An electronic patient record system has been blamed for a massive financial shortfall at Sheffield Teaching Hospitals NHS Foundation Trust.
The so-called Lorenzo system has been fingered as a major problem by an integrated performance report carried out by the board of directors at the trust.
Sheffield Teaching Hospitals NHS Foundation Trust went live with Lorenzo in September last year but, according to the report, it is one of the main reasons that Sheffield Teaching Hospitals has underperformed.
“The under-performance remains largely in respect of elective activity, out-patients, critical care and a larger than expected deduction for emergency re-admissions within 30 days. There are still data issues following the implementation of the new Lorenzo PAS [patient administration system] towards the end of September, which are creating challenges in reporting complete and accurate income figures,” the report claims.
Additionally, the report states that the operational impact of the new system has been largely negative for the Sheffield-based trust, with the booking and scheduling processes, particularly in out-patient services, being particularly detrimentally influenced.
Since the implementation of Lorenzo, the trust has seen a rise in did not attend (DNA) rates for outpatient appointments, with an analysis of the issues has shown that for some patients the DNA status was recorded incorrectly.
And the new system has also caused problems with a variety of administrative processes, which have concurrently affected pathway management.
This is obviously extremely concerning, as the Lorenzo system was essentially intended to improve administration at the Sheffield trust, whereas in reality the opposite appears to have occurred.
With the trust having seemingly openly acknowledged that the system is causing difficulties, Lorenzo system experts have been summoned to visit outpatient areas with the intention of recommending changes to existing processes.
The problems experienced by the Sheffield trust are a long way from being the first associated with a public IT system.
Major national projects have indeed been shelved owing to IT difficulties, with the government recently announcing that it is to review £500 million of Atos contracts owing to IT failings.
The report on The Lorenzo system based in Sheffield stated that the trust has been financially impacted by the implementation of the system, and that this remains of considerable concern.
It added that action was being pursued to improve the delivery of activity, efficiency and financial plans and to mitigate risks and to maximise contingencies.
“Resolving the issues following the Lorenzo implementation and getting activity back to normal levels is critical,” it said.
The Sheffield Teaching Hospitals NHS Foundation Trust is just one NHS trust facing financial problems, as trusts all over the NHS run up sizeable deficits.
The Health Secretary Jeremy Hunt will announce plans tomorrow for a £4.2bn investment to create a ‘paperless NHS’.
With government departments generally embracing the digital revolution, it is hoped that the NHS can set high standards in this area.
Hunt will make a statement indicating that the investment in this department will enable the NHS to deliver superior and more convenient services.
It is also hoped that clinicians will be able to provide faster diagnoses, which will free them to spend more time caring for patients.
Full details of the funding are still being agreed between the Department of Health and NHS England.
But early indications are that £1.8 billion will be set aside in order to create a paper-free NHS, removing outdated technology such as fax machines from the health service loop.
In addition to this £1.8 billion investment, it is also anticipated that £1 billion will be set aside for cyber security and data consent.
This must be considered particularly important, as it has been made clear recently that IT vulnerability in the NHS is a concern.
£750 million will be invested in order to transform out-of-hospital care, medicines, and digitalise social, urgent and emergency care.
Finally, around £400 million will enable the NHS to construct a new website, develop apps and provide free Wi-Fi in all NHS buildings.
It has been confirmed that NHS.uk will be the domain name for the new website of the health service.
The government is also developing a new click and collect service for prescriptions.
Hunt offered the following comment on the multi-billion pound plan.
“The NHS has the opportunity to become a world leader in introducing new technology – which means better patient outcomes and a revolution in healthcare at home.
On the back of a strong economy, and because of our belief in the NHS and its values, we are investing more than £4 billion across the health system to ease pressure on the frontline and create stronger partnerships between doctor and patient.
Under the plans everyone will have access to their own electronic health record, which will be shared between professionals to prevent patients from having to repeat their medical history.
Patients will also be given the opportunity to upload and send real-time data to medical professionals on long-term conditions such as blood pressure.
By 2020, it is hoped that 25% of all patients with long term conditions such as hypertension, diabetes and cancer will be able to monitor their health remotely.”
However, despite the apparent advantages proclaimed by the government, Shadow health minister Justin Madders was sceptical of the value of this new scheme.
“Any investment in technology is welcome but it’s unclear how much, if any, of this money is actually new. Rather than re-hashing old announcements, Jeremy Hunt needs to be telling the public how he intends to sort out the crisis facing our NHS.”
