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Improve Local NHS IT Fast – Get Rid Of the Legacy

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By Tony Backhouse, Business Development Manager – Healthcare Division, SynApps Solutions

I want to take the opportunity with this blog to talk a bit more about the challenges that NHS customers have been telling us about – the kinds of challenges that have led us at SynApps Solutions to build not just our established VNA PACS platform but also our new Clinical Content Store (CCS) (see ‘Saving the NHS – Let’s Start with Local Health IT’)

What we are hearing from NHS Trust leaders can be summed up under the following headings, I think:

What to do with all the old data: the NHS legacy system challenge

Hospitals maintain a large number of systems for managing patient records and associated information. The problem: a lot of these systems have become “Read Only” or obsolete or are to be consolidated and replaced by newer technology. At the same time, they also have a lot of in-house applications that have accumulated large volumes of data and/or documentation over the years. And while a lot of this information is no longer ”Active”, it needs to be maintained, which can be costly. Meanwhile, in most cases, unfortunately, the performance of these systems is getting worse over time.

If they could, Trusts would like de-commission these systems so as to save the costs of all the associated software licences, servers, storage, and ongoing maintenance and administration these legacy systems represent. Especially, for all the multiple back up and archiving routines. But as I said, the data in these systems is still important and needs to be preserved. In fact, gaining access to this information in a patient-centric manner, whether across the hospital or externally across the patient journey is seen as something that will add significant value in the kind of new NHS its Chief Executive, Simon Stevens, envisages.

But first, we need to do some work on that mass of information that’s built up. We know that some of it we need to keep, for compliance reasons, meaning it cannot be deleted or altered. And it must be auditable, and readily available when asked for.

Well, the good news here is that the Clinical Content Store we have just built will let you work very effectively with that information, letting you easily retire, retrieve and in general, better manage inactive clinical application data and documents in a central, scalable, non-proprietary, compliant archive. Just some of the ways it does that is by a powerful, Web-based interface that enables search of data from decommissioned applications, even as far as cross-application searching via a single portal to view the information. Another feature is the way we can guarantee you a full audit, ensuring that the data is not tampered with and there is an unbroken ‘chain of custody’ from the point of data extraction to future usage.

All this capability means that we know the CCS can handle a big part of the admin load of the Trust. But that’s not all it can do, nor is it the only problem it was set up to tackle. Take another:

The data burden from your current, operational IT

You will also, of course, be running core, strategic systems that support the day-to-day running of your Trust – which tend to run on high-end servers, associated with high-cost storage platforms and which tend to be buttressed by expensive backup systems and configured for high availability and disaster recovery.

All of this costs – and as the volume of data being generated and managed by these systems grows, so does that cost. You will know that without effective management of such a stack, data application performance degrades, backups cannot be completed in available windows, additional software licences are required and upgrading applications becomes extremely difficult and time consuming. So you will have invested in archiving, 99% of which are point solutions addressing a particular system or data type – and whose use results in the creation of an increased number of information silos, which has just added to that legacy system and data problem we were just talking about.

What would be better? How about a unified archive platform, capable of ingesting and managing any type of data or content, structured or unstructured, on a low cost compliant infrastructure? A platform that also has a central archive that means your patients’ clinical data from legacy applications can be made available, so medical users have access to the information they need but admin people also have their needs met so as to serve the whole Trust’s business and compliance requirements. And what if that information can be shared using internationally recognized standards such as XDS?

If you had such a system, those legacy ones could be switched off, removing a huge chunk of support and maintenance costs. And as you retire old systems, you start to provide greater data availability for structured and unstructured data, as well as requiring less storage to accommodate the data. You can also stop paying unneeded application and database licenses and you will be able to reduce costs for backup, restore, and upgrades and cut down on all your data centre costs by removing solid servers that consume power, space and server support charges. The list goes on!

And that’s the list of what the Clinical Content Store can do. What’s better, we conservatively estimate that Trusts can bank on a data and storage bill of something like 60-70% less of what it would have been if you had kept it in your main operational system.

Putting all this together, it’s clear that the only real way to get on top of the data problem is to look for technology that works the way the CCS does.

