Blog

Time To Plug Every Paper-Created Care Pathway Gap

24
May 2016

SynApps’s Mark Winstone looks at how NHS CCIOs and CIOs can make a smart move to new ways of paperless working in a crucial part of hospital workflow – Care Pathways

“We are a long way to getting to our paperless targets – but we are still working to remove paper out of our medical records work.”

The quote is from David Walliker, CIO at the Liverpool Women’s NHS Foundation Trust – and I am sure his is a reality many NHS teams can relate to.

In fact, even as we are moving to a paperless NHS by 2020, many hospitals are still shuffling a lot of paper around. This is happening even though a fair number have adopted leading-edge EPR (electronic patient record) suites that are making a lot of their processes fully digital.

Why is that a problem? There is one serious problem with paper still filling up the hospital –and another that’s absolutely critical. Actually, they are inter-related, as we’ll see.

The first one is simple efficiency. When you start a Care Pathway, such as when a patient comes into A&E, if your staff are having to transcribe details onto paper or on and off terminals, that’s simply time wasted – and time they should be using to help the patient directly.

Don’t let Never Events happen because of the paper chase

The second critical issue is that a complicated, disjointed system that’s paper here and digital there means there are gaps – gaps into which patients can fall. And, tragically, they do, resulting in what NHS England classes as the unforgivable Never Events – “serious incidents that are wholly preventable as guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers”.

We know of at least one Never Event caused by such a disjointed process: a Trust that has paper at a crucial part of its emergency admissions – and some paper got lost, and a patient ended up with double the dose they should have received.

Minimising the chance of Never Events is one of the principal drivers of the whole move to paperless. But not everyone has an EPR: not all Trusts have turned on all the modules; not all systems have been joined up.

That means there are gaps, often at crucial steps in a Care Pathway, that don’t have any support for a better, more digital way of inputting data and keeping it safely in a central repository. That’s now possible, however, via some great new technology that’s being brought on to the marketplace by our key Enterprise Content Management (ECM) partner Alfresco in the shape of something called Activiti, a functionally rich Business Process Management (BPM) solution.

What Trusts can do is automate some parts of their care Pathways with Activiti, which is a simple but powerful way to build easy to use e-forms that can plug these gaps – and help stop these Never Events ever happening.

‘Significant efficiency gains’

One Trust that’s already finding out just how useful paperless support for Care Pathways is, is Liverpool Women’s NHS Foundation Trust. Let’s find out a bit more about just how.

One of only two hospitals in the UK dedicated to the care and treatment of women and their families, Liverpool Women’s is also the largest women’s hospital of its kind in Europe. And as part of its commitment to a paperless NHS, the Trust recently made the move to an EPR it thinks will completely transform the delivery of its patient-facing services, enabling better, more informed patient care at the point of care while streamlining working practices between clinical teams. The project will generate significant efficiency gains alongside major operational cost savings for the organisation.

A great way to make sure you don’t miss your RTT target

But interestingly, says CIO David Walliker, management soon realised as the EPR project progressed that the non-clinical workforce could similarly benefit from an enterprise content management solution. “It was time to initiate a more efficient paper-less ‘next generation’ working approach that was better aligned with how business users need to operate today,” he says. “Implementing Alfresco will improve staff access to documents and, in due course, support remote access to our resources by mobile workers and remote workforce personnel.

In specific terms, that’s going to include advances like automated electronic document management processing, task management and powerful workflows that he thinks will maximise workforce performance and internal collaboration capabilities, he predicts.

So what’s his view on Activiti? Very positive. “It’s been very quick to develop and get up and running,” he has recently stated. “We’re replacing our paper forms with e-forms this way, starting with emergency staff.” Team members are very enthused by how easy this way of working is, he says, especially how connection with that back-end EPR means many fields in a Care Pathway can be automatically populated by the system itself.

Efficiency is also helping patients, as better record taking and information inputting has started to cut down the need for pregnant mums to come in, he adds.

