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Disappearance from healthcare IT of another well known NHS supplier name may be seen by users as a limitation on choice but by remaining suppliers as a chance to reach sustainable revenues from healthcare. Will there ever be a consistent view between suppliers and users?
As the large healthcare IT systems suppliers get larger by take-over or amalgamation, the gap between large and small suppliers in the NHS market widens. Although this means increasingly intense competition between diminishing numbers of suppliers at the top end of the market, this is not the main problem facing the companies concerned. Competition for orders is something most suppliers can handle. A far greater worry is the lack of significant healthcare NHS IT procurements to compete for in the first place.
Lack of inspirational leadership
From an NHS management viewpoint, the problem is manifested in lack of funds and lack of supplier understanding of their needs. 'Industrial strength' healthcare systems are difficult to justify against money spent directly on short term healthcare needs. At the same time, suppliers are seen to be concerned more with pushing their own particular products than addressing the individual needs of healthcare users.
Neither side is entirely to blame for this. Suppliers have failed, either individually or jointly, to put across a convincing argument for IT that has excited healthcare management and clinicians. At the same time, those inside healthcare have generally failed to look up from day-to-day pressures of work to see where the healthcare process is leading and what part IT can play in its future development. This has not been helped by lack of inspirational leadership from the centre, particularly in relation to change management.
Hastening supplier attrition
Draconian procurement procedures have also afforded ample opportunity to choke off the demand for strategic IT projects. But if the objective was to reduce over-all NHS expenditure on IT, it has not succeeded. IT expenditure has continued to rise; the balance has just shifted from large strategic procurements to a tidal wave of purchases of low cost, high volume commodity hardware and software.
Winners in this process have been the growing number of suppliers of generic PC hardware and software plus networking components. Losers have been specialist healthcare IT suppliers who have seen their margins dwindle to a level where the gains are hardly worth the entry cost. Having to sell strategic products and services at commodity prices has hastened the attrition amongst dedicated NHS solution suppliers. Analysis of reported UK financial results reveals supplier margins which can no longer justify high sales costs or significant investment in developing new products.
Case for data collection has to be fought
It is generally recognised by both suppliers and the NHS that the future development of healthcare relies on collecting and sharing accurate clinical data - basic facts on healthcare processes essential for subsequent analysis and control. Beyond this simple statement, however, the gaps in understanding begin to appear. Suppliers tend to assume that the case for collecting data has been made and the question is more about how to store, process and present it. On the ground, however, this rationale is far from universally accepted in the NHS - even though the issue is more fundamental to NHS success than any detail in a typical POISE procurement process.
Clinicians not subject to audit and scrutiny (and therefore free to choose their own method of working without recourse to any factual evidence of best practice) are naturally resistant to the idea of recording their activities in detail. The argument is not difficult to make since it is just as possible to draw false conclusions from recorded data as it is to produce worthwhile guidance. This is not, of course, a reason to ignore facts - merely to be careful how they are analysed. Nonetheless, the case for data collection has to be fought and won before any meaningful use of data can be made.
Nursing is another good example. Nurses complain continually about the amount of data they have to record as part of their work. Questions on the subject are too often met with the response that data collection is 'a statutory requirement'. In practice, however, NHS defence against malpractice fails in many cases through lack of adequate medical records. "Because I say so" is clearly insufficient motivation to produce the desired results and the main stumbling block is behavioural change rather than IT.
Tell it like it is
In every circumstance where the motivation to collect accurate data is missing, the argument for IT falls at the first hurdle. So the message about the vital importance of IT has to be put across in a way that shows real personal and professional benefits from having the right information at the right time. And the difficulties should not be underestimated. Few believe that implementing significant IT projects is easy. Anyone who implies this lacks credibility. By 'telling it like it is', suppliers are more likely to win the trust and appreciation of their NHS prospects than by trying to imply that their system magically makes everything easy. Suppliers have repeatedly come unstuck by inflating user expectations beyond their means of meeting them and the whole industry has suffered as a result.
Rationale for IT from both sides of the market has to come from seeing the operational benefits of accurate information, whether this be to avoid or defend litigation, improve clinical processes, increase professional respect, cope with informed patients, maintain financial viability, justify investments or otherwise to provide a basis for rational decisions. If the right language is used to get this message across, the right motivation will exist to unlock the real benefits offered by IT, in which case decisions on relevant standards, systems and investments needed become much more straightforward. If not, the NHS can look forward to even more restriction on its choice of strategic systems for the future.
First published in BJHC Nov 97
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