Or even better, cut to the chase and use the proper Store itself!

We are currently offering a free consultative study to scope out the potential of CCS to meet your need, but be aware it is time-limited – so start talking to us today!

Please – take advantage of our seminar [https://www.synapps-solutions.com/events/addressing-the-twin-challenges-of-retiring-applications-while-increasing-access-to-patient-information] on Thursday 29th January at 12.30pm at the London Chamber of Commerce, EC4R 1AR, and find out more about the Clinical Content Store and how it can help you meet your EPR challenge.

 

Saving the NHS – Let’s Start with Local Health IT

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By Tony Backhouse, Business Development Manager – Healthcare Division, SynApps Solutions

“It is perfectly possible to improve and sustain the NHS over the next five years in a way that the public and patients want.

“But to secure the future that we know is possible, the NHS needs to change substantially.”

These are the words of no less a figure than Simon Stevens – head of NHS England, so very much a figure whose ideas on the best ways to take the health service forward we need to listen to.

Stevens made the statement as part of his landmark October ‘Five Year Forward View’ vision for what the NHS has to do to survive.

Note my emphasis. Not ‘would like to do.’ Not ‘is asking the taxpayer nicely for.’

No, Stevens said ‘needs to do’ – in order to survive.

The document lays out many different policy, social, structural and indeed cultural changes that, not just the NHS as an organization, but we as users of it need to start making – from looking after our health better to that long-awaited health and social care integration we have been hearing about for so long finally kicking off.

But Stevens is also famous for being an NHS leader with not just real knowledge of ICT, but a deep conviction of its central place in the revolution he wants to spark in the British healthcare system (“We will invest in new options for our workforce, and raise our game on health technology… unless we reshape care delivery, harness technology, and drive down variations in quality and safety of care, then patients’ changing needs will go unmet” being just two of the many remarks he makes on the topic in the Five Year Forward View).

Well, we’ve all heard similar statements before. Many of you reading this will have some experience with the National Programme for IT (NPfIT), to name the most notorious example of what can happen when ambitious, top-down technology-led change is imposed on the NHS. (The NPfIT was an initiative by the Department of Health in England to move the NHS in England towards a single, centrally-mandated electronic care record for patients and to connect 30,000 GPs to 300 hospitals, providing secure and audited access to these records by authorised health professionals.)

I use the word ‘imposed’ deliberately. Stevens in this document lays out what happened before when Whitehall says what Trusts need to do without taking enough consideration of their specific needs.

But this time, he says, it’s going to be different. Which is where technologies such as those being developed by SynApps Solutions are going to really start helping you.

The Clinical Content Store: a major SynApps development

What do I mean? Stevens, acknowledging the issues that have plagued attempts at getting more tech into the NHS before, makes a very significant statement that I want to draw your attention to: “Nationally we will focus on the key systems that provide the ‘electronic glue’ that enables different parts of the health service to work together. Other systems will be for the local NHS to decide upon and procure.”

In other words, we (NHS England) will put some systems out there for you – but the rest, the ones that you know work and can source and implement the way that makes sense for your hospital, is down to you. How can local IT do this? They need to strip out old IT and use those savings to part fund the right systems that will share information in the right way. Step forward, just such a system –the SynApps Clinical Content Store.

You will be aware that SynApps, working with key partners like EMC, has been building a great system for helping Trusts start to better manage complex, large image files, which they needed to do as the old National Programme central radiology contracts started to wind down. This is our VNA, Vendor Neutral Archive (see, for example, our blogs on here from last year like ‘WHY DOES VNA MATTER – AND HOW DO YOU IDENTIFY IT?’ and ‘‘ROYAL’ APPROVAL FOR A VNA-BASED EPR?’).

The VNA has been doing some fantastic work out there. But we haven’t been sitting on our laurels – far from it. Instead, we have been building out the VNA and adding other functionality to it to create this new CCS, or Clinical Content Store – a place to bring together all kinds of information at the local level to help create a true Electronic Patient Record, from the bones of all the old systems and alongside the new. A place to start building powerful, flexible ways to not just ‘go paperless’ but to, at last, integrate the structured and unstructured digital and non-digital patient data needed.

