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Imperial College Healthcare Trust
Playing a key integration role at the UK’s first Academic Health Science Centre
The UK’s first Academic Health Science Centre, Imperial College Healthcare Trust, is based on similar institutions abroad, such as the US Harvard Business School.
It involves the merger of two London NHS Trusts - Hammersmith Hospitals and St. Mary’s, Paddington, with Imperial College and marks an important milestone NPfIT program
The development also represents the combining of five hospitals – Charing Cross, Queen Charlotte’s and Chelsea, Hammersmith, St Mary’s and the Western Eye – with a world class university.
This bringing together of clinical services delivery, teaching and research has been shown to yield dramatic improvements and better clinical outcomes for patients. The new Trust has an annual turnover of £760 million and employs nearly 10,000 staff. It offers more than 50 clinical specialities, from conception to end of life care, and has one of the largest portfolios of services in the country and expects to treat more than a million patients a year.
Bringing it all together
However, such a large organisation comprising so many disparate elements, poses a major challenge when it comes to bringing together the IT operations of the various hospitals – particularly so in the context of achieving Connecting for Health (CfH) targets along the NPfIT road.
St. Mary’s with whom ReStart has been associated for a number of years, had already demonstrated an impressive lead in embracing the national NHS IT programme.
Now it is one of the first in London to deploy London Configuration Cerner Millennium Care Records Service (CRS) R Release 1 (LC1). Millennium will be used across all Trust sites.
The company has been working with St. Mary's since 2004 on a variety of different projects and assignments in which pre-eminent has been the implementation of a CfH compliant e*Gate integration interface environment. ReStart has implemented interfaces for a wide range of applications at St. Mary's. These include a Patient Administration System that covers all message types including demographics, updates, merges, order comms, waiting lists and schedules.
Also, the CMIS Ziconia Maternity System, with demographics, births and updates, and Prowllness Diabetes, an outpatient clinic system for managing diabetics. This last application presented a particular challenge and required a complex set of interfaces to be developed to overcome unnecessarily costly database access.
The proprietary software licensing structure was based on the number of patients in a database, whereas the number of patients for whom there as an information access need was actually very small. ReStart’s interface enables those patients at risk to be pre-identified and dramatically reduce the database access usage overhead.
Reducing costs
To reduce costs to a minimum it was necessary to identify patients through a separate mechanism. It was determined that a specific blood test would accomplish this. So a filtering system was implemented on all pathology results messages with a search for HBA1C - which carries a 98 per cent probability of diabetes. The patient record was then flagged in a database - also developed by ReStart - that can be queried by the Prowellness system.
If one were to consider that there are about 1.5 million patients in St. Mary's PAS system, and that if all were loaded on the Prowellness system at 20 pence per patient - that would cost the trust about £240,000 in licensing fees - for a service delivery only actually required by no more than a few thousand patients.
The implementation of this resulted in very significant savings. It also provided a number of additional benefits. For example, the new database enables a completely automated clean-up capability for Trust data in preparation for CRS implementation. It also enables similar projects to be undertaken for such areas as Pediatrics HIV.
This also requires similar identification of patients through a specific blood test. Other projects in which ReStart were involved included radiology order comms and demographics implemented by iSoft and BT - under the overall project management of ReStart. Yet more are Coloscopy, Endoscopy, Pathology. Here, further savings were achieved by building in outsourced consultant letter typing.
Other challenging integration assignments include the implementation of a link between St. Mary's and Chelsea and Westminster NHS Trust, who are also a ReStart client, to pass virology test results over a network.
Since implementation, this has enabled St. Mary's to generate revenue-earning external business for virology tests.
Now, for Hammersmith, ReStart are helping to support the expertise within St. Mary’s to implement a complete integration solution. This will provide the Trust with an architecture that is supporting a seamless merger of IT functions.
Laying a strong foundation
"In the drive to a paperless environment for patient care records, such a merger of organisations as the foundation of the new AHSC represents presents special challenges," says St. Mary’s IT director Phil Jones. "Essentially, it is a case of two institutions in the same business, yet each has systems and processes and support environments that are different at every level".
"Healthcare differs from most other organisations in the criticality of systems. In business, public administration, if things go wrong then financial loss, inconvenience and hardship can result. In healthcare, if things go wrong, people could die"!
IT is really becoming central to all that we do and has to be very carefully managed. Without wishing to overdignify my own IT profession, I believe that IT in the medical and healthcare sector has to be approached with the same fastidious professionalism and ethical ethos as the medical profession itself. This extends to providers of services and support as well as hardware and software – who themselves must be imbued with the same attitudes".
