The chief information officer at Blackpool Teaching Hospitals NHS Foundation Trust has just seen a new IT system go-live in ED. But, he tells Lyn Whitfield, that was just the first step in an ambitious digitisation programme, based on an “open source first” approach.
The NHS knew this was going to be a hard winter. Back in September, Simon Stevens, the chief executive of NHS England, said flu was on the way from Australia and New Zealand and the “top priority” was to make sure services were “as strong as possible.”
With bad weather forecast as well, some trusts might have hesitated to plan a major IT go-live, in December, in the emergency department. However, Steve Bloor, the chief information officer of Blackpool Teaching Hospitals NHS Foundation Trust, says his organisation couldn’t risk putting off the switch.
“It was an ambitious go-live date,” he says. “But then, ‘winter’ tends to start in October. In fact, there are really only two months in the summer that are a bit less busy.
“It was December, but delaying further would have impacted patient flow. Our old ED system was running on old infrastructure. It was large and complex and due for replacement. So, we really pushed to go-live when we did.”
Starting with the start of the patient journey
Blackpool Teaching Hospitals became a foundation trust in 2010. Eighteen months later, it merged with the community health services of the primary care trusts covering Blackpool and North Lancashire.
As an integrated trust, it provides tertiary services to a population of around 1.6 million people, acute services to a population of around 340,000, and community services to a population of around 500,000. Plus, the 11 million visitors who come to the seaside every year.
A five-year strategic plan, published in 2014, identified a need for significant investment in buildings and IT. The trust has been running IMS MAXIMS’ Hearts patient administration system since 1992; but has developed an open source portal to give clinicians access to its PAS and other key systems.
In 2016, it announced that it would deploy the latest, open source version of the MAXIMS electronic patient record as part of an “open source first” policy. So, the December go-live was not just a step-off an old ED system, but the first step in a more ambitious roll-out plan.
“The emergency department is the start of the patient journey, so it is a logical place to begin with MAXIMS,” Bloor says. “It is the core of our wider ambitions.
“The next steps will be to change the PAS and theatres [which are running the legacy iSoft system, Ormis] and roll out order communications across the trust. We want to start later this year, and we have a really good plan for that.”
Open source first
The NHS has had something of an off and on relationship with open source (which is usually defined as software for which the original source code is freely available for redistribution and modification). Two or three years ago, the idea had significant backing from central bodies.
NHS Digital set up an open source team, a Code4Health project to ‘get clinicians coding’, and backed open source projects via the second of the two tech funds set up to support health secretary Jeremy Hunt’s ‘paperless’ agenda.
Then, a Treasury raid on the fund – inevitably to pay for ‘winter pressures’ – and a change of personnel at both NHS England and NHS Digital seemed to bring a lot of this activity to a halt.
NHS England is now focused on its ‘global digital exemplar’ programme, which will complete the deployment of electronic patient records at 16 trusts, and develop ‘blueprints’ for others to follow. Just one of these trusts, Taunton and Somerset NHS Foundation Trust, another IMS MAXIMS customer, is working with an open source product.
Bloor remains confident that Blackpool has the right approach. When the trust announced that it was going MAXIMS, he said this would mean “a much lower total cost of ownership”, not just because it would not need to pay license fees, but because it would be able to source integration, support and other services “from a competitive market.”
In addition, he added, the trust would have more say in the development of the product. “We have been working with IMS MAXIMS for 25 years,” he points out now. “There is mutual respect. The system is open and flexible. It’s the relationship and the product and the philosophy behind the product that’s a really good fit for us.”
The health and policy challenge
Blackpool Teaching Hospitals faces some significant challenges. It is located in one of the most economically deprived towns in the country, with some of the most significant health problems.
Last July, a Guardian article described Blackpool as “the most unhealthy place in England”; one in which “more than half the population smokes… alcoholism is rife, and deaths from drug abuse rival the worst estates in London or Glasgow.”
Then there is the age profile: already high, the Blackpool joint strategic needs assessment, estimates that elderly people will make up a quarter of the town’s population by 2039. One effect of this combination of ageing and ill health is a lot of demand on A&E.
As part of its strategic plan and winter preparations, Blackpool Teaching Hospitals invested £2 million in an overhaul of its A&E facilities last year, opening a new urgent care centre for minor injuries, and a new mental health ward for people in crisis.
Yet it still came under considerable pressure this year. The local health community has recognised the need for a long-term solution, and is building on a history of joint working to try and find one.
Two clinical commissioning groups, Blackpool Council, the trust and other partners have formed the Fylde Coast Health Economy, to develop a community based, multi-disciplinary, ‘extensive care service’, targeted on people aged 60 and over, with two or more long-term conditions.
Last June, Stevens announced that it would become one of a handful of ‘vanguard’ projects that would be greenlighted to work towards becoming an ‘accountable care organisation’ (referred to locally as an accountable care partnership and now renamed, nationally, an integrated care system).
Building IT to support change
All of this also has an IT component. Local GPs are long-term users of EMIS systems, and in 2014, Blackpool Teaching Hospitals announced that it would extend the use of EMIS Web to the community health services that it had taken on two years earlier.
Information sharing agreements are in place to give hospital clinicians access to information held by local GPs, community and mental health services, all of which now use EMIS Web, via the portal.
Once MAXIMS IS deployed, the trust will have two big IT platforms that it will be able to link-up through the portal, to give clinicians access to information wherever they happen to be working.
Indeed, Bloor has said that he wants to give staff working across the accountable care partnership “the kind of consumer experience” they get when they use platforms such as eBay or Amazon, in which they “use a lot of different systems” but so seamlessly that “they do not perceive it that way.”
Platforms for an open, integrated approach
“We are moving the trust towards an open, integrated approach,” Bloor concludes. “No one system will deliver everything that we want to do, so MAXIMS is our chosen engine in the acute environment, and EMIS is our chosen engine in the primary care and community environment.
“We have a portal that sits on top of MAXIMS, our PACS, our radiology system, and EMIS Web, that will enable us to share information across the whole health economy. That will enable the clinicians in the ACP to do their jobs without having to log-into lots of different systems to get the information they need. That’s where we are trying to get to.”