Madders also delivered a damning verdict on the management of the NHS by the Conservative party.
“The Tories cannot hide from the fact that the NHS is going backwards on their watch. Hospital departments have become dangerously full, patients are waiting hours in A&E, and the health service is facing the worst financial crisis in a generation.”
Despite the political wranglings, it does seem that a digitalisation of NHS services is overdue.
As figures indicate that healthcare is responsible for more data breaches than any other UK sector, can the NHS do more to secure the critical and sensitive information that it holds?
Not only is the NHS facing IT challenges, but the number of data breaches within the NHS is also increasingly rapidly.
There were 734 such instances in 2014, and year-on-year numbers doubled from April-June 2013 to the same quarter the following year.
And this is not a problem that is confined to the UK or the NHS.
In the United States, 91 per cent of healthcare organisations have suffered at least one data breach in the past two years, and 40 per cent have suffered more than five incidents.
This is nothing new, but the nature of these breaches is shifting.
In the past, such problems were typically associated with mistakes and negligence, but in the contemporary environment of a hostile Internet and reportedly profitable hacking, this is no longer the case.
Thus, criminal attacks on the healthcare sector have increased by 125 per cent since 2010.
And when hackers strike health systems, far more data is lost than when errors occur. For example, the recent attack on Excellus is believed to have involved up to 10 million individual records.
So the expectation placed on the NHS to protect data is increasing, and the sensitivity of the information that the NHS deals with cannot be understated.
At the same time, with the strain on NHS services being amplified by numerous factors, the budget for, and indeed focus on, IT security can fall by the wayside somewhat.
And the NHS does not have a fantastic track record with IT systems, with past projects often ending as expensive failures.
Nearly £6.5 million in fines have been levied for losses of sensitive personal information, the majority coming from public sector organisations.
The largest fine to date, £325,000, came against Brighton and Sussex University Hospitals NHS Trust in 2012.
In response to this, the Department of Health launched the Information Governance Toolkit; a response to the need for improved control of sensitive information within the NHS and government authorities.
Yet surveys in February and March 2015 found that fewer than 40 per cent of respondents felt the IGT met their needs.
Responding to this perception, NHS England has recently implemented a new technology solution to manage its information assets.
Live within three months, the Information Asset Manager (IAM) provides the management layer missing from the IG Toolkit, giving demonstrable control over information assets and data flows, and clearly identifying key risk areas.
It is believed that this will lead to a huge reduction in the administrative burden of Toolkit compliance; and minimisation of the risk of data losses – and costly fines – due to mismanagement and human error.
In the short-term, this may tip the balance back in favour of data privacy, but the NHS will unquestionably face many more challenges as this area of its operations evolves.
A survey of digital security in the NHS conducted by a major Internet firm reveals some interesting results and perceptions related to the health service.
Sophos interviewed 250 NHS-employed CIOs, CTOs and IT Managers and found that there is a significant gulf between the way that digital security is perceived in the NHS, and how it actually operates in reality.
Of those surveyed, 76 per cent think they’re suitably protected against cyber-attacks.
On the other hand, 72 per cent say data loss is their biggest concern when it comes to IT security.
IT managers were also of the opinion that encrypting NHS data is particularly critical, yet this can be considered another major area of concern.
In fact, the encryption of data in the NHS is rather paltry, with only 10% of respondents indicating that encryption is well established within that particular NHS organisation.
59 per cent of employees have some sort of email encryption, while file sharing encryption is used by 49 per cent of employees, and 34 per cent have encrypted their data stored in the cloud.
These must be considered extremely inadequate figures considering the sensitivity of the data involved, and the hostile environment that is the contemporary internet.
It seems that the perennial issue of finance plays a major part in the way that IT security is dealt with in the NHS.
There is a constant balance to be found between protecting information and saving money, and the Sophos survey found that this is a critical element of the overall digital culture of the NHS.
The Sophos survey also interestingly states that 42 per cent have cited mobile use as the main initiative driving change in the industry.
Commenting on the findings from the survey, Jonathan Lee, UK Healthcare Sector Manager for Sophos UK and Ireland, struck a note of caution, suggesting that the NHS should play very close attention to the trends outlined in the research.
