Interview: Andrew Donald Health Sector Manager, ntl:Telewest Business
by Sali Earls
Andrew Donald joined ntl:Telewest Business in 1996, and his previous roles within the company include Director for Wales and New Business Director for the Celtic Regions. He is a member of the
Welsh Assembly Government's Thematic Advisory Group for ICT, Innovation and R&D, and advises a number of Agencies and Partnerships on ICT and Regeneration.
Recent developments in communications technology have revolutionised the healthcare landscape. Next generation networks will provide healthcare organisations like the NHS with the advanced
level of integration and service required to help support better clinical care and increase operational efficiencies. Sali Earls spoke to Andrew Donald to find out how the communications tools built on the
NHS network infrastructure can facilitate better working practices and deliver the most effective healthcare service.
What exactly are next generation networks (NGNs)?
Many different things are said about next generation networks. From a technical perspective of course, you're moving into the optical medium, as opposed to the sound and clicks and whirrs, etc; so
therefore the ability to transfer information at far greater speeds than we've ever really thought. So next generation networks are effectively unlimited capacity in terms of bandwidth, whereby you have
capacity limitations from things like copper, as an example. Optical fibres will give you literally an unlimited amount of bandwidth.
I guess that's something that's potentially very useful for an organisation like the NHS
Absolutely - it's completely vital for what they're trying to do as they become more bandwidth hungry, and more intelligent, obviously they do tend to eat up bandwidth.
How long have you been working with the NHS on this project?
I've been specifically working within the health arena since 2006, so 3 and half years focussing on the NHS which has been eye opening from a personal perspective, and also from a business
perspective as well.
If the NHS deals with one million people every 36 hours, what kind of technology infrastructure is required to cope with that, from your perspective?
The amount of physical traffic an organisation like the NHS has - from some of the larger trusts like Cardiff and the Vale, down to some of the smaller ones in some of the outlying areas - it's absolutely
phenomenal, and the management of information is key within that.
As an example, take a single paper record about you - you may have visited a hospital in Wales ten years ago and had your appendix out; to try and link that up with your GP records, as say, you
went to see him last week regarding a problem with your tonsils, the challenge is enormous. That information has always typically been held on paper files - we actually have photographs of 'paper
mountains' which are as tall as the person standing next to them! - so trying to bring all that information together to ensure the right clinical diagnosis is made, is one of the key thrusts of what the NHS is
trying to do. So the single patient record is something that is an aspiration at this stage, but will become more and more important as the health sector goes forward.
It is about managing the volume of individuals, and that's almost a staffing resource, but then managing the level of information behind that is a whole different thing. Each of the trusts in Wales will be
setting up bigger and bigger data centres, and having access to those will not be a 'nice-to-have' - it is absolutely critical.
Is patient information currently available across the NHS, so if someone from Cardiff ends up in hospital elsewhere records can be accessed?
As I mentioned earlier, the single patient record is still an aspiration. Also if you take the example a pharmacy and its patient prescribing records, that's another large piece of information that would need to
be linked. What a lot of the organisations are doing at the moment, certainly in Wales with the All Wales Network, is trying to ensure they are linking up. For example if you went to University in Bangor
and spent three years with your medical records in Bangor, then went to live in Cardiff you would be able to have access to that information if you were admitted to hospital in an emergency, or even then
if you were just simply visiting your GP. We are not there yet, but that will be a key method of improving the efficiency of the NHS.
What are the timescales for that?
I know that in Wales with the All Wales Network, and in England with the Community of Interest Networks, those things are being worked upon as we speak, as part of the national programme for
IT.
How do you ensure network integrity when dealing with such large quantities of sensitive data?
Our networks, along with any other network provider, are very large, very secure and very robust, specifically designed to ensure they have the maximum amount of 'up-time'. You can never 100%
guarantee against failure, but most of the back-ups, even on an individual trust basis, individual hospitals will have their own back-up and disaster recovery.
Of course, large network providers such as ourselves will have methods in place to ensure that they do not end up with networks physically failing.
What equipment will staff have at their disposal to access patient information?
I think that's the interesting journey now, many different organisations have different challenges going forward. I was looking at a survey specifically about a problem nurses currently encounter as part of
their job at the moment. On average, a nurse will work over 8.5 weeks of overtime in a year; they walk 3.89 miles a day; they deal with 33 telephone calls per shift; and in fact they're mobile for 70% of
their time. They spend 50% of their time outside the hospital, and even admin staff spend 20% of their time on the move. So the key issue within the NHS of course, is getting the right information to the
right person at the right time.
For example, I don't know if you are sat at your desk at the moment - but I am, and I am speaking on a landline, I have my Blackberry beside me, I have my laptop on and I have my personal mobile
with me too. If I was a doctor, I may also have a pager. If someone was to try each one of those devices in turn, they may find that it would take five or six attempts before finding out I was potentially out
of the office. So having single devices is something that is very important.
There are a number of trials currently going on in Wales and the UK centred around single devices which give you access to mobile telephony and access to a fixed line using wireless technology,
which effectively have a single point of contact. They also have 'presence' function built in, which would tell you automatically if the person I was trying to contact was in a meeting, unavailable or on
holiday - removing that kind of delay that currently exists in just trying to find people. It is actually a very large part in improvement of efficiency in any organisation.
