Coming Ready or Not Responding to the National Programme for IT in the NHS

1
Coming Ready or Not! Responding to the National
Programme for IT in the NHS

• Freeman Seminar, University of Brighton
• 26th November 2004

2
NHS IT policy key documents

• Delivering 21st Century IT Support for the NHS
  National Strategic Programme, 2002
• Building the Information Core, 2001
• Information for Health, 1998
• National IMT Strategy, 1992

3
Building the Information Core 2001
For too long the NHS has thought of IT projects
in isolation. Something to be left to the IT
specialists. Something that is not a priority for
patient care and health services. Let us set that
right. The better capture, management and use of
information is central to managing change and
modernising the front-line delivery of care,
treatment and services to patients. It is central
to improving the day to day working and skills of
staff.
4
NPfIT

• Clinical 'ownership'
• Ruthless standardisation
• Obsession with delivery targets
• The appointment of a 'tsar'.

5
NPfIT core systems

• National email
• Care Records Service (CRS)
• 'Choose and book'
• E transfer of prescriptions (ETP)
• national infrastructure (N3)
• QMAS, 'supporting GP practices' (General Medical
  Services new contract)
• Picture Archiving and Communications Systems
  (PACS)
• Secondary Use Services (SUS)

6
Organisation of delivery the Southern cluster

• Total Population Served 13,047,968
• Covering seven Strategic Health Authorities
  (SHAs)
• From Kent to Cornwall
• includes 81 primary care trusts, 63 hospital
  trusts, 35 social services

7
Science, Technology and Society (STS)

• Machines work because they have been accepted
  by relevant social groups (Bijker, Hughes and
  Pinch, 1987)
• the fate of machines is in later users hands
  their qualities are thus a consequence, not a
  cause, of collective action (Latour, 1992).

8
STS in healthcare

• many of the computer-based PCISs (Patient Care
  Information Systems) that litter the cemetery of
  failed attempts were bound to fail because the
  model of health care work inscribed in these
  tools clashed too much with the actual nature of
  health work (Berg, 2004, p48).

9
The contextual nature of medical information
(Berg and Goorman, 1999)

• information is always entangled with the context
  of its production
• the disentangling of that information for use in
  another context is work
• the further the information has to travel (i.e.
  the more different the contexts of use), the more
  work is required to disentangle that information

10
COTS in Health Sector

• Organisations face new challenges to select,
  assemble and configure solutions that are
  appropriate to their needs and to reconfigure
  them as those needs change. COTS solutions are
  merely indicative of design issues postponed, not
  resolved (Hartswood et al, 2003, p396)

11
SDO study (Greenhalgh et al, 2004)

• Diffusion-a passive phenomenon of social
  influence
• Dissemination- active and planned efforts to
  persuade target groups to adopt an innovation and
  
• Implementation- active and planned efforts to
  mainstream an innovation

12
Success in innovation

• the development, empowerment, and emerging
  self-efficacy of vulnerable communities rather
  than individual behaviour change in line with
  instructions passed down from central agencies
  (Greenhalgh, 2004, p10).

13
Implementation

• active and planned efforts to sign up to the
  process of innovation and change and the
  disruptions, negotiations and re-fitting that
  such a commitment implies
• active and planned efforts to ensure that all
  stakeholders are able to sign up to the process
  of innovation and change and the disruptions,
  negotiations and re-fitting that such a
  commitment implies.

14
Great expectations?

• PACS has a very pivotal and extensive role to
  play in the NHS Plan. It lies at the heart of
  modernisation of the NHS IT infrastructure, as is
  inexorably linked to service improvement,
  advancing technology and a changing and
  developing workforce. PACS therefore has an
  amazing potential for the modernisation of
  service delivery for both patients and staff.
  (NPfIT/National Radiology Service Improvement
  Team document, 2004?)

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One size doesnt fit all
16
One size doesnt fit all

• Flexible standardisation is not a
  contradiction in terms.
• Flexibility implies that the system is not more
  detailed than required, not more stringent than
  necessary, nor more imperative than usable.
  (Berg Bergen 2004 p95)

17
Paper records are consigned to history
The continuing importance of paper in clinical
practice
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Of babies and bath water

• The vital part of this concluding stage is
  ensuring that new information is recorded
  electronically. Paper records are consigned to
  history, with the consequences that savings will
  be made both in capital and revenue expenditure.
  (Burton PID cited in Kay et al. 2001 p294)

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The clinical/IT hybrid
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The clinical/IT hybrid

• She is frontline midwife. Shes ideally placed
  because she has a lot of clinical experience, she
  still does a bit of clinical work and she has a
  huge knowledge, which nobody else does, of the
  systems. It has to be someone with clinical
  knowledge otherwise it would be pointless.
  (Midwifery Manager, EPRs in maternity study)

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Future research

• Integrates service development and
  research/evaluation
• Pro-active or formative evaluation
• Involves partnerships and multidisciplinary
  collaboration involves users
• Research can be
• Analytically oriented (development of theory)
• Critically oriented (focus on users and change)
• Normative (practice or policy oriented)
• Or all 3!

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• Flis Henwood, Social Informatics Research Unit,
  CMIS
• f.henwood_at_bton.ac.uk
• Andrea Jones, Centre for Nursing and Midwifery
  Research
• a.jones_at_bton.ac.uk
• University of Brighton