“This study highlights that NHS organisations still face significant IT security issues and that IT decision makers have work to do to address gaps in their security. Failure to take the necessary precautions to keep cyber criminals out, to safeguard data and ultimately to protect patients and staff will continue to cause significant problems for NHS organisations. However, budget cuts and changes to working practices, such as the increase in mobile working, all present significant challenges within the sector.”
In particular, Lee felt that the NHS should beef up its encyrption arrangements considerably, recognising it as an area in which the health service has been neglectful.
“It’s no surprise that only 10 per cent of NHS organisations stated that encryption was well established within their organisation. Most have encrypted laptops and USB sticks because they have been mandated to do so, but, currently, that is often where it stops.”
The new Carenotes EPR system is part of a digital revolution intended to improve mental health services across the United Kingdom.
And St Pancras Hospital is among the first health facilities to benefit from this sophisticated system, with Camden and Islington NHS Foundation Trust leading the way with the technology.
The hospital has already gone live with the Carenotes system, ensuring that patients are provided with a superior service at the healthcare facility.
Carenotes is a leading Electronic Patient Record system produced by Advanced Health & Care.
Since going live, the solution has already helped the Camden-based hospital to meet a raft of ambitious delivery targets.
Carenotes played a particularly important role in the completion of a focused two-year project within the hospital.
The new Carenotes system enables staff to view patient records more expediently, enabling staff to make quicker and more informed legal decisions.
It is expected that the increased data access facilitated by the Carenotes system will enable more accurate clinical decisions to be made owing to the increased data accessibility allowed.
In addition, it is also hoped that the software will facilitate more consistent working processes within hospitals, providing efficient and joined up multi-agency working.
St Pancras Hospital has already reported improved patient care and satisfaction, based on surveys of existing operations, and it is projected that this could spread to the rest of the UK in time.
Wendy Wallace, chief executive of the trust, took time out of her busy schedule in order to explain the benefits of the system as perceived by the Camden and Islington NHS Foundation Trust.
“Our ambition is to lead a digital revolution to provide better overall patient care to thousands of people with mental health conditions. By working in partnership with Advanced to meet tight project timescales, we now move this vision closer to reality,” Wallace explained.
Wallace was also keen to emphasise that the implementation of this new ambitious patient record system has certainly been a success, despite the fact that it is still in its embryonic stages.
“Our successful ‘go live’ is not only a great achievement for the technical teams, but also for all our staff who have committed to training in the new Carenotes system. I’ve been particularly impressed by the network of highly-enthusiastic champions that have stepped forward to support their colleagues and the trust. User confidence is one of the keys to a successful transition and we are clearly demonstrating this now,” Wallace asserted.
The Camden and Islington trust has moved quickly to recruit 165 ‘Carenotes Champions’ to smooth the process of transitioning to this software.
This group of people comprises staff volunteers, and enables personal skills and management experience across the organisation to be developed significantly.
David Jackland, associate director of ICT at Camden and Islington NHS Foundation Trust, is pleased about the impact that Carenotes is making. “To deliver a project of this scale is a remarkable achievement. Everyone’s considerable efforts have been rewarded,” Jackland noted.
As the NHS continues its transformation to a paperless organisation, systems such as Carenotes can play a major role in the transition.
Health and social care leaders are to announce detailed plans that will improve services for patients by “making better use of technology” that will increase transparency across more services and ultimately save money.
The plans, which have been designed to build on the successes of the last 12 months which have seen 97 percent of GP practices offering patients the chance to book appointments, order repeat prescriptions and view a summary of their GP records online, commit to giving patients full access to their entire digital health record in real time by 2018.
In a bid to drive up quality and efficiency, MyNHS will be expanded to include new information on local NHS commissioners and care homes. This step builds on the popularity of the MyNHS site, which has attracted over 200,000 visits since it was launched in September last year.
To underpin this and support the NHS on its journey to harness the power of data and technology, the National Information Board (NIB), established by the Department of Health and chaired by NHS England’s National Director for Patients and Information, Tim Kelsey, will look at the feasibility of turning the entire NHS estate into a free Wi-Fi zone.
It is thought that Wi-Fi would reduce the administrative burden on doctors, nurses and care staff, currently estimated to take up to 70% of a junior doctor’s day, freeing up more time to be spent with patients.
“The NHS is embracing the offering of digital services to patients, with more than 55 million patients set to benefit from progress”, said Tim Kelsey, National Director for Patients and Information.
“As well as giving patients more choice and control, better use of technology can save money. Letting people rebook online will help tackle the estimated £160 million that missed appointments cost the NHS each year.”