I guess with those devices comes the inherent security queries - whether they will cease to function offsite, or if they would require very particular policies in place relating to the use of that
information stored on the devices. I guess that's a question for the future really.
Of course, and that's a local area network issue, relating to firewalls, security and authentication - because obviously, this data is highly confidential and important and all those features are, as you can
imagine, the top priority.
There was a lot of media buzz recently about telehealth - how will NGNs help drive this forward?
Once you have a network in place that enables you to reach anywhere, you are almost limited by your imagination. I have been to many boardrooms across the UK which has a television in the corner
with a piece of teleconferencing equipment that has been sat gathering dust for years, which also hasn't been used since the one guy who knew how to use it left the company! But now the prospect of
HD imaging brings a whole new opportunity to the health organisation.
I was with a customer this morning discussing stroke care in a rural community. Take the example of a stroke specialist in an acute hospital, with 6-7 hospitals around the area, and then what
effectively is a trolley with a HD imaging television screen attached to it. The patient would see the doctor on screen and communicate with them remotely. There would be sufficient image quality that the
doctor could actually tell and potentially diagnose what type of stroke the patient is having just by being that close to them.
In some cases they could install DSL lines into the consultant's home, so they could actually be sitting in their home whilst the patient is at a clinic, doctors' surgery or hospital. They would be able to
diagnose - with of course time being of the essence with strokes - whether or not a person needs a certain type of treatment, which could in turn almost mitigate the effects of a stroke.
Would this HD imaging developed in-house by ntl:Telewest Business or are you working with other organisations?
Effectively, the imaging technology is something that we would work on with partners and we would then control the distribution of that over our network.
How will technologies such as RFID be integrated into this project?
Well RFID is one of my favourite technologies! There are a number of issues occuring in trusts at the moment which could benefit from this. For example, in one Midlands hospital only 17% of equipment
had its planned preventative maintenance service performed on the required date. A major reason for this is that they don't actually know where the kit is. One hospital in the North East has two members
of staff whose full time jobs are to look for things. At another Midlands hospital, it takes two people working fourteen weeks at a time to try and locate kit for its bi-annual equipment sweep.
The problem of trying to locate equipment within the hospital is absolutely enormous. For example, a nurse fetches a piece of equipment from a central store. At 5 o'clock when he/she finishes their
shift, ideally it should be returned to the central store, potentially needing to retrieve it again at 9 o'clock the next morning. However, what tends to happen is that it is kept on the ward, but of course if
someone else requires that piece of equipment in the meantime it is unavailable.
This becomes expensive, particularly taking barometric beds as an example. If you consider that a normal hospital bed can take a patient up to 15 stone, anyone heavier would need a barometric
bed. Trying to locate such a bed in the hospital can be difficult, and in this situation they are rented, at a cost of about £900 a week. Problems then develop when these patients get better and are
discharged and their barometric beds are re-allocated to patients who do not necessarily need them. In turn, if there is then a need for another barometric bed - they would just hire another one!
This is the type of issue faced by the NHS and hospitals can spend up to half a million pounds a year on equipment rental. What an RFID tag would allow you to do is not only locate the barometric
bed in the hospital via a detailed map locating which ward the bed is on, but you would also have RFID tags indicating whether or not a patient is actually occupying the bed.
Another problem hospitals face is during the discharge of patients. When a patient is discharged from hospital, a wheelchair and a porter are often needed to take them to the front desk.
Unfortunately locating porters and unoccupied wheelchairs within the hospital can be a difficult and time-consuming task. There are now applications based on IP telephones, which you can press to tell
you where the nearest available porter and wheelchair are, which enables the patient to be discharged a lot quicker.
All these types of technologies improve the efficiency of an organisation. We talked about nurses, doing on average 8.5 weeks of overtime per year. It is important to bear in mind the importance of
staff being used efficiently, particularly if agency nurses, who have higher rates of pay, are being employed. If you can improve your efficiency it has a significant impact on the value of your services and
what you're trying to do. I think the key thing facing the NHS organisation at the moment of course is costs. The physical costs of the NHS are very large are going to be with us for some time.
- In 2001 it was the first time that there were more over 60s than under-18s living in the UK
- At the moment we spend 9% of GDP on healthcare
- By 2014 there will be more people over 65 than under 16 in the UK
- By 2050 there will be four times as many people needing the care and four times the cost
- If we were to maintain exactly the same methodology and level of service we have at the moment, it means that 36% of the entire GDP of the country would have to be spent on
healthcare
With these stats in mind there is an absolute need to invest in technology that improves the efficiency of the people working in the organisation. I think that's what the future direction of networks and
networking applications will have to be to drive through those current cost savings.
I was at a trust recently that have to make a cost saving of £19.8m for 2009-2010, and if they do they will achieve their budget which is currently at £9m deficit, so they have to be doing everything
they can from a technology perspective.
As mentioned, I became interested in this from a personal perspective as well as a business one, as these are the fundamental things that are going to affect you and I, and of course the next
generation ahead of us.
Send a comment about this article to editor@itwales.com
| 
Cymraeg
Subscribe to