In the next couple of blogs, I’m going to tell you about the CCS, why it matters, how we see it starting to help organisations just like yours. We will also talk to this important theme of ‘national glue’ provided by NHS IT systems buttressed by flexible, local systems.

I think it’s going to be a fantastic journey. But it’s also hard to think of a more important IT project: one that means you will play a core role in the saving of the NHS.

Are you on board?

Tony joined SynApps in April (https://www.synapps-solutions.com/tag/recruitment) to help further build our success in this sector

We are currently offering a free consultative study to scope out the potential of CCS to meet your need, but be aware it is time-limited – so start talking to us today!

Please – take advantage of the seminar [https://www.synapps-solutions.com/events/addressing-the-twin-challenges-of-retiring-applications-while-increasing-access-to-patient-information] on Thursday 29th January at 12.30pm at the London Chamber of Commerce, EC4R 1AR, and find out more about the Clinical Content Store and how it can help you meet your EPR challenge.

 

ConXPhoto 2: Not Just Solving A Real Problem, But A Signpost To The Future, Too?

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SynApps has just announced an exciting new product: ConXPhoto, a new addition to its expanding Vendor Neutral Archive solution set for NHS users. The idea: make it really simple but also totally safe and trackable for nurses to take the digital pictures of patients increasingly demanded by medical needs, but which have up until now too often been stored in haphazard, inaccessible ways.

Here, Mark Winstone, SynApps Solutions’ Sales and Marketing Director, continues to explain the functionality of the product and how ConXPhoto, despite being an obvious solution to a specific problem, actually fits very neatly into the wider SynApps Solutions VNA-based EPR philosophy.

Last time I started to tell you about why we’d built ConXPhoto: NHS Trusts up and down the country are struggling to properly manage and keep all the digital photos they need to take of patients, which are often very useful in their care but which can also be very important if any kind of dispute or legal action happens once the patient is discharged.

Last time I talked about why the product came into being – how we were introduced to the whole problem of modern digital patient photography management by the Kingston Hospital NHS Foundation Trust.

Following what the Trust’s Deputy IT Director had told us, we looked into the problem and discovered that there were some real issues here. Images were being created but not properly stored, deleted or backed up. You can’t blame the busy ward sisters for that: we employ them to look after us when we’re ill, not to be data management experts. So what could we do to help?

We have worked with Kingston, and a number of other significant London area Trusts, to produce ConXPhoto which we think it will really save everyone a lot of time.

In essence, we have put an extension into the digital cameras that the Kingston nurses are using which intelligently routes the images to a safe place: so not the thumb drive or shared drive where they were putting images before, but a central repository. We offer a simple Web-based interface that displays all the pictures in a ‘light box’ format, so they can easily click on the ones they want to save for the patient.

We then prompt them to enter appropriate information – but what’s better is that we’re getting the metadata in: the nurses are inputting the NHS ID number of the patient in question by linking into the other records we have for that individual in the main hospital database.

Which, if it is ours, will also be the place where the patient’s case notes, radiology files, endoscopy video (video is almost as big an issue for the NHS as patient still photography), scanned paper notes and so on all reside. Once again, you have the connected, holistic electronic patient record basis that we have been waiting for.

The end result of our work with Kingston and the other Trusts we have been piloting this with is ConXPhoto: a way to safely record and validate accurate, time stamped, auditable images around a patient journey, stored in the correct, safe way and in a medium (such as a VNA system) that lends itself to easy access and integration.

The shape of all patient records to come?

To sum up: there are four big winners from ConXPhoto.

One is the nursing staff – who can get this small but important job done much more efficiently.

Two is the CCIO, the Chief Clinical Information Officer (the IT leader in hospitals who looks after the health-IT interface) who will get compliance and a proper way to manage clinical information.

Three is the CIO or IT Director of a Trust – who will be able to see that a chaotic process, leading to proliferation of files on all sorts of media, is going to be done in a controlled and validated way.

Last, but absolutely not least, – the patient. Patients will see more efficient wards with clinicians able to spend more time on our care and who will be storing away information that may be highly useful to refer to in an accurate, dated and detailed way.

