As NHS IT professionals, our primary objective is to help clinical staff treat patients effectively, ensuring patient safety and that staff act as efficiently as possible. This is based on two main activities: keeping the IT lights on and things running smoothly, and being innovative wherever possible to deliver better results.
The NHS expects efficiency gains and more results to be delivered from its spending. With current budget restrictions, the ability to be innovative is more critical than ever. In this financial environment, these restrictions can actually be a spur to new ways of thinking about workflows, patient care and delivering more effective support for clinical staff.
For Cambridge University NHS Foundation Trust, we have applied the concept of electronic decision support to pathology tests. Decision support has previously been in place around drug prescription, offering doctors and consultants access to more information on treatments as they might need it so that they can make the right choice on medication for a patient.
The IT team has worked with the clinical staff at the trust to apply this same approach to pathology test ordering, providing more information on tests to improve patient care, but also reducing the number of test orders where appropriate.
The clinical team has put together some rules around common test orders, which the IT team has implemented as part of the decision support solution.
As part of the order process, the clinician can look at existing test orders where they have already been completed. For example, if a patient has been tested on several occasions over the past few days and the results have been normal, the clinician can see this and evaluate whether a test is necessary in this situation. If not, the order can automatically be cancelled within the system and the patient does not have to undergo another test.
At one level, the IT side of this project applies existing ideas to a new area to provide clinicians with better support for their decisions. However, at the clinical level, the aim is to make sure that every test provides a definite benefit for the patient. As a teaching hospital, this implementation also helps our clinicians, particularly junior doctors, to think about their reasons for testing a patient and the impact it can have.
By looking at the whole experience around patient care and test ordering, the trust is able to improve this for both the patient and the clinician. The last ancillary benefit is the potential for cost reduction: by eliminating unnecessary tests, the trust estimates that it can reduce its pathology spending by over 10%. Applying this approach across the whole NHS could very quickly add up to a major cost reduction.
IT now supports so much of the NHS's work, both at a local and a national level, that the potential risk to innovation affects frontline staff performance as much as it does the back office. Many of the efficiency savings that clinical departments are tasked with delivering are based directly on IT being able to improve performance for their staff.
Without this ability to look at innovative ways of working, or new changes in workflow that IT can support, the NHS can only continue to work at its current pace.
Di Nixon is head of strategic systems at Cambridge University NHS Trust
From Bubb's Blog
From Whitehall Watch
