Model for the future

In a personal opinion article Pete Marsh, technical director of Wirral Health Informatics Service offers an alternative model for the future, questioning the value patient administration systems offer in clinical settings.

Given the opportunity around the three Northern clusters, where the plan remains iPM Patient Administration System (PAS) and iCM clinical system followed by Lorenzo, maybe now is the time to pause for a thought on what model we should try and achieve for secondary and tertiary care clinical systems in the near future.

Certainly a lot of delay around roll out of product has been caused by business requirements being given priority rather then clinical need and in my view this is driven by essentially non-NHS personnel, led by politics and politicians.

Department of Health civil servants and the extensive use of contractors and large service organisations whose industry knowledge is limited have also exacerbated the problem. They can all have their own axe to grind and have conflicting priorities, not always shared by the NHS.

A large part of that process that is in constant change revolves around required “PAS” functionality to meet changed policy goals (Choose and Book, 18 weeks, etc). In fact I have often thought there really is little need for a PAS in a clinical setting.

Now with Payment by Results (PbR) it is starting to look like we are heading back to the days of the Thatcherite market-based model of sacrificing all local creativity and effort in using IT to improve clinical process to the altar of producing invoices.

If not PAS then what would be the alternative? If we decided to create a model of , say, a master patient index – the local Administrative Register (AR) as we once called it, an enterprise scheduler, order communications and clinical noting and pathways I believe we would be able to provide 90+% of what clinicians actually want.

Once these key tools are in place to support clinical care then the “PAS” function can be explored at the back end in the form of a data warehouse where all data is extracted and transformed into whatever reporting requirements the current political fashion of the day determines.

I realise that I make this sound simplistic, but it does achieve independence from the politics of the day, preventing policy changes from impacting rollout of clinical development of systems. The politicians/business side of the NHS should then be allowed to play only in the data warehouse in terms of change, allowing the NHS to get on with treating patients.

In my personal view, the current bulky, unwieldy, profit driven, bureaucratic ill-informed process we have today is highly unlikely to succeed even if the promised next-generation Lorenzo system were ready to roll out today.

Pete Marsh MBE, Technical Director, Wirral Health Informatics Service (WHIS)

This article reflects personal opinions only, and was written prior to this week’s announcement on CSC taking over development of Lorenzo.