So there seems to be real basis for optimism here: Activiti does seem to be a way to build more digital NHS workflows. And it’s worth bearing in mind that when you start a Care Pathway of any kind, the clock starts ticking for your RTT (Referral to Treatment) waiting times – another reason to ensure a streamlined, safe way of Care Pathway building.

We really think there’s value in this approach, and I encourage any NHS IT team to explore how it might help.

Mark

Mark is joint Chief Executive and head of all Sales activities at SynApps Solutions

You can see a short video about how Liverpool Women’s NHS Foundation Trust is benefiting from Activiti on YouTube here, while a fuller case study can be found online at our partner Alfresco’s site here.

Plus, if you’re interested in finding out more about e-forms and an automated approach to get to paperless Care Pathways, you may want to go to one of these upcoming roadshows. In them, you can hear more about the Activiti technology and about Trust experiences.

The events are supported by NHS England, and are being run in London on June 22 and Liverpool on June 23: please go here for full details, including how to secure your free place if you are a qualified NHS professional.

Hope to see you there!

How To Win Your Share Of Beverly Bryant’s New NHS Tech Budget

15
Mar 2016

Gary Britnell, who leads SynApps Solutions’ work in the NHS market, finds much to reflect on in a previous US Presidential race

Back in 1992, a certain James Carville came up with a phrase that helped the guy he was working for win a big competition.

You might have heard about his boss, if not him: I am referring, of course, to the successful Democratic challenger Bill Clinton’s race to the White House on the back of a tellingly-simple slogan:

‘It’s the Economy, stupid!’ (see here)

Well, I think we need another new slogan for health informatics and health IT (HIT) in the post National Programme for IT NHS:

‘It’s ECM, stupid!’

What actually works in British hospital settings

Not that I am calling anyone who works in the NHS stupid, to be clear.

What I am saying is that the scar tissue we all acquired during the years of the National Programme needs to be used in a positive way – and inform a next generation of truly useful, value-adding hospital IT technology roll-outs.

I should know. I was there. I wasn’t a front line NHS CIO or CCIO, but I started off in health IT recruitment and put some senior IT people into key roles in the bigger Local Service Provider areas.

That experience led me to set up a consultancy that did a lot of work alongside the Programme, which deepened my knowledge of what works and does not work in British hospitals.

One insight is that we don’t have an insurance-based model of compensation – so parachuting in huge US EPRs that were predicated in every line of code on such a model was never going to work.

A lot of those years were very frustrating, to be honest. However, I watched some great work – the Spine is the prime example – of fantastic, collaborative information-sharing functionality that helped a lot of health institutions.

But that was the exception, and a lot of the time, there was a great deal of metaphorical banging my head on my desk.

Was I the only one who could see that the missing link was a way to combine all the siloed hospital PAS and PACS systems into one, useful whole?

From National Programme to a great new NHS England-backed IT culture?

I wasn’t. Part of the recruitment work I did then was for a certain new ECM (Enterprise Content Management) firm, Documentum – which led to SynApps Solutions and indeed, my own role here now, working with our growing roster of NHS customers.

Last month, you’ll have seen that NHS England confirmed it has £4bn earmarked for making the NHS digital, delivering free wi-fi to all its hospitals, but also creating a great new wave of supportive IT applications (see here).

However, the money isn’t going to be handed out the same way it was for the former Programme. In the words of Beverly Bryant, director of digital technology for the organisation, she and her team are going to “look at the digital maturity” of all organisations bidding for money out of the fund.

Let’s help you win some of that budget for digital transformation!

SynApps is here to help. We can help you build a rock-solid business case that will help secure some new funding to deliver the electronic hospital systems you need.

And the key to that is ECM. ECM is the best way we’ve found so far, after all, to unify HIT systems into useful, coherent, safe and standards-based wholes.

So, Bill Clinton – I’m taking the slogan you rode all the way to the Presidency, and changing it to help SynApps customers win the backing they need to succeed as well.

Hope you don’t mind!

