Features: August 27th, 2004

Prevention Is Better Than Cure

By Tony Martin

The introduction over the next five years of the NHS National Programme for IT is prompting trusts to think hard about different ways to manage IT. The next major step is the introduction of the Electronic Patient Care Records Service. The challenge is to manage the different systems which have grown up over the years as a single entity. This article describes how the South London and Maudsley NHS Trust in partnership with Computer Associates transformed its management practice to achieve this aim.

The Trust¹s IT infrastructure is very complex, incorporating more than 2,500 computers running a wide range of software applications. Based in Stockwell, the 22-person in-house IT team services the needs of more than 4,500 contracted staff, based at 140 healthcare facilities throughout Lambeth, Croydon, Southwark and Lewisham.

The challenges that the Trust faces are similar to the challenges that are faced across the NHS. Millions of pounds are being spent at the Trust and billions more are being spent across the entire NHS on the National Programme for IT (NPfIT) over the next five years. The value derived from both projects is dependent on the reliability and availability of all IT infrastructures.

The challenge was to develop IT infrastructure to a nationally recognised standard. The aim is for all business critical infrastructure to be available 24×365 to support the national Electronic Patient Care Records Service.

The management software from Computer Associates allows the IT team to see parts of the network that are on alert status. Once these points of weakness are identified, the team can react quickly to fix the problem, minimising systems downtime and reducing lost productivity.

What do users expect?

The NHS is the UK¹s largest employer. As a result, the scale of cultural and business process change required to make the various concurrent NHS IT projects a success should not be underestimated.

The bottom line is that if the new technology is difficult to understand, hard to use or inefficient, it will have disastrous, long-term consequences for the NHS. The challenge is to deliver a smooth transition to electronic systems that automate many of the mundane, repetitive and time-consuming tasks that make for a lethargic healthcare service.

In addition to improving the availability and reliability of IT resources, the project is changing the way users will call for and receive IT support. The idea is to streamline and expedite the process to minimise downtime.

How will projects like this improve life for NHS IT staff?

The Trust is attempting to transform the way it manages and maintains its IT systems, moving from reactive service, maintenance and help desk support to a more proactive approach. This will involve pre-empting network service issues and preventative maintenance to minimise downtime.

The most marked impact that the project has had on attitudes and behaviour within The Trust to date is to establish clear lines of responsibility for all component parts of the network, including hardware, servers and systems.

By having far greater transparency across all IT infrastructure, IT managers can see at a glance where any existing or potential problems lie, the team can work together to improve the reliability of the system. The new approach has eliminated the blame culture that so often develops within an organisation where there is uncertainty or confusion over the causes of systems downtime.

A new approach

The Computer Associates solution allows the project IT team to install new software upgrades and proactively distribute software patches to PCs across the network from one central terminal. This eliminates the need for armies of IT foot soldiers to personally visit each site to perform the same task.

The software also allows the IT team to control the bandwidth at any of the 140 Trust sites, thereby reserving a portion of the network download capacity for transporting the new software or patch. This enables each site¹s daily computing operations to proceed as normal during the installation of new software.

Asset management

The asset management function of the CA software pulls hardware and software information back from the 140 disparate sites and delivers it in an easily read format to the IT Department.

It has already been used to verify and correct information that was previously gathered manually during the Trust¹s very time-consuming email and internet roll out.

The Trust is currently in the process of upgrading its 2,500 PC to Windows 2000. The asset management capabilities of CA¹s software has allowed SLAM to identify the exact number and location of Windows 95 machines still to be upgraded.

Remote service

The remote service element of the solution will deliver long-term cost savings to the Trust. It allows most problems to be solved from the centralised location, without the need for an engineer to physically travel to the site of the problem. One of the main benefits of remote service is that it enables the help desk team to easily identify whether problems stem from user or software errors. A lot more calls to the help desk are now being closed at level 1, rather than being escalated to level 2, where they become the responsibility of the Desktop Support team.

Ensuring the availability of IT

In the past, a great deal of the IT team¹s time has been preoccupied with network issues that arose from the way various sites had installed non-standard IT equipment on the network. The team used the software to find devices on the network and log them on a central register. They are now able to proactively set network performance thresholds. The Trust periodically revisits these thresholds and reset them as demands on the network changes. It allows the team to plan bandwidth to optimise performance across the network.

The impact of national developments

The project has been completed to prepare the Trust for the transition to the Electronic Patient Care Records Service and joined up government services. The availability and reliability of IT systems is an issue that goes well beyond the NHS. The success or failure of all e-government initiatives will ultimately rest of the performance of PCs, internet connections and networks across the country.

Tony Martin is managing director at Computer Associates UK & Ireland,