Successful PFI Installation Serves as Role Model

Countess of Chester Hospital NHS Trust
United Kingdom

Developing an IT Strategy

The Countess of Chester Hospital Trust Board adopted a new information technology (IT) strategy in October 1995 with the arrival of its new IT Director, Keith Richardson. That same year, the NHS Executive published procurement rules stating all major investments must be approved by the Hospital Board, the local Health Authority, the NHS Executive Regional Office in Warrington, the NHS Executive Head Quarters in Leeds, and Her Majesty's Treasury in London.

The first step was to draft an outline business case. "It showed that a new information system would impact directly on the core business of the hospital, enabling us to modernise processes and procedures for the benefit of the patients. We emphasised that an integrated system would provide the best value," ays Richardson. The Trust was granted permission to begin looking for a vendor to provide the first part of the project. The next part of "Phase I," along with each succeedingphase, would also follow the same review channels.

Selecting the Right Vendor and Solution

Rather than rely solely on demonstrations given at the hospital by IT vendors, Countess of Chester scouted out things for itself. The Trust gathered a "procurement team" comprised of 25 clinicians and five Health Authority and General Practitioner (GP) representatives. This team of specialists visited other hospitals to see information technology in action. The members used an "evidence based procurement approach," placing serious weight on the opinions of end users at the hospital sites.

"The team paid little attention to vendor promises for things like installation time frames or performance claims. We basically wished to counteract the potentially misleading impact of slick on-site demonstrations," says Richardson.

"We found that some healthcare organisations were not integrated, and as a result, they experienced similar difficulties such as: hidden administrative costs, especially while trying to interface different systems together; duplication of records; and excessive staff intervention required to get routine information," says Richardson. "In contrast, the real benefit of an integrated system is it can get important clinical and hospital information to A to B and back again much faster than any other method." An audit conducted at the hospital which solicited the opinions of staff confirmed the decision to adopt one singular, integrated system.

With all goals in mind, the full business case for Phase I was submitted and approved. MEDITECH was selected to provide the Trust's HISS, and Data General (DG Ltd.) would provide the hardware and act as prime contractor. It was also established that the procurement would be accomplished according to the requirements of a PFI contract. "The procurement team's final conclusion was that MEDITECH offered a complete, integrated system that has been specifically developed with clinical use in mind, while still meeting the administrative and statistical reporting requirements of a hospital," says Richardson.

Designating Key Players

Given the weight and scope of the project, it was essential that the hospital select the right people to serve as key players during implementation of the MEDITECH applications. The technical analysts who helped train staff users were drawn from Countess of Chester's pool of clinicians and administrators. "A great deal of time and effort was spent selecting people with rich clinical and administrative backgrounds, who also proved to be technically adept and possessed optimistic, 'can do' personalities," says Richardson. "The careful selection process was well worth our energies because we now have a cross-section of hospital staff which is instrumental in facilitating communications and prioritizing changes.” Countess of hester's technical analysts include three nurses, a mid-wife, and employees from the Radiology and Medical Records departments.

Hospital and Vendor Commitment Enables Fast PFI Implementation

"Speed and quality" was the mantra at Countess of Chester as the hospital began installing MEDITECH applications. Countess of Chester was on a fast track for two main reasons: the hospital needed to replace its existing non-Y2K compliant systems; and the procurement was accomplished under the British government's PFI. Obtaining approval from the PFI is a rigorous vendor screening and procurement process that is designed to help UK hospitals secure quality HISS solutions. "We had overwhelming support from the hospital staff as well as the MEDITECH/Data General Ltd. partnership, who combined, have much experience in the PFI process," says Richardson. "The widespread support from all people involved is the most important reason why we were able to install our system in half the time most organisations require to implement a project of this breadth."

Implementation at Countess of Chester happened in several phases and is ongoing. The first phase — the most crucial and challenging — replaced what was once the core of Countess of Chester's system, patient administration system (medical records), and several standalone waiting list management systems. Andy McCulloch, Deputy IM&TDirector, helped lead employees through a rapid five-month implementation and training period instead of the normal year-long process. "The challenge seemed overwhelming at first: 1,200 users needed to be trained on our new system. Plus, we had grown accustomed to our ten-year old methods. I attribute the smooth transition unequivocally to our staff's commitment," says McCulloch.

Subsequent additions to Countess of Chester's HISS were mainly clinical- based and proceeded with the same characteristic smoothness as Phase I. "We welcomed applications such as X-Ray [Radiology] and Theatre Management to replace obsolete systems that were not Year 2000-compliant," says McCulloch. "Other MEDITECH applications were implemented to replace paperbased methods. Those applications support tasks including waiting list management, outpatient clinic management, inpatient and day case administration, case note tracking, ordering, electronic reporting, and care planning. In all, seven million patient records have been transferred onto the system to represent more than three years of historic data, open episodes of care, and future outpatient appointments."

Fostering Clinicians' Acceptance of IT

The benefits of Countess of Chester's system are evident to clinicians every day. Libby Everett, who works in the Radiology department, says,"The biggest advantage we'reexperiencing is the ability to import information into the system that we didn't previously have on-line. In retrospect, we had grown comfortable with our former ways of documenting patient information. But without the on-line records or the integration it was of no use to anyone else."

MEDITECH's flexible software suite stands in contrast to other "one-sizefits- all" systems on the market. Trish Fielding, a Project Manager, assists the departments in customising some aspects of the software to make it work best for the Trust. "We are tweaking the system's clinical and demographic data collection and report capabilities to import hospital-specific statistics such as survival rate and flow. The fact that we can have a hand in developing the reports as our hospital evolves places MEDITECH head and shoulders above its competitors."

Know No Boundaries: System Expansion Made Easy

Many new endeavors are on the horizon for Countess of Chester. Next in line is an upgrade to incorporate MEDITECH's new user interface. The hospital also plans to add MEDITECH's Pathology and Pharmacy applications and has already signed up for MEDITECH's Data Repository, which will be used for reporting statistics to the hospital consultants, nurses, board, managers, and the government, and for clinical analysis.

How can this expansion be accomplished? Flexibility is inherent; new applications are integrated with the rest of the system. And, the Trust is building on an established infrastructure, which includes DG Ltd.'s AViiON servers and CLARiiON disk storage devices. These core components are linked to Countess of Chester by a Wide Area Network. "Laying the groundwork with an infrastructure and a network makes adding new applications to the system much more straightforward," says Richardson.

Ways to Command Industry-Wide Attention

A model to other hospitals, the Trust was selected by the NHS Executive to pilot a series of training courses for clinicians, managers, and hospital staff. Countess of Chester is also helping to develop an NHS Executive-driven programme for information management and technology (IM&T) staff across the region titled, "Understanding the Clinician's Perspective on IM&T."

Most recently, Countess of Chester has been asked by the NHS Executive General Practitioner (GP) Links Program to host sessions for GPs and other health service staff on implementing clinical information NHSNet links between hospitals and GPs. Given its track record, it's safe to assume Countess of Chester will remain at the helm of the healthcare industry.

Medical Information Technology, Inc.
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