Gary

Gary is the Healthcare Account Manager at SynApps Solutions, and would be delighted to help with any enquiry you may have about how to use Enterprise Content Management to help your Trust secure some of the new NHS budget

An ECM Isn’t A Website. So Why Stress Test It The Same Way?

25
Feb 2016

SynApps Solutions’ joint chief exec James Paton gives some useful tips on avoiding some common problems with moving to the cloud
I’d like to pass on some friendly and useful advice to anyone looking at sizing up a new Enterprise Content Management (ECM) system in the cloud.

Why is this a problem? It comes down to sizing their new system. Quite often customers approach an ECM solution the same way that they would approach a website when it comes to sizing it.

What do I mean by that? Well, with a website you work on the principle of how frequently you hit that website in terms of making sure there’s enough capacity, effectively measuring the number page impressions as your metric.

Say you have 10,000 users. By using this website-driven logic, you assume you’re going to have 10,000 users hitting the website at the same time, so that’s the metric you use for building the new content management system.

But it doesn’t work like that. While there may be some busy periods for which you have to account, what you actually need to measure the system on is concurrent users. When you come to load testing your ECM solution, treating the ECM solution and the way users access it in the same website-driven logic generally results in bringing it to its knees.

When sizing a ECM solution you need consider carefully how your user population access the content and how frequently they will need to be present in the system. Quite often the key consideration for scaling up ECM is not how frequently the users are accessing the pages, it’s how many users are logged in at any one time. Each user has a memory footprint and that introduces load in terms of memory usage within the infrastructure, as frequently a user logs into the solution performs a search to retrieve content and then opens it and reads it, thus their session in ECM becomes idle. When scaling ECM solutions so you’ve got to scale up to make sure that you have got that capacity for those users.

The 10-15% rule of scaling thumb

Think of it another way; imagine you had 9,990 people in the company who only ever read one document – and ten people who each time they logged in, wanted to read 10,000 documents. I exaggerate to make the point, but your system needs to be able to deal with this kind of asymmetric demand. You need to distinguish between heavy and light users, because a light user accesses one document and the heavy user 50. But the one that accesses one document hit the ECM server twice, so he is causing no activity to speak of on the ECM server, whereas the heavy user is accessing it frequently – he may hit 50 documents, which is a lot more activity. The gap between a user retrieving a document and searching for the next document is often called the Think time.

Having empirical data to back up the user concurrency is extremely valuable but quite often many organisations do not know what their user concurrency rate is likely to be so as a rule of thumb organisations can take that user base estimate to be 10-15% of the total user population. This group can be further split into heavy vs light users thus allowing some realistic calculations to be taking on the sizing requirements for needed for the ECM solution.
One example should suffice: In an insurer, underwriters are going to look at the documents on an as-case-needed basis, i.e. if there is a claim coming they need to go and refer to the document once. By this logic, they are light users. But that insurer’s back office finance and accounts team would be classed as heavy users, because they are accessing the system all the time. It’s important therefore to look carefully at the types of roles that the teams perform that will be using the system; there is no scientific formula to it, but a rule of thumb we find fairly consistent is that 10 to 15 per cent want to access an ECM system concurrently, so if you look at what that top percentile want to do in terms of access you should be safe.

In fact, scoping out the likely balance between light and heavy users is very sensible from your point of view. Light users are barely going to use the system and will have a small footprint; if you have a lot of light users who only typically want to access a document per hour, your server requirement gets a lot smaller. That will in turn reduce the cost of ownership of the application (as it cuts down a lot on the overhead in terms of infrastructure requirements). Equally this process may help identify when there are burst requirements, such as end of quarter scenarios.

When it comes to sizing a ECM solution the User usage profile is often the most mis-understood aspect of the architecture. There are many other factors to be considered for example Existing Content volumes, new content created and/or bulk ingestion of migrated content. Ultimately many organisations initially treat ECM like a website, which you cannot do, or you’ll end spending much more on infrastructure than is actually required in real-world situations.

