iSoft director says NPfIT systems 'interchangeable'

Tags: Cerner CfH Community iS iSoft London Lorenzo Mental Health NPfIT Security Solution South Spine Standards

03 May 2007

Nick Harte, product management commercial director at iSoft (pictured right), says the systems being delivered into the five clusters of the English NHS National Programme are all “interchangeable”, thanks to Connecting for Health’s decision to adopt a Service Orientated Architecture based around the spine services.

Harte, who led the development of iSoft’s Lorenzo product, said that this approach, combined with mandating of tough standards, means that iSoft could in theory now deliver elements of its software the South and London, with Cerner potentially doing the same into the three clusters iSoft software has been chosen for.

He pointed to the ‘iSoft seven’ – the seven NHS trusts outside in London and South which have been granted a dispensation to stick with iSoft for the time being – as an early example of this in action.

Speaking at a recent European E-Health Conference in Berlin Harte said the decision had been taken by CfH to begin by first replacing NHS organisation’s core patient administration systems – a task he described as extremely challenging. “We had to replace the engines while in flight”.

He told the audience that “the National Programme had wanted a very, very aggressive timetable”. Despite the initial pain he said the NHS National Programme for IT (NPfIT) had taken the right route in mandating tough standards and adopting a Service Orientated Architecture (SOA), the benefits of which were now being seen.

Outlining the scale of the challenge faced in, the North-west West Midlands, one of five clusters for the English NPfIT programme, he said: “In one region we’re having to replace 15,000 systems.”

He said that meeting the demands of the programme has proved too much for some companies. “There have been some changes to the major players. This is to be expected. IDX [now part of GE] struggled to meet the standards imposed upon them and were replaced.”

Despite these difficulties Harte said that in about 70 acute, mental health and community trusts the main existing PAS system had been replaced to date. “We’re now working on layering on the clinical functionality,” said the iSoft director.

Through its national procurement, NPfIT had “defined standards and demanded ruthless adherence to them.”

Harte stressed this ruthless standardisation included prohibiting local NHS trusts from selecting their own systems “It doesn’t allow individual trusts to do their own procurements.”

Referring to the way IT systems had previously been bought by NHS organisations he said: “Because the way we purchased and procured systems was never going to support the patient journey.” In the old world of local NHS IT procurements, he said “requirements for an integrated architecture were always an afterthought.”

But with an SOA and the national core systems now in place he said that the national programme was being made more locally responsive, with a local ownership programme now being introduced. “It will be possible for local SHAs to determine what systems they want, or at least what order they come in.”

Harte said that, with standards and core national infrastructure now in place, the additional supplier procurement was a “logical next step”, which he described as a “vindication” of Connecting for Health’s approach.

He acknowledged that clinical buy-in had been a problem though and said “The first three years of the programme have been about getting clinical engagement.”

The iSoft director said that one of the critical key decisions taken by the national programme was to define and adopt an SOA for healthcare, comprising centrally-provided national services – the spine ‘business services’. These include patient ID, security and authentication which can then be utilised by interoperable administrative and clinical applications.

The introduction of new national systems based on an SOA had brought fundamental changes, he added. “We’ve changed the focus nationally to a secure central repository of data. We’ve done this through secure role-based access, which is relatively unsophisticated so far but will grow over time.” The next step he said was the “introduction of legitimate relationships”.

He said an SOA was the only way to deliver the ambitions and scale required by the programme. “A Service Orientated Architecture recognises that no one company has the solution.”

“Interoperability is the key,” said the iSoft director. “All the elements of the solution being put in are 'interchangeable.' We could deliver aspects in once cluster and vice versa.”

Harte added that by providing core services centrally, which a small number of standardised applications can then access, it “enables organisations to focus on workflow and care configuration”.

A further advantage of the SOA model, he added, was that it provided the means to break down boundaries between organisations. “It does this by providing business services. It doesn’t matter where you get these services as long as it fits into the architecture.”