ConXPhoto is a really exciting and useful product solving a real problem for the NHS of 2014 – but it is also yet another example of the fantastic way that a VNA system, which by definition is a system that can capture and help manage any sort of digital information, is the way all patient information systems really need to go.

 

 

 

ConXPhoto 1: An Important Contribution to Helping a Serious Issue for Today’s NHS

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SynApps has just announced an exciting new product: ConXPhoto, a new addition to its expanding Vendor Neutral Archive solution set for NHS users. The idea: make it both really simple but also totally safe and trackable for nurses to take the digital pictures of patients increasingly demanded by medical needs, but which have up until now too often been stored in haphazard, inaccessible ways.

Here, Mark Winstone, SynApps Solutions’ Sales and Marketing Director, outlines some of the reasons why the company has decided to invest in this intriguing new area of functionality. We’re hopefully not giving anything away when we say: it’s all about customer demand.

We’ve not been talking to you for a while, on this blog, about our great solution for healthcare users – the VNA (see ‘Royal’ Approval for VNA-based EPR’) based foundation we (and our growing roster of NHS customers) feel is the best approach to building the workable electronic patient records (EPRs) the NHS is crying out for.

In this, the first of two short blogs, I want to bring you up to speed on what’s happening there –not so much with the EPR directly, though that is relevant, but about how we have gone from helping one Trust with one particular problem into adding functionality we know is going to be applicable across the health service.

Let’s start the story by explaining a bit about the problem we addressed.

Poor collection of metadata

Time was hospitals had an internal photographic department. Its purpose was to take photographs of patients, e.g. if they had come in with particular sorts of injuries, had developed a particularly severe rash, had (unfortunately) developed a nasty bed sore and so on.

In the days of wet film, all this was done by non-clinical staff and there was structure to it – prints were included with the paper files. Times have moved on, both in terms of NHS budgets and the state of modern camera technology. Now photographs are generally taken by a nurse, typically via a £100 digital camera.

We don’t need those extra staff and it’s obviously more convenient to have those images in an electronic format. But what happens to those images? Where do they end up? Who is looking after them? Are they being routed, as a matter of course, to the hospital’s main PAS (patient administration system) or other database?

In most cases, they are going on to USBs or CD or on to the nearest laptop or desktop, or who knows where. And while the nurses are obviously doing their best to label everything correctly, they are not metadata experts – so the link to the rest of the patient information isn’t always getting properly captured.

Photography management

That’s obviously a bit disorganised. The situation is a lot more worrying when you reflect that a lot of doctors and Trusts get sued: patients can end up very unhappy with their treatment, alleging poor care and malpractice. But if a legal dispute comes up and proper evidence in the form of contemporaneous images isn’t to hand, that’s going to be a problem. Now think about how you’d find a particular image for a patient internally – and then for another hospital needing to know what that skin condition looked like on the 4th of May.

Not straightforward.

It was certainly presented to us as a problem by one of our key customers, Kingston Hospital NHS Foundation Trust. Its Deputy Director IT and IT Programme Manager, Norman Harling is interested in the possibilities of VNA as an EPR foundation, but when he told us that a more immediate issue was this area of patient photography management, we started to think about how we could help him.

Now that I have set the scene as to why this NHS photography area is a live issue. In the next blog, I’ll delve into what we have specifically done for Kingston and how that has become the basis for this wider ConXPhoto product.

 

 

Why ConXReporting Really Is ‘XBRL AS A Service’

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Last time (‘Can CRD-IV Compliance Be Made Into A Process?‘) we looked at the implications for banks and financial services organisations resulting from new regulatory demands from the EBA the European Banking Agency.

The EBA has mandated that all reports filed to it going forward need to follow certain prescribed formatting rules, centred on the database language of XBRL– with the first real deadline being FINREP, for FINancial REPorting which you need to be set up for by no later than November.

