Doug Howe - Deputy Director, ICT

My Way - IT at Barts and the London NHS Trust

Barts and The London NHS hospitals are undergoing the largest and most complex hospital redevelopment project in the world, and ICT from vendors Siemens Enterprise Communications and Enterasys will play a major role in supporting the new facilities, deputy director, ICT Doug Howe explains to E&T.

Engineering and Technology: This is a large and complex IT project - how is it coming along to date?

Doug Howe: We've completed phase one ahead of time. This includes the complete network infrastructure, delivery of PCs, printers and other peripherals that go to the departments and wards, and integration of the picture archive and communications system (PACS). Obviously all projects come with some challenges and we had our own; but there was nothing that stopped us from hitting our milestone targets.

E&T: Barts has some quite old sites; what were the legacy issues that had to be dealt with?

Howe:Obviously the new-build is not an isolated building, it has to fit into a legacy infrastructure. One of the early discussions with Siemens was to make sure that, firstly, we had a 21st century infrastructure in the new-build and, secondly, that they could access every service that the trust expected them to do. It's a seamless network.

E&T: Across how many sites?

Howe: We're across three sites - St Barts, the Royal London, and the London Chest Hospital. Then we also provide services for two other acutes, a mental health foundation trust, three Primary Care Trusts (PCTs), two charitable foundations and a commercial company. We've got something like around 6,000 PCs to manage.

Also, we don't only provide services to Barts London: we provide service desk and hosting facilities to a number of other trusts in the East End of London. Our builder company buys support services from us as well. The days go very quickly! It's quite a big organisation in terms of IT, providing 24/7 cover. It's an interesting job.

E&T: What about the IT-specific legislation and regulatory compliances that you and your team have to deal with. Did any legalities impinge on the project?

Howe: Not particularly. With regards to the wireless network, there was sign-off in terms of what radio frequency we were transmitting on, making sure that that it did not interfere with hospital equipment and that it was appropriate in terms of access in the right places and secure. Apart from that, it's something we do regularly anyway.

E&T: In general, are you finding the regulatory and legislative compliances that the IT function has to adhere to are becoming more onerous on the kind of work you have to do?

Howe: It probably is onerous, but we are so used to it now that it becomes part-and-parcel of the day job. The demands on IT are about security - it is about access rights, etc. In terms of demand for IT services there's been a fairly big increase, not only on the number of services, but also availability, speed and security.

E&T: How many people are involved in a project of this scale?

Howe: On the IT side, there were nine project leads. There's a total of 62 operation staff within ICT, plus we have got a national programme deployment team added onto that. We did bring additional resources in, mainly for the installation of desktops; so where it required heavy resources, we brought the resources in. Where we had to make sure the internal services worked, we used existing staff.

During the integration of PACS we used radiologists, specialists in their areas. We used their skills because they had to eventually sign the thing off as being fit for purpose.

The blend of skills was quite enormous within the team, but mainly it was bread-and-butter networking, PC installation, and configuration of back-end systems.

E&T: When it comes to administration and facilities management (FM), have you found that through the project you have begun to work more collaboratively at all? E

F Howe: We have to work quite closely with FM anyway, because we do not do our own installation of cabling. So, for example, when putting in additional network points we have to get a permit to work, describing what the work involves, and so have to have a relationship with FM to get into the building anyway. That's normal.

E&T: How did that work in respect to access to the new building?

Howe: With the new building, we had to work with the PFI [Private Finance Initiative - the vehicle for building new hospitals with private funding rather than public funding] partner quite closely because we did not have that relationship previously. It was a new building, and so when we went in to install our equipment it was still a building site - it had not been handed over to the trust yet. Contractually we were only allowed a certain period of access to the communications room. There were financial penalties if we overran and didn't deliver the network on time; so there was a lot of pressure to get the network infrastructure installed.

When we came to put in the wireless access points around the building, we found the contract actually didn't allow us to go onto the floors. We had assumed we would be given free access to floors to install the wireless access points and contractually we could not.

E&T: How did you get round that?

Howe: We had to create an arrangement with the builders to allow us to have access to identify where the wireless access points would be installed, and then physically install them.

E&T: Does the project seamlessly integrate with your move towards the electronic patient records, and has this been a big project to handle in its own right?

Howe: The concept of electronic patient records goes back ten or more years, and we are involved with the national programme, the National Patient Care Records System (CRS). One of the drivers for the new hospital build was to go towards a paper-light service. We're not there yet, but that's still an objective.

We've got some pilot sites running to look at ways of taking technology to the bedside, so we can reduce the amount of paper that goes into patient notes. There is a big ambition to reduce the paper, but it is difficult. We've got a project starting to look at electronic document management, and it is not only going forward, but also looking at what you do with the legacy records.

E&T: That would presumably be a very big job.

Howe: A massive exercise. I think there will be spot solutions; there will be an increase in use of bedside devices to capture notes. Medium-to-long-term, the intention is to start capturing E F vital signs through devices that you plug into the patient, and which goes straight into their notes. That's the vision, you capture it at source, confirm that the system had recorded it correctly, and it is put straight into the notes.

E&T: What systems are you using for this?

Howe: Our core application for clinical systems is based on the CRS, around that there are obviously specialist systems that can be integrated. The idea is that the patient's records, demographics and core details are held on the CRS system - then other systems feed that with specialty information.

E&T: With the implementation of so much new high-tech equipment, have you considered introducing entertainment technology for the bedside?

Howe: [Yes.] We have identified a supplier; we are doing the business case now to put it into Barts' phase one. We have had a previous contract with Patientline, now we are looking to take the next step. We want to put in a bedside device that is for patient entertainment - TV, radio, telephone, and Internet - but will also provide the clinician access to records through use of a smart card. So the bedside device would be both a clinical device, and a patient entertainment device.

E&T: So it is financially a good idea too - one device with two uses?

Howe: Absolutely. You may still want some mobile devices for specialist areas; recording vital signs, etc., but if you have got a device that can access information as easy as that, you would not need a computer on wheels, or a tablet [device].

E&T: Can entertainment provision actually help the recovery time for patients during convalescence?

Howe: Apparently it does. More people expect these services, and I think it does aid recovery because people can be in for a long time, especially cancer patients. You want to keep in communication with your family and friends, and not get bored. We want to make the patient experience as best we can.

E&T: So now that phase one is complete, what's next?

Howe: We start virtually straight away on the Royal London site. Phase one was eight floors, 120 beds (eventually 300 by 2014), 23,000m2 of floor. The Royal London is 141,000m2 of floor; three towers, two with 16 floors, one with ten. The magnitude of the task is enormous.

If you saw the buildings, you would ask: 'How are you going to do that? The time scale is slightly longer, but challenging.

E&T: Will the IT team headcount stay the same?

Howe: We will have more people on it to deliver what we need. We know when we have to go in and when we have to get out. It is now a question of working out how we are going to do it.

E&T: Do you expect that to entail some sort of Cloud Computing solution?

Howe: There are still a number of issues [with Cloud Computing] that have not been satisfactorily articulated or satisfactory answers provided... I believe at the moment [Cloud] is an IT solution looking for a problem. Suppliers are keen to look at a new way of presenting IT solutions, and this seems to be it.

E&T: Working in the healthcare sector is generally perceived to be unusually challenging; is it?

Howe: It is, but we are not on the clinical side. Sometimes IT is IT and it could be done anywhere. We have got to bring it back to the business that we are in, and remind the staff that it's not delivering IT for IT's sake, there is a patient at the end of this.

We're looking to make sure they get the best care that we can give them.

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