By Richard Tarring, Commercial Director at Sirona Care and Health Community Interest Company.Procurement processes and IT deployments in the health service are rarely known for their flexibility or agility. So what happens when you combine a not-for-profit community interest company (CIC) and two innovative UK technology suppliers? The answer for people receiving learning disability and community services in South Gloucestershire is starting to emerge.
2014 saw Sirona take on learning disability and adult community services across South Gloucestershire. It was the start of a different way of doing things that is already enabling better services; a journey that began with better information.
Integrating data - an agile approach
The previous provider of South Gloucestershire's community and learning disability services had relied on a costly arrangement with a local supplier for its reporting to commissioners from its RiO patient administration system.
However, we decided to remove this arrangement and utilise in-house IT resources for reporting, which we were already doing for other services across Bath and North East Somerset. The decision would deliver an annual £500,000 saving and would give us the ability to redesign services around the needs of patients and service users. However, the move required a rapid and complex programme of data migration, which posed a significant challenge, as we were not familiar with the incumbent RiO system.
In a very tight and challenging six month time scale, Sirona needed to seamlessly replicate more than 200 reports that clinical staff were already using on RiO, into CXAir, a new organisational analysis solution that was being deployed across the organisation. This should have been a significant task, one which Sirona only achieved by being able to quickly collaborate with external expertise, unrestrained by the traditional, burdensome procurement processes often encountered in the NHS.
A tripartite partnership was quickly formed. Connexica was already engaged for the analytics and reporting tool. Sirona then turned to Apira, an NHS implementation specialist, to provide the necessary advice on data migration from the existing RiO system, without which locating the data necessary to generate reports would have been like trying to find a needle in a haystack.
Each partner had its own role to play, to ensure every report was re-written from scratch within CXAir, so that they would appear to clinical users in exactly the same way that they had done on the RiO system.
The process involved a highly unusual level of collaboration and agility. Input from all sides, including teams and clinical staff at Sirona, was critical. And instead of starting with a detailed specification, ideas were discussed and an overall working framework was created, which kept the project agile enough to quickly change direction when problems or issues were encountered, or when new actions were suggested by one of the partners to achieve results.
An NHS project of this nature would have required a fully costed and detailed specification, as well as a tender process. Sirona didn’t have the time to do that. We had six months from start to finish. We found the partners that we needed to deliver and then we engaged them. Other companies might have been phased without a detailed spec, but the flexibility that all parties brought to the table was reflected in the result.
The result - real time intelligence for better quality care
Sirona can now not only fulfil its contractual reporting requirements to commissioners, but has moved from measuring activity in monthly reports to having access to real time intelligence that is integrated across the services and geographical areas it serves. This has real meaning for patients who use our services - the start point and the end point for everything we do. As a not-for-profit organisation, Sirona is only interested in providing better quality of care. The system has allowed us to do that from the moment it was rolled out.
Redesigning services, managing resources
We have been able to look at internal efficiencies. We can see why we might be more efficient in one district nursing area than another, for example. We can start to redesign services and by looking at capacity and efficiencies, we can start to identify where we have bottlenecks. We can compare activity information from our community nurses. If one nurse can carry out eight visits in a day and another is able to do six, we can start to look at the reasons why: Is it due to travelling time? Do we need to look at the routes they are travelling? Does one nurse go into the centre of the city? We can now use this information to try to increase the amount of face time clinical staff get to spend with the patient.
Following the patient journey
Staff now have far better visibility of patients. The whole journey can now be charted to show where a patient has been and where they are going. This can be very powerful information in delivering the right care, at the right place. If we can cut down the need for a visit, that helps the patient. If they don’t have to come to an outpatient clinic, a home visit could happen instead. We also no longer have a need to ask for a patient’s history over and over again as clinicians draw information from the same system.
Access to information at the point of care
One of the biggest benefits is the availability of information to our community based staff. Previously they would have needed to travel back to base to look at the patient record. Now, thanks to new reporting and the new systems that we have put in place, they have access to that information in the field.
Moving into the future - predictive care
What has been achieved is only the beginning. There are big plans ahead to develop the systems to provide even better information and patient care. At the moment we react to things. In the future we intend to start being predictive and intervening earlier. This is the start of things rather than the end product.
Beyond NHS IT disasters to new ways of delivering care
This may be one of the first projects of its kind, but community services will continue be managed in new ways by organisations like Sirona into the future, meaning further movement towards a more flexible, commercial way of doing things. This will save money and improve services for the end user.
We are now looking at more than £1bn of new contracts and thanks to the project undertaken with Apira and Connexica we are in stronger position to offer an alternative to the NHS. Sirona now has the building blocks to rebuild reports from other systems that may be unfamiliar to us, which will help the CIC to successfully bid to run more community services as it presents a more cost effective model that better serves patients. More broadly, we now have a project approach that can be used in the future, one that is based on flexibility, agility and unorthodox routes to effective and rapid collaboration with innovative and supportive parts of the healthcare technology marketplace.
The NHS has seen some big IT disasters in the past and so even though this is a relatively small win, it is a definite win.