A Holistic Approach to Information Management

Simon Mortimore, Head of Information Services, University College London Hospitals NHS Foundation Trust, joins Pharma IQ to discuss developments and challenges in e-health and informatics.

Pharma IQ: Could you explain a bit about what a Management Information Strategy is and why it is necessary?

S Mortimore: We realised about 18 months ago that the traditional way we make decisions to manage our healthcare delivery wasn’t really going to be accepted going forwards, so we spent a lot of time thinking how do we make a better decision and what do we need to put that in place. From that we devolved or implemented our Management Information Strategy. Now, I think ours is slightly different from the traditional one in that it is actually recognising that you’ve got to look at a holistic picture. So we’ve got five key themes of delivery in ours. There’s the IT architecture, which is very traditional, but also things like developing the skills of the people that manage your infrastructure, data and information quality, process optimisation and then authorisation, but most importantly looking at our colleagues in the hospital and saying how do we actually develop their skills to use information, to make better management decisions and therefore make and get better healthcare delivered. We came out with a snappy strap line which was Better Information, Better Decisions, Better Care.

Pharma IQ: Have you encountered resistance to new technology uses from either hospital personnel or patients?

S Mortimore: I think we’ve got the traditional change problems that you get with any sort of informatics implementation. It’s new technology, it’s changing ways of working, and we’ve handled those in a very traditional way of making sure that we engaged people up front, got them involved from a very early point in the project with designing, getting them into sessions to design what they were going to see. The thing with managing information is you have some additional change issues that, by the nature of Management Information, people feel exposed by what it’s telling us. It’s shining torches into corners that maybe people don’t want light shone into. So we had to be very positive from the start of the project around getting them engaged and making them feel they weren’t going to be exposed. Now, part of its problems, for example, was we’d done a significant amount of automation, which means that people’s job roles were going to change. Therefore we had to be very proactive in developing training sessions that moved people from being data producers to information users. In terms of patients, we’ve had no resistance. In fact, sometimes I think we tend to over-worry about the perceptions that our patients may have about information technology and healthcare. I sometimes think we forget how much of an IT literate and engaged society we live in, and I’m sometimes surprised that they don’t criticise us a bit more for not using it, but we haven’t had any problem with the patients in terms of data information at all so far.

Pharma IQ: You mentioned the importance of using technology to improve healthcare decisions. Do you have any examples that you could share with us?

S Mortimore: Yes, one of our major focuses in the previous year has been developing our planning capacity models, so having a direct link between what activity we do and what resources do we need to do that. Very traditional – beds, imaging etc – and that had the direct effect that when we ran the models in our planning process, we could much easier see where we were going to have bed capacity problems and issues, and we actually did quite a major exercise in reconfiguring one of the major components of our hospital to look at the beds so it was more in line with the activity we predicted. Obviously you then get into reducing cancelled operations, you’ve got more capacity and you deliver better clinical care.

We’re also looking at things like it helps by the fact because we can then start integrating services, for instance, imaging and pathology, etc. Those guys had a much better heads-up about what work was coming down, so they were less reactive and they could start to plan their capacity more in line with what actually was coming through the system. So, again, it’s better for the patient, so less waiting time and less stress on the system.

Pharma IQ: You also said that you’re working towards better data integration along patient pathways. How is that progressing, Simon?

S Mortimore:Very well. Because our underlying philosophy has one single data warehouse of activity information, which we’ve built – it has about 98% of all the hospital’s activity in it now – we can much more quickly, much more easily see the linkage and the pathways of how patients flow through the hospital. As I mentioned, it’s much easier to know how much resources a particular patient pathway will need. We know in a particular speciality how much theatre time they will use and what sort of theatre resources they need, what sort of imaging resources they need, so it’s allowed us to manage the pathways much better.

It also allows us to get a more holistic picture and spot variants in patient pathways and question why those are there and start to identify any action we may need to take. And I think now we’re beginning to look at how we start integrating the patient pathways outside the organisation with GPs and maybe third party suppliers. That’s the sort of thing we’re just beginning to think about now.

Pharma IQ: In a nutshell, how can implementing new technologies or IT strategies help to reduce costs?

S Mortimore: What we found immediately was a significant part of the work so far has been on process automation. We handle around 170 feeder files into our data files into our warehouse for performance reporting, management reporting and billing, etc, and we automated the vast majority of those files, which dramatically reduced the amount of agency and temp staff needed. But also, more importantly going forward, increased the efficiency of the team by around 30-40% which meant we could actually produce more information for the same or slightly less resources.

A good example of that is we used to produce monthly activity and revenue reports; we now do that on a weekly basis, so my colleagues, operationally, on their desks on a Monday morning have an activity and revenue variance report, which allows them to take action far quicker if there’s an issue arising.

Going forward I suspect that we’re also integrating. Our data warehouse is becoming the primary source for finance colleagues, for their costing model as well, so I suspect going forward there will be a much better correlation between activity and costing, and we’ll be able to identify cost savings far more easily than we have done before, which has been a huge data exercise to try and get any meaningful information.

Pharma IQ: I guess you learn as you go?

Simon Mortimore: You do. One of the things around management information is it’s very evolutionary. You don’t switch the system on and it works. You’ve got to recognise the fact that there’re five things you focus on. It’s a very evolutionary approach and you’re constantly learning and constantly evolving, and it’s one of the key challenges for the informatics community, management information. You can’t deliver it in the normal informatics traditional way. It’s one of the things we’ve learned and taken on board.

Pharma IQ: You’re going to be delivering a presentation at our E-Health and Informatics Conference. What’s going to be the key learning points for the audience from your presentation?

S Mortimore: I would say one of the key learning points is don’t become what we call IMT myopic. You’ve got to recognise that you have to address the five key issue areas that we’ve already mentioned. Engage with your clinical and non-clinical colleagues as upfront as possible. We took a very open approach; we took a building site approach where people could go onto the website and see the dashboards we were building as we implemented our MIS, so we were very engaged with people. Recognise people’s fears and address them; don’t just let them fester because not only will that demotivate them, but it can make them active blockers of the project. And I think, finally, don’t forget data and information quality. They’re two sides of a different coin, but they’re very highly linked and it’s very important that you practically address data information quality issues, which I’ll be going through at the presentation upfront and honestly because, in the end, that’s what the users will see when they’re using your system and it will live and die by what they perceive to be the quality of the data and information in the system.

Pharma IQ: We look forward to hearing about this topic in more depth at the conference. It’s certainly an interesting one and something that people can gain from. What are you looking forward to most at the event?

Simon Mortimore: I think I’m looking forward to gaining some knowledge and understanding of what the latest trends are, meeting colleagues. It’s always very interesting that when you meet colleagues in these events how much you can learn from their experience, because I think we sometimes forget a lot of the challenges we face in the health community are actually very similar across all organisations. We tend to think we’re unique and actually we’re not, and sometimes it’s very good, if not a bit therapeutic, to sit down and understand that a lot of other people have got exactly the same problems and some very innovative and good ways of solving problems.

Interview conducted by Heelen Winsor.