Waiting not an option

Brian James, chief executive of The Rotherham NHS Foundation Trust

Brian James, the chief executive of The Rotherham NHS Foundation Trust tells Jon Hoeksma why it has decided to spend on its own electronic patient record system. A vision for clinical change, pressing financial issues and the continued non-delivery of Lorenzo all figure.

Brian James is unusual. He’s the chief executive of a leading foundation trust with a background that includes information management roles. The biography on his trust’s website even lists computing among his interests.

Unsurprisingly, he has sought to raise the profile of IT within his organisation. “When I joined this trust in 2004, the chief executive didn’t even have a PC in his office,” he says. Nor did The Rotherham NHS Foundation Trust have its own director of informatics.

Now, James is not only looking towards a paperless future, but increasingly willing to talk about how the trust needs to make its own investment decisions, even if these take it outside the National Programme for IT in the NHS. It is due to announce the award of a contract for a new electronic patient record system that will see it spend an estimated £30m-£40m over the next ten years.

The Rotherham has pressing clinical and business needs that cannot wait for the programme, James says. “There are plenty of people telling me how great the local service provider system will be when it is provided. But I’ve had assurances that I would have a new system since 2005, and it hasn’t happened. They aren’t chief executive at this trust. I am.”

HISStory

From 2002 until his 2005 appointment as The Rotherham’s chief executive, James was executive director for strategy and innovation at South Yorkshire Strategic Health Authority.

In the 1990s, he was responsible for implementing the Hospital Information Support System (HISS) at Darlington Memorial Hospital in County Durham – one of three national pilots for an advanced patient administration system.

In 1995, HISS was a cutting edge project. James says that, with some notable local exceptions, the NHS as a whole has since failed to make much progress since then. He says relatively few trusts have progressed beyond the three HISS pilots of the 1990s.

Paperless by 2012

There are now many requirements on trusts and foundation trusts in particular to report on and manage performance. However, in IT terms, James feels this misses the point. “It’s not about use of information to deliver better management information, it’s about the use of technology by clinicians to deliver improved patient care,” he insists.

James wants The Rotherham to “become completely paperless by 2012.” Asked whether this can be achieved, he says: “I’ve got to be optimistic. Whether it can be completely paperless by 2012 remains to be seen we’re not deep enough into the project yet.”

On the other hand, he says: “We are making clear to all clinicians that this is our objective.” He says the clear aim is improved patient care, but the backdrop is ever tighter budgets.

Under the spotlight

The Rotherham is a successful foundation trust, but it became the focus of media attention – and held up as a microcosm of the NHS’ ills – two years ago, when it let in the cameras for the BBC documentary ‘Can Gerry Robinson fix the NHS?’

Among the problems singled out by the business guru was the delayed implementation of the NHS Care Records Service, which was then just two years late. Two years on, the Lorenzo system that Rotherham is due to take is four years late, although it is finally in limited use at one primary care trust and one acute trust.

James, who was at the centre of the BBC’s very public examination, says the show didn’t feature in the decision to invest in information technology as a tool for modernisation. “It had no influence on our decision,” he says.

Instead, he the NHS has historically underinvested in IT and “most business would not try to use our technology.” However, he is at best sceptical about the maturity of Lorenzo. “I see nothing at the moment. I’ve never even seen a prototype,” he says.

Confidence in NPfIT

James’ issue boils down to a lack of confidence that NPfIT will be able to deliver the integrated clinical system his trust needs to achieve a paperless hospital in an acceptable timescale. “It is an issue of confidence. And I have no confidence that this programme will deliver what I need in time for 2010-2011.”

Even if it waited for Lorenzo until 2010, when its McKesson TotalCare patient administration system is due to lose its support, he asks: “What will I get? A PAS.”

The Rotherham chief executive says his clinicians and staff need far more than a replacement patient administration system in order to deliver the far reaching change to safer, digital healthcare the trust is aiming for.

As a result, Rotherham decided it had to outside NPfIT to buy an ‘interim’ system that meets its needs. James says the risk of penalties has gone, as LSP Computer Sciences Corporation has not come up with a suitable offering.

The trust went out to OJEU tender last April and E-Health Insider understands that the shortlist of suppliers includes the University of Pittsburg Medical Centre and Cerner, Meditech and SystemC Healthcare.

Technology needed to deliver efficiency targets

Despite this, James says he remains committed to the objectives of the national programme. “The NHS IT programme has clearly set a direction of travel,” he says. “I’ll be happy to replace our new system with Lorenzo when it is a proven system, but we need something right now.”

He feels there is a narrow window of opportunity to become a paperless hospital and so improve patient care and boost productivity, before the growth money of recent years ends, and increasingly tough efficiency targets bite.

Meanwhile, he says the trust’s new system will require a “major rethink of care pathways” and that it won’t just be replicating existing processes once it has it. The benefit, he says, is that: “We are buying a system that gives us the best chance for a future of improved patient care and productivity.”