He explained that the SOA model with health applications using common business services, “Will always respond to end users in the same way, allowing users to move from organisation to organisation without having to re-learn systems.”

Identifying the key lessons that others could learn from the programme he cited the need for a SOA model to deliver at scale, providing the core infrastructure and business services “you can then plug in around the periphery.”

He also urged others not to try and develop and deliver software simultaneously. “Don’t mix development with delivery – there are already a lot of good things out there today.”

Readers Comments

Living in hope

03 May 07 16:07

Interesting vision. But you can't interchange anything until it's delivered and delivery seems to be an ongoing problem for NPfIT. And if Mr Harte really believes that the programme has got anything resembling "clinical engagement", he should spend some time at the NHS front line.

Lack of understanding

08 May 07 09:55

I wonder if Mr Harte can explain how his vision will deliver the level of integration required to achieve Strategic Systems Maturity Level VI with separate LSP systems?

The spine will not provide the underpinning scheduling required to support 'whole patient journey' care planning - from primary to secondary to tertiary to community care - for example.

Whilst it makes sense for current ISOFT deployments in London and the South to maximise the benefits of their investments over the coming 3 or 4 years, if the integrated vision of NPfIT is to become a reality (and it's a very big if) they will need to move to the local LSP offering - which might be hard for a commercial director to swallow. (Post edited by EHI)

Alot of good things out there today - we knew that

08 May 07 10:24

And most of them outside the clutches of CfH and the LSPs.

The CfH architecture increasingly does not address the joined up vision, with Systems of Choice for GPs, Single Assessment Process, Mental Health all peeling off in different directions. The arguments for Isoft in London and the South, And Wirral in the North could equally be applied to a number of other good existing systems, which are integrated to the Spine for Choose and Book, and with a fraction of the NHS money that has been spent with the LSPs, could use the Spine messaging infrastructure effectively.

Either monoculture, or Systems of Choice for hospitals. An Oligopoly of two does not feel much more comfortable than a the Monopoly status given to LSPs.

Wrong and Wronger

08 May 07 12:21

I sometimes think iSoft employees reside in some kind of fantasy land bubble. Let's take this quote for a start:

"It doesn't allow individual trusts to do their own procurements."

Wrong. Since the establishment of Foundation Trusts, Boards of Governors can buy what ever system they want. The SHA can do nothing about this. Monitor requires that Trusts demonstrate co-operation with CfH but the primary requirement is financial stability. Anyone viewing the national programme go live can see that CfH and 'financial stability' are completely at odds.

Here's another ruthless inaccuracy: 'Through its national procurement, NPfIT had 'defined standards and demanded ruthless adherence to them."

Wrong. There is no compatibility or interoperability between Cerner and iSoft products. There is no standardisation model in CfH. CfH have merely purchased two different PAS systems for the UK and called it standardisation. The outlying diagnostic systems are the usual systems we have all known and loved for decades. Cerner and iSoft offer two completely different systems, what standardisation there is consists of being able to connect to the spine (a thing many 'legacy' systems can do). We don't even know if Lorenzo is going to be 'standardised' compared to iPM. There was a world before NPfIT and CfH. In that world many computer systems were procured and successfully installed. Many trusts were already passing messages between primary and secondary care and also social service discharge systems were common. In the old world, systems were developed where budgets allowed and developments addressed local needs. Much excellent work went on and still does.

Who will save the NHS from this runaway train disaster? The PAC? The NAO? A new Labour administration? Foundation Trust Boards? iSoft? Meanwhile grass roots NHS IT staff will continue to keep their heads down, hide their email address and hope the whistle doesn't blow in their trench. (Post edited by EHI)

Open EHR Architecture

10 May 07 14:01

Some of the more technically minded of your readers may be interested in the Open EHR project which describes open, standard based EHR architecture in some detail. http://svn.openehr.org/specification/TAGS/Release-1.0.1//publishing/architecture/overview.pdf