Joined-up healthcare in Belfast: An interview with NHS BHSCT director of IT Paul Duffy

Duffy tells Computing how mobility and Civica's Paris EPR system are helping the Trust to provide better patient care

With more than 21,000 employees and an annual budget of £1bn, Belfast Health and Social Care Trust (BHSCT) is one of the largest NHS Trusts in the UK, delivering care to 340,000 people.

As it is in Northern Ireland it is structured differently to most Trusts in the rest of the United Kingdom in that it provides both health and social care. That gives Paul Duffy, co-director of IT and telecommunications at BHSCT, a unique challenge.

"It means some of our approaches are more holistic than they would be within Great Britain. We tend to work much more in federation with our colleagues in the other Trusts and are less standalone," he told Computing.

Being responsible for both social and healthcare, the Trust's IT infrastructure needs to connect and process a wider range of data than in a typical NHS Trust, which is a cause of complexity.

"There was a mixture of silos that looked after parts of the community care records, but there was no way of holistically seeing patient or process-led information around the client," Duffy explained.

So Belfast needed to procure a new system, but it had to be one that met the very specific requirements of the Trust.

"We had a list of criteria which made it very clear that the system we needed had to have a strong healthcare integrated platform and that requirement alone reduced the number of applicants in that particular space," Duffy explained.

"The only one which was really capable of delivering that was the Civica Paris EPR and case management system," he said. "It was the only application that looked after both the health and social care record without us having to link together multiple systems."

Accurately joining up patient records, which could encompass both health and social care records, is vital to the work of BHSCT.

"For us an electronic patient record [EPR] is everything related to the patient, both health and the community... everything that happens to you in Belfast in a community care setting is being recorded on Paris and that's a really strong thing for the patient," said Duffy, before going on to describe the impact the deployment has had.

"It means all healthcare providers and professionals who interface with that patient can see the activity related to them, the other services that they require and those that they've had," he said. "It can only benefit the patient, having all that information in one central system."

Essentially, Civica Paris centralises the information so it is more readily available to doctors and nurses, enabling staff "to get the right data at the right time at the point of need".

"It's enhanced the delivery of care by consolidating the information captured about the patient, but not just about that one service, but all the other services that engage with them, be it mental health, community services, whatever it happens to be."

Duffy said Civica's support played a big role in the successful deployment of the solution.

"We wouldn't have been able to deliver this without Civica's involvement. We've 4,500 users on the system with another 4,000 to go, and at that scale it's a very complex project which required help from Civica, both technical and advice. And there's the processes side, too."

The Paris application is currently desktop-based, but Duffy explained how BHSCT is working alongside Civica and its partners to "write a truly mobilised application which is reflected around the processes of the healthcare professional".

The aim of this application will be to reflect the "technological sequence on what that professional does during an activity, going from one screen to another screen," said Duffy, adding that it should "take them logically through the process and be designed for a touchscreen interface".

"It's all about providing a solution, rather than a mobile app," he said, explaining the difference between the two.

"A solution is very much geared around what it takes to make it better, faster and more accurate, as opposed to saying there's an app, you make your processes around that."

Importantly, a mobile application allows healthcare professionals to instantly enter data. This should ultimately lead to better patient care.

"We'll only get proper patient care if we can get healthcare professionals to record data at the exact time it's being taken. If you capture it two or three days later, it isn't going to be as accurate and relevant."

While mobile devices and their use in healthcare is very much of interest to BHSCT, Duffy explained that there are legacy software issues that must be addressed first.

"Everyone thinks that they want either an iPad or iPhone, but when they come to use it they find that the Trust doesn't currently provide for that form factor. If you're trying to put a desktop on top of an iPad it will not work, because it's keyboard and mouse driven," he said.

The answer, Duffy said, is "to be solution focused rather than device focused", while at the same time providing a range of appropriate devices to the end user.

"We find that sometimes users want a less heavy device or a larger screen, because if you're using a seven-inch tablet for half an hour, it's fine, but if you're there longer then a lightweight laptop tends to be much more acceptable because of the need for keyboard and mouse," he continued.

"Once they know what they want, we come back and say 'tell me your problem, what do you want as a solution?' Is it the right device, or a solution they can use on any device?" he added.

When asked if BHSCT has plans to follow in the footsteps of other healthcare providers in deploying business insight solutions, analytics or other big data tools, Duffy replied in the affirmative.

"It's an absolute given," he said, going on to say that data quality must come first - a problem being addressed by Paris.

"Before we get into that we have to make sure the information we're reporting on is accurate. So we're trying to not leap into BI as the answer to everything until we ensure the environment is right for that to happen," he said, emphasising once again the importance of the data input process.

"We need to ensure that the way we record things is timely, because we might want to do real-time, near-time or long-term analytics - there's a place for all of those."

The applications required to harness the information still need to be designed, he said, and this required careful planning.

"The challenge is what are you going to do with that information? Because anybody can create dashboards, but you can't create personalised access," Duffy explained.

And budget constraints mean that investing in BI may not be the best use of resources at the current time.

"With so many people coming to our doors, we've got to be clear whether this particular thing has more merit over something else, so it's about constrained resources and focusing on the benefits, rather than just another screen that someone can look at," he said.

Looking to the future, Duffy described how he has a vision for IT and telecommunications at BHSCT which involves the department being viewed as a business enabler, rather than just a bunch of techies.

"We need to be more focused on the business and the benefit and see how technology can deliver that. I always get afraid that we're perceived wrongly by those outside IT, that we're too technology focused and not business focused, but we're trying to completely change that view," he said.

"I'd like to see ourselves being about business change, becoming business improvement experts who happen to use technology," Duffy concluded.