James is Joint CEO for SynApps Solutions UK

The 5 Things SynApps People Are Always Doing You Never See

11
Feb 2016

SynApps’ James Paton outlines the five things he always insists on when his team go out to work with any customer

My job at SynApps is to make sure each and every project we do – the work we carry out for you, our customers, in other words – also only ever goes well.

How do I get the team to focus on that? I have five demands, five things I need to see happening with every engagement. Let me tell you about what they are, so you can be reassured about how highly we value customer success here.

First: did we scope it right?

The point of the scoping exercise is to know what your expectations are. We don’t just look for half a page of text from you on the task. We need to probe and find out what areas of risk there might be that you might not have thought about. We also need to give you options if we find any.

Also, we hardly ever are in the unique position of being the only thing you’re concentrating on. Often a client may have dependencies, e.g. we’ll provide the hardware for this when we’ve completed that. We have to plan around that. We have also got to know your expectations of when my team needs to be available so that you have got clarity into overall timelines when the project starts.

Now with ECM (Enterprise Content Management), there are some things that are quite unique. One of them is product versions and dependencies. Sometimes we’re working with one particular product or integrating with another sort of product; the client may have a version of the system that they use but we don’t – so ensuring that when there’s an upgrade we are all still compatible and that the stack still works together is important.

Equally important is to check if there are any migration points. You may be going from legacy to new and there is content that has to be migrated (this is where our tool ConXLoader can be a great help in mapping content from one to another).

I say ‘content,’ but it’s never just that – it’s going to be your metadata too. And if you, as the client, decide that you want to hold it in a different way because five or 10 years has gone and you have got new ideas about how you want to manage it, that’s fine – but I need to know my team has prompted you about this.

Second: what’s the method in the madness for this one?

Method is how we are going to do all this for you. We are flexible and multi-skilled – we never just apply one thing to everything. For some things traditional waterfall is best, for others it’s Agile. We can do all of this, but part of picking the method is working with you to understand what you’re comfortable with. If you don’t look likely to be able to make people free at certain times to be in the ‘scrums,’ then we’d take a view, for example.

Once we have defined what our methodology is going to be, the other element is what the costs are of doing a particular project are shaping up to be. Even for the safest looking project, I want to have some contingency – not for my profit margin but your protection (and my peace of mind). I can share with you the models and heuristics that we use and which allow us to slice and dice the estimates for you if you decide on a different scope or if you want to add more functionality etc.

Third: what are we doing to deliver all this the way you need it delivered?

So then it comes down to delivery. The biggest factor here is having experienced people. We’ve got that – staff with many years’ experience doing content management and ECM heavy lifting. You are never going to have on payroll on your project a graduate learning on the job. We only hire experienced people. Plus, our resources are all UK-based, so if we have meetings with clients we can respond instantly; there is never a time zone issue. We find that that really cuts down your costs, because you get close collaboration between the SynApps resources and your project resources, so if there is an issue we’re white-boarding it out with you straightaway – cutting down on lengthy timescales and those deadly Telepresence meetings we’ve had one too many of.

Four: let’s try and make that ‘partnership’ word mean something

We take a partner approach with our clients. Yes, I know, you’ve heard that one before.

But it’s genuinely true here. If there is something we need you to be aware of, we insist on telling you. We make sure that the client knows the information they need to make any decisions – even ones that might hurt us. It’s better to be open and fair.

A way we see that done is the mid-way checkpoint. A project manager will check progress, the deliverables and the budget at about the half-way mark; they also effectively take on a business analyst role. And remember, I told you these are experienced ECM project managers. They can see issues and respond to risks well before people closer to the situation, which is why we put them in. Remember, all this process is always defined within the statement of work so that there is a clear definition of what the sign-off and acceptance criteria is. A SynApps projects is a project where we take responsibility and want clear definitions so we know what your expectations are and what the delivery cycle is. That matters. Believe you me, I know, because I’ve seen the mess where this didn’t get done.

And five: defining victory

Project creep? Horrible – and, perhaps contrary to expectations, it’s not really lucrative if it drags on, because that means we can’t redeploy our team to another engagement.