More importantly: we started to talk about what you could do to prepare. You won’t be surprised to hear that vendors are scrambling to offer ‘solutions’ here. What you actually need, though, is more likely to be what we at SynApps solutions, working with our key partners of XBRL firm CoreFiling and main enterprise content management partner, EMC (with the Documentum platform) have brought to market: the production of EBA-conformant reports via the delivery of XBRL as a service.

We do that via our ConXReporting tool, which takes the correct XBRL that CoreFiling helped produce but as part of a more complete system that can help you build a transparent, reliable process for getting things like FINREP production right.

This is what I want to discuss a bit more today. What might we mean when we call this a service?

Do you have the time to do this any other way?

I think this is an efficient service for the following reasons:

Because it’s a cloud-delivered solution, there’s no time-lag or big up front investment needed on your organisation’s behalf. A lot of projects, even for vital work, get pushed back because of the issues of provisioning resource, setting up servers, assigning development resource. You don’t need to do that with ConXReporting – and to be honest, given it’s now Q2, I wonder if you would have the time anyway.

This is a real service that you can just plug in tomorrow and work with.

Secondly, there are features of the ConXReporting approach that are genuinely unique to it that the other solutions don’t have – which means you’d have to work on providing them. Take persistence. The vast majority of the other systems hold validations transiently – they don’t store them for future reference. That will almost certainly prove to be quite a hassle, as chances are the whole EBA system will change (it has done so far!) and things like the taxonomies will change. That means if the data is not there in three months time if you have to re-jig it, you’d have to go back and start over – which isn’t just a chore, it invites the same opportunity for manual error that you wanted to avoid by automating your XBRL work in the first place. ConXReporting offers you ways to re-apply and re-validate, which is a great back-stop should you need it. (Think of it like a tax return. Few people keep all the information after they finish; most of us file online and that’s it. FINREP is like doing the tax return every two months – so you would want to keep the data and only update as needed, surely?)

Risk management

Persistence – keeping the information – is very useful then. But that’s not all. The workflow aspect of this is just as vital, our customers are telling us. Banks want to delegate EBA report work out and handle it as efficiently as they can internally. To do that, they want a process but also visibility. Who did this work? Where did that figure comes from, what were the bases used to derive it? What happens if you need to change resource allocation around? Our ‘XBRL as a service’ procedure is very good at helping your managers and administrators handle the HR and auditing/security side of FINREP (and soon, COREP and the rest). You are going to know, very quickly, who did what, when did they do it and why they did it – or be equipped with enough insight into the process to ask why.

To sum up: we genuinely are offering a service-led way of helping you manage the CRD IV report production process. That means from the efficiency, risk management and general peace of mind aspects, ConXReporting is going to be the way you want to get set for all this XBRL-based work, going forward.

Can I end by wishing you both an amazing summer – but also not too many headaches dealing with all things XBRL!

Can CRD-IV Compliance Be Made Into A Process?

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Can I ask how you are coping with all things CRD-IV reporting? The reason I ask is that, as you will know, SynApps has recently moved into this market.

What sort of a market is it? It’s one tied to the twin themes of compliance and deadlines. As anyone in the European financial services sector will know – the EBA, the European Banking Agency, is pressing for a uniform reporting structure to help it better track banks’ underlying financial strength. In practical terms, that means you complying with its strict requirements in terms of filing your financial records in the database language of XBRL.

That’s the compliance side. The deadline side is just as important. As it stands, the deadline that is mostly affecting you is likely to be that of FINREP which is looming for the end of the year (November), with another, COREP , coming soon after. And if you are a financial services organisation, you have no choice but to give the Agency what it wants and in the form it wants, when required.

That’s the CRD (Capital Requirements Directive) (more accurately, CRD IV) system summarised. The question has to be, then, are you – as a financial organisation – set up to properly conform to these compliance structures – and meet those non-negotiable deadlines?

The chances are that if you aren’t looking to make the production of XBRL-format reports as slick as possible, you may struggle. After all, you’re going to need to do it in as consistent and as compliant a manner as you can.

That’s why we at SynApps have started talking about XBRL ‘as a service.’

Let’s dive down into that a bit more. As you may know, we’ve been working with a company that is 100% focused on the XBRL problem, a great UK firm called CoreFiling. What CoreFiling has done is to produce a way to allow you to accurately produce, and even more importantly validate, XBRL.

