Public Services > Healthcare

Cambridge trust set for IT services market test decision this summer

David Bicknell Published 08 May 2017

Timetable for £140m outsourced IT services tender will see Cambridge University Hospitals trust decision by end of the summer; trust details digital exemplar ambitions

 

Cambridge University Hospitals (CUH) NHS Foundation Trust says it expects to make a decision within the next few months on the commodity IT services it needs as it nears the end of a market test process.

Dr Afzal Chaudhry, the trust’s chief clinical information officer, who was speaking in a session on Global Digital Exemplars at the e-Health Week event last week, told Government Computing that the expected timetable would see a decision being reached by the end of the summer following the market testing process.

CUH issued the tender last September for “outsourced commodity IT services for enterprise infrastructure, service desk and end user computing including the provision of server, storage, electronic patient record application, LAN and WAN”.

The tender’s estimated contract value is around £140m, with the requirements spread over two lots for a seven year period, with the option to extend for a further three years based on 12-month incremental extensions.

Lot 1, worth around £100m is for outsourced commodity IT services for enterprise infrastructure, end user computing and service desk, while Lot 2, worth £40m, is for outsourced commodity IT services for enterprise networks and security.

Explaining the move at the time, Dr Chaudry said, “Almost four years into the eHospital programme, CUH has exponentially increased the use of its Electronic Patient Records and seen a growing demand in the size and types of commodity IT services needed by the trust.

“As such, we are market testing to ensure best value for public money to meet these needs, whilst recognising our partners, HP, have and continue to meet their contractual obligations."

The trust’s 'eHospital' programme went live in October 2014 as part of a long-term strategy to streamline how patient data is accessed and used to enhance quality patient care.

In what was described as a first for a UK trust, Addenbrooke's Hospital and the Rosie Hospital implemented new patient record software designed by Epic. The software was due to run across 7,000 devices either provided by or supported within the accompanying infrastructure agreement with HP. The eHospital contracts with Epic and HP were expected to run over a ten-year period at an estimated total cost of £200m.

Exemplar

At the e-Health event, Dr Chaudhry outlined where Cambridge had got to and where it wanted to go with its digital exemplar programme.

He said, “Last month was six years since we started our procurement process that has taken us to implementing not only Epic in terms of the software but also changing all of our infrastructure across our entire hospital. And that has been quite a fairly bumpy journey as many of you will have heard.

“But now that we’re just over two and a half years since the go live of the system, we’re seeing significant numbers of benefits, not only that have potential within the hospital but also now in terms of the Global Digital Exemplars programme and our extension into the community.”

Dr Chaudhry said CUH began its procurement process in 2011. “We went through a process of over a year to get all the assurance that the Trust Board needed to sign off the bids that we had.

“And in terms of monetary value, because people always ask, the entire programme over ten years was costed at £200m. So £140m for the infrastructure piece. And the comparator work that we did at that time showed that had we done nothing and just stuck with what we had, we’d have spent £110m, and the software piece, £40m, and on top of that, £20m of implementation costs from our own hospitals.”

He continued, “And that is one of the very striking things and is one of the reasons why ultimately I think we have been successful. It’s because the hospital invested in a capability, invested in its staff in order to do this implementation. And at the peak time we had just over 100 full time equivalents of staff fully funded by the trust for 18 months to do our implementation.”

Stage Seven aims

Dr Chaudhry explained that on the first day of October 2014, CUH went with a “big bang” approach that included a patient administration system (PAS), bed management, case note tracking, enterprise scheduling, care plans and pathways, reporting dashboards, cardiology, oncology and workflow management.

“All of this was switched on on the first day. So basically the entire hospitals changed overnight. And the only piece that we don’t do was paediatric chemotherapy and that was a conscious decision at that time. And we’re now working to implement that and have that work by the end of this year going into next year. Last year, we switched on our patient portal and this year we’re working on our connections out into the community, to Care Everywhere which is connections between hospitals and EpicCare link which is mainly a connection into Primary Care.

“We were very pleased to be rated as a Stage Six hospital. The issue that we’ve been tasked with as part of the Digital Exemplar programme is to move us towards a Stage Seven hospital and we can talk about whether all these labels are important.

“But for me the importance of being Stage Seven is it’s a reflection of that standardised clinical and administrative workloads, and we know we need to remove unwanted variation, whether it’s clinical, operational, managerial, whatever it is. Because that’s where we start to see efficiency benefits, safety benefits, and it gives you a baseline by which you can then start to restructure the approach to continuous change and evolution.”

Chaudhry said he was being “quite candid” the difficult time CUH had after going live. “We received quite a lot of negative press around that, some of which I think was warranted, but certainly not all of it.

He explained, “We focused around patient care and everything we wanted to do with all this programme was about delivering better quality of care to the patients. The single most useful thing for us in terms of delivering benefits is that we have one integrated system across our entire hospital. We know that means that we can add in things like outpatient kiosks, and the patient portal.

“Patients when they arrive in the emergency department, as soon as they walk in, they get a wristband. We’ve introduced a number of technologies. In the paediatric ward, not only can the nurses scan the wristband of the patient to identity the patient, but they scan the medication as well. And that is internationally recognised as the safest way to do administration. We need to roll that out further.”

Digital exemplar

Discussing the trust’s goals as a digital exemplar, Dr Chaudhry spoke of how CUH has been tasked with moving towards become a Stage 7 hospital.

“For me that’s about reducing our unwanted clinical variation. Some of it is technological; we need to roll out our bar code med administration to the entire hospital and that will bring us undoubted safety benefits.  But it is about engaging with operational colleagues to make us as effective and efficient as possible.

“For us we’re now working with our sustainability and transformation plans (STPs) and looking to how we can extend not only the reach of our system but also the reach of our data out into the community and how we in turn can benefit from bringing their data into us so that we can work collectively. We were recently certificated by NHS Digital as a Mesh IT care sender for total document architecture for transfer of care. So we we’re working with some local GP practices about sending structured tools, structured data and transfer of care documents."

Procurement

Discussing the procurement lessons Cambridge had learned, Dr Chaudhry said, "We learned a lot particularly around what was important to us as a hospital. We particularly weighted our procurement in favour of clinical activity. We took a very strong view at the beginning that this was about our hospital changing so that the clinicians receive information as close to real time as possible and all of the downstream processes should then flow from that.”

Dr Chaudhry also defended his decision to opt for a ‘big bang’ implementation approach and argued he would do the same again.

He said, “In terms of would I do ’big bang’? Yes, I would always do that. I would do it again. And there’s a number of reasons. Everybody says, ‘We’re all in it together.’ And that does create a very strong spirit within the hospital. This is a vision of the hospital and we’re all going in the same direction and we’re all going at the same pace.

“And the second thing is, when you have a system that’s very integrated and you start to try and (decide) which bits should you or shouldn’t you implement, actually it’s almost impossible. The final thing I would say about ‘big bang’ is nothing ever goes perfectly. And if you do big bang and you know it’s going to be really hard, you can start with a shorter period of time, with the right support. I’m not saying we did have the right support. In retrospect I would like to have had more. But if you try and do this over 3 months, 6 months, 9 months, 12 months, 18 months, that’s a very hard thing for any hospital to sustain.

“And often you get stuck, because people say, ‘We’re not going to do the next bit until the first bit is perfect.’ And to be honest, it’s highly debatable as to whether any of it is ever perfect, because the NHS, the hospital, everything is constantly moving underneath you. So I would do ‘big bang’ again.”

 

 

 

 

 








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