So we both need to define what the finish line is – and what delivery really means for you. Never start a project if you don’t know how you’re going to finish it. Many clients want someone in very quickly, which we can do, sure. But we help you more if for even the quickest win, we have a definition of what ‘successful delivery’ looks like. It is never likely to be just the technical delivery, for instance; there are still 5,000 users that have to be trained. Again, having that prepared and helping you budget for it is going to be a huge help to everyone involved.

That’s our list of top five tips for project success. If I know this is going on every day, then I am happy. If I’m not happy, don’t worry. A lot of people are going to be told that before you’re even dimly aware of the slightest disturbance.

Finally, please drop me a line if you haven’t see any SynApps consultants adhering to these five principles – a genuine request. Thanks for listening – and good project success!

James is Joint CEO for SynApps Solutions UK

SynApps Takes A Look Forward To 2016

15
Jan 2016

Can I first wish you a great 2016! I hope the return to work hasn’t been too much of a shock to the system. Perhaps, console yourself with the happy thought of how slim you’ll soon be with that new gym membership. Ahem.

Moving swiftly on, as they say; when we last spoke before the break , I shared some thoughts on how I saw 2015 as a year in our growth. Well, this time, it’s a bit of crystal ball time: what does this bright young year of 2016 look to hold for us here? Here’s our take.

We’ll See Our NHS Business Continue To Grow

We plan to consolidate and grow our opportunity in the health service, an absolutely vital market to us. We will grow our footprint in key Trusts but also extend our visibility with CCGs and other stakeholders. As we know, collaboration, cross-team and cross-organisation, is the route of travel here as part of both the Five Year Forward View but also the best response to a tough November Spending Review.

We anticipate some of that will extend out of the NHS and into other parts of local government and social care, even the private sector. Contracts that span three or four once very separate organisations will become the norm, I predict, and very soon. Here, the driver is probably not going to be VNA and DICOM so much as efficient workflows. Email is a terrible way for big teams to work together – we all know this. So content collaboration and document sharing will come to the fore, acting as a lubricating mechanism to get better, slicker co-operation going. That’s going to help patients and the NHS, and we are looking forward to seeing as much of it as possible! (What’s great is how our chosen DM/ECM platforms of EMC Documentum and Alfresco dovetail just so well into this kind of work.)

We’ll Help NHS Bodies Save Money

Cash is the problem for the NHS right now, as we all know. The government’s given it a billion to help with technology, but most commentators are saying the service really needs a lot more to meet all its ambitions around the move to paperless. Meanwhile, it’s being asked to find at least £22bn (some say that’s really more like £24bn, considering some got pushed ‘ahead’ in the balance sheet of the 2010-15 efficiency drive) of savings.

Technology has got to be central to that. And we expect to be in the thick of it: not just on the PACS supplement/replacement front, but in lots of things like storage; moving to putting more and more content and documentation in the cloud and off physical storage will save money by definition. We are also going to be making a quiet and very useful contribution helping to rationalise data out of various expensive or legacy silos, as is the case in 90% of Trusts, into more sensible common repository, based on our standards-centric stores.

A Bigger Role For Our Hospital Visual Media Service

And finally, we expect a lot of interest for our recently-enhanced ConXPhoto service, which we rebranded ConXMedia at the end of last year . Trusts always needed to capture and store a lot of photos to help patients and track cases; that need’s never been greater, and now video and medical imagery’s being thrown in the mix too.

As a result, I predict this area will become an important one to us – and also, of course, of genuine practical help to nurses, doctors, radiologists and administrators in the Trusts we work with, all of whom want to safely and efficiently store and manage this data asset.

So – there are my best guesses for the next few months. Will I be proven right? Only one way to find out – let’s shake off the last of the festive merry-making and begin a busy and interesting 2016!

Happy New Year,

Mark

Mark Winstone is SynApps’s Joint CEO and Sales & Marketing Director

SynApps Takes A Look Back At 2015

18
Dec 2015

Can I first wish you a Merry Christmas, and extend a sincere hope you get some good time off in the next couple of weeks? Try not to eat too many calories if you can and remember – the dog will always appreciate a walk if it all gets a bit too claustrophobic with the relatives in front of the Queen’s Speech.

