Opinion Article: Clinical Portals - Technology to Empower Health Service Delivery

CarefxBy Wayne Parslow, European Vice President and General Manager, Carefx.
The true measure of healthcare IT is the benefit it brings to people. First and foremost that means patients, but many others too including staff, carers and even taxpayers. The advantages aren't just the obvious and essential ones of greater speed and efficiency and lower cost: sometimes it can be a matter of life and death. I read about an unconscious woman rushed to hospital who, little did staff realise, was the carer for a severely ill daughter at home. A good system, capturing data about people's circumstances as well as personal health, could have flagged this up. None existed, no one was alerted to an extreme human need.

On the plus side, the NHS has a great deal of excellent IT already in place. It's established and trusted, performing particular roles exactly in ways the staff like. Vertical systems which do specific jobs for particular departments, or fulfill a narrow range of functions across a broad area of work, are great as far as they go, but don't go far enough. The patient journey is along the horizontal, and healthcare providers can take service quality and efficiency to a whole new level once their technology reflects this reality. That, in essence, involves being able to electronically and instantly share, exchange and update all the relevant information about any patient all the way from first referral to discharge and beyond for those with long term conditions.

There are a number of ways this can be achieved and perhaps the most agile and cost-effective is through the use of clinical portals. The beauty of them in these cash-strapped times is that they are relatively inexpensive. They are not the same as a new and all-embracing EPR (electronic patient record). In essence they create bridges between existing systems, of which any trust may have dozens, allowing them to work together as if there was just one. They can also provide additional capabilities according to the needs of the customer.

Fast, clean and easy
In practical terms the clinical portal looks to users like a complete new solution, because all relevant information is available on a single screen, so there's no logging in and out of different systems and remembering all sorts of passwords. It's immediate, clean and easy. But the time and money invested in legacy systems hasn't gone to waste, as they, and their essential business logic, are all still there and working away for the benefit of healthcare staff and patients.

It's a route which much of the commercial world has already gone down. When you buy insurance, books, flowers, do your banking, or any other online activity there's a good chance that the process is handled by an efficient portal tying together all sorts of legacy systems. Some of these may be 20, even 30 years old, but are still functioning efficiently. One of the key advantages is that when any of these underlying systems does finally become obsolete they only have to replace that particular element. Everything else stays up and running as normal, which minimises fuss and disruption.

Healthcare and IT are spheres where change is ongoing, rapid, and to some extent unpredictable. The NHS also has to be responsive to shifts in political direction. All this adds up to the need for electronic systems that are flexible and future-proofed. Portals are ideal for this kind of environment because they are about providing a framework which allows disparate systems to act like a seamless whole.

A virtual patient record
The term 'portal' is used quite widely but there is sometimes confusion about what they actually are and do. Some systems which claim to be portals frankly aren't. The defining factor is that a genuine portal simply locates the information you want and presents it on your screen - in the way the Google search engine does. What it absolutely does not do is copy information, transfer and hold it in a data warehouse and, once all that is done, pass it on. That kind of process is entirely different and is full of data security and governance issues. Few patients mind a clinician being able to call up the data they need to provide fast and effective treatment. They are more likely to worry if their most intimate details are filed away by private companies they know nothing about.

When a clinician calls up information using a genuine portal they get a virtual patient record. Everything is provided on a single screen, in a familiar format and with a single log in. Once they have finished the whole record evaporates rather than being held elsewhere, leaving only an audit trail of what was done. Having said that, because the portal takes the clinician directly into the underlying system, they can update and modify information as they go along.

The other immense advantage of a true portal is that it works in real time. Anything you call up is the latest recorded data, not a copy that may already be obsolete. That means it's perfect for finding out which patients have actually arrived for a clinic, rather than just being able to access a list of those who were supposed to be there. The real time element is critical if we are to get out of professional silos and provide proper joined-up services. It's pretty unsatisfactory that in 2011 a GP doesn't necessarily get immediate information when one of their patients has been in hospital. It is even more absurd that health professionals sometimes have to order duplicate tests because they can't get hold of results.

Collaboration is key
As every health service manager knows, a step change in IT capabilities is needed as a matter of urgency. The population is ageing while the healthcare workforce is dwindling. Much more needs to be done remotely, and in collaboration with patients and carers themselves. The idea of patients being able to review their records and care plans, and even make changes to them, increasingly looks like a necessity. If someone can feed in data about themselves from home, and have virtual consultations, it saves a lot of time and money and greatly improves the patient experience - removing the need for the patient to travel. As different organisations invest in systems to make these things possible, it is only the portal approach that can join up the disparate elements - which are often otherwise incompatible.

We also need to be thinking big, about how to bring primary, secondary and social care providers - and patients themselves - into an IT framework. Related to this is the need to ensure that authorised people can access information on portable devices, whether that's smart phone or tablets. Portals have no problem with this.

Agile solutions for a complex world
The future is all about being agile and responsive to change. And we are passing from one stage of electronic evolution to another. Portals make the most of the fact that there are lots of brilliant people out there coming up with all sorts of innovative ideas for electronic systems that can improve particular aspects of care. The NHS has to be able to take advantage of these, so it makes sense to move forward on the basis of platforms like our own Fusionfx one that are not only open to change, but embrace it. That way we can ensure that IT strategies are people-centred, which then allows our health services to be ever-more sharply focused on patients as whole, social beings. With that comes the hope that when someone is rushed, unconscious, into A&E the hospital has instant access not only to the information they need about the patient, but is aware of anyone else who depends on them.

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