In one move, that offers you a lot of help in terms of meeting the CRD-IV requirements. What we are doing – working with our enterprise content management partner, EMC (with the Documentum platform) – is to make that process into an actual service.

Conformant

What do I mean by that? Well, with a piece of software called the ConXReporting tool, we use CoreFiling to validate the XBRL and add a complete environment around that to help you and your team complete the requisite CRD IV work – at such a level of automation that we think the term ‘service’ is entirely accurate.

How? Through templates that are fully conformant to the regulations, you can help team members quickly and comprehensively fill in what they need to. They can do this by the mechanisms they are used to/happy with, like Excel – as everything will be checked by the system and made consistent.

Which gets you the report completed quicker and more accurately. However, that’s not really enough, if you think about it. That’s because you also need to think about the workflow and the process. In each and every organisation needing to do FINREP, or COREP, etc., there will be identified individuals you need to push elements of this process out to. You also need reviewers to check and if necessary query what comes back, so as to make sure that what gets put in the central ‘pot’ for the final report makes sense.

It’s the production of that valid whole that we call the XBRL service.

We are going to take you from what is likely to be – if you have even got as far as properly preparing for this – a very manual, ad hoc effort to a smooth, safe and automated validation process that will offer you a way to implement a proper, auditable, internal process.

Now that I have given you a top-level view, in the next blog I will dive a bit more into what the specifics of the XBRL service is.

Thanks for your time – and good luck with CRD-IV!

 

The Last Piece of the CRD IV Puzzle

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In our previous blog, (‘The Beginner’s Guide To CRD IV Reporting – And Why Banks Need To Pay Attention’) we examined the detail of these new, mandated structures that financial services firms have to comply with to meet European banking reporting requirements. We discussed CoreFiling and its technology contribution. Now, we need to discuss what EMC and SynApps are offering this market.

So where does Enterprise Content Management come in? What we have done, as experts in ECM, is to integrate the XBRL processing engine from CoreFiling, our partner, with a state of the art business process management engine from our partner EMC which allows you to move information between different people to work with and collate and enter data. Finally, we are utilising ConXReporting technology which gives you the taxonomy and associated templates in the form of workbooks, managed in an enterprise document and records management environment.

ConXReporting allows us to generate the right output for all the various CRD IV formats, COREP (Common Reporting), LC (liquid coverage), FINREP (Financial Reporting) and Large Exposures and Stable Funding Ratio. This means you as a bank can now jump straight from data to report templates specific to your organisation, and based on a taxonomy which has been mandated by the European Banking Authority. For each of those report types, we can create reports that are specific to your organisation. We also provide security so that only the appropriate people will ever see those reports. As well as the compliance in ensuring that the reports are retained for the appropriate duration.  

We are used to working with big, complex document-based systems – it’s what we do! Here the emphasis is in particular on workflow. We also define a review and approval cycle so when Q1 2015 comes along and you have to create a COREP report, you can press a button that will then set off a business process defined for that template. All of the version and audit trail functionality that is within the underlying document management system is so great it just kicks into play, thus helping the team member do the job safely and efficiently.

One of the key things that happens here – which is over and above what you would get from regular ECM – is that CoreFiling converts your workbook to XBRL, validates it against the taxonomy and either approves it or sends back the information for the author to clean up and re-submit.

When the XBRL in that particular form has been validated and all the forms have been completed, they are merged into one report which then goes off to a different team who have access to the entire report, for final validation. Once that is done, the report is locked down and made available to the relevant regulatory body.

To sum up: you don’t have to edit XBRL and you get a full audit history of the review and approval cycle, so you always know who and when it was completed and signed off, and we will maintain this information for the regulatory number of years. You also have access to historical reports, should they be needed, so everyone (including your auditors) can see what has previously been submitted.

This is a very compelling set of features that is going to help financial institutions meet not just the first but all of their CRD IV deadlines, and in a very efficient, pain-free way.

That’s a lot of detail, but I hope we have got to the heart of what we are offering with our financial reporting functionality.