite only.

Within each community, tools are available to make for easy dissemination of information. These include:

• Discussion boards - for collaborative conversations

• Events – including the distribution of reference documents for attendees

• Workspaces - for the storage of documents and presentations or for sharing project work.

The administrator of each group has the flexibility to manage access by each member to different areas of the Workspace; but universal permissions throughout the trust can also be overlaid by the IT manager to ensure that general data and security policies remain intact.

For users, these communities operate exactly like online meeting places- indeed access is via a SharePoint address which looks just like a web address (and can be saved into your Browser Favourites list).

Mr Bower says: “With Collaboration Fundamentals Enabler, we have squared off the problem of building communities without overburdening the IT department.

“The IT team still has overall control, but administration is simple. Management is light-touch enough for these communities to remain easy to use and for collaboration not to be stifled by technical complication.”

“We’ve kept the deployment cycle short, too. Out of the box, Collaboration Fundamentals Enabler has perhaps 80 per cent of the customisation required to deploy it already completed - and the CUI team’s guidance documentation will take local IT managers through the rest. All the software required is also covered by the Microsoft/NHS Enterprise Agreement.

“Finally, NHS-specific templates have been created for tools like discussion groups and events lists, so users can start to realise the value of these tools straight away.”

There is no doubting the value bringing together staff of hugely varying disciplines in order to provide better knowledge-based healthcare. Connected people share information, experiences and skills. The challenge has always been the barrier of complicated deployment.

Collaboration Fundamentals Enabler simplifies the deployment of these tools without sacrificing function, to make shared working a financially- and resource-viable proposition.