It’s been a big year for us here – especially in our core NHS market. Let’s wrap up a few of the main trends we saw there, and how it’s helped shape SynApps and our progress over the past 12 months.

Tactical VNA

Fantastic to see so many Trusts coming off the National Programme PACS contracts and making the tactical move to not re-order expensive DICOM platforms but move to VNAs. That way, they’ve got their data back and can keep it in a safe and affordable format. A lot of CCIOs did this without much strategy, and it was the smart move.

Becomes Strategic VNA

Then, a lot embarked on the next equally smart step: now that all that X-ray and image/DICOM data has been repatriated, HIT (health IT) leaders are increasingly looking to exploring using the VNA to work with both that structured but also all that unstructured data . This is almost always under the rubric of the move, set right at the top by the Department of Health itself, to move to a ‘paperless,’ or at least radically digital, NHS by 2018. We’ve been pleased to have been part of such discussions – and, better, to be the chosen means of taking them forward.

Collaboration Emerges As A Key NHS Informatics Theme

Over the year, we were struck by a sea-change in NHS technology. We were expecting to hear a lot about sharing of data – between departments but also, at least tentatively, between different/disparate health and social care teams.

That happened, yes. But better, we heard more and more demand for doing more – to not just share but to actively, proactively, collaborate – and almost always in an open source, XDS way.

The goal was to join up the gaps that have for so long been there in the patient journey, not just through the system but across our lifetimes.

So what starts as an in-house collaboration space naturally soon evolves into a cross-organisational shared space, in the cloud, and with stakeholders, clinicians, social care professionals, starting to look to move data around in ways that best suit the patient.

This is really exciting and important. It’s been amazing to have seen this start and to play our part to help it along. This has to be the best way for the NHS to evolve, and it can solve so many social problems with our ageing society. I expect collaboration to become not just a nice-to-have but a requirement for our NHS projects in 2016.

How about that for a high note to end 2015?

Merry Christmas – and see you soon,

Mark

Mark Winstone is SynApps’s Joint CEO and Sales & Marketing Director

We’ve Improved ConXPhoto And It’s Now ConXMedia

11
Dec 2015

ConXPhoto is a great system we developed in partnership with NHS customers.

It helps hospitals better manage their growing mountain of internally-captured medical pictures – items like photos of wounds, bedsores or patient conditions and so on. These all get photographed by nurses and technicians and are of great use, but they end up poorly filed, stored and managed, and we wanted to offer Trusts a better way of automating and controlling that process.

Today we’re going to tell you about the next chapter in ConXPhoto’s evolution. It’s being extended and upgraded to become ConXMedia instead. You may not be too surprised to learn why; as hospitals used to the system, they started asking why they couldn’t use it to manage other media, like videos and other imagery.

And we see great potential in doing just that – of offering an easy and reliable way for hospital administrators and clinicians alike of having a control panel to work with all the multiple forms of images, they want to.

Underneath the hood here is our full-power Content Management System, which is allied to the standards we know help NHS information mangers the most – VNA (vendor neutral archive) and cross document sharing (XDS). The combination of a CMS, a VNA and XDS capability when it comes to patient imagery is a very powerful one.

As an example, we can easily ingest vast amounts of images, in bulk, across the department. We can store them properly and share them safely and appropriately via XDS. All your access and confidentiality/compliance issues get dealt with in one go, basically.

This is all delivered in the form of a highly cost-effective IT system that reduces your admin and ups the efficiency of your team. I am also delighted to say that a major partner is making the move from ‘Photo’ to ‘Media’ – the team at our long-term customer Kingston Hospital NHS Foundation Trust.

Look for more details and specifics about ConXMedia on the site soon. In the meantime, if you have any questions about the extended product, please feel free to contact me or your SynApps Solutions sales contact, and we’d be delighted to help answer your questions.

Jason Scholes
Co-Founder
SynApps Solutions