© Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Creative Tensions in Healthcare Provision Dr Lester Russell Chief Medical Officer, Fujitsu

© Fujitsu Services “I need someone expert in the art of extreme torture – do you know PowerPoint?”

© Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Standardisation Interconnection Personalisation

© Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 What’s happening in England?

© Fujitsu Services What’s happening in England? “No, the computers are up. We’re down.”

© Fujitsu Services The Five Clusters The programme has divided the country into five geographical areas, or "Clusters". A Local Service Provider (LSP) has been appointed to implement IT systems for the NHS in each Cluster Key ClusterLSP Main Health Systems Supplier SouthernFujitsuCerner LondonCCAIDX North EastAccentureiSoft EasternAccentureiSoft North West & West Midlands CSCiSoft

© Fujitsu Services Southern Cluster There are 7 Strategic Health Authorities in the Southern Cluster: 1.Kent & Medway 2.Surrey & Sussex 3.Thames Valley 4.Hampshire & Isle Of Wight 5.Avon, Gloucestershire & Wiltshire 6.Dorset & Somerset 7.South West Peninsula

© Fujitsu Services Basic Demographics The Southern Cluster includes: 81 primary care trusts 63 hospital trusts 35 social services Organisation TypeCluster Total Acute Teaching Trusts5 Large Acute Trusts12 Medium Acute Trusts17 Small Acute Trusts7 Acute Specialist Trusts3 Mental Health & Community 19 Primary Care Trusts81 Ambulance Trusts12 Total156

© Fujitsu Services 2005 PACS Deployment – Overall Status – 4 th November 40 Initial Engagement Meetings completed Live Services: West Dorset – PACS Salisbury – PACS + locally-hosted RIS Maidstone & Tunbridge Wells – CR / MasterPage / Printers Dartford & Gravesham – CR / MasterPage + Data Centre-hosted RIS Poole – CR Milton Keynes – PACS James Paget (EEM Cluster) – PACS PACS Cluster Data Store – fully operational (6,089,130 images at 4 th November) RIS Data Centre Applications and Databases – operational (4 SHA domains in use) James Paget – data centre connection 2 nd November Royal Surrey – RIS commenced service on 4 th November Poole – RIS 7 th November Gloucester – RIS 7 th November Dartford & Gravesham – PACS 8 th November

© Fujitsu Services 2005 Equipment delivered and implementation proceeding at: East Kent, Ashford & St Peter’s, Gloucestershire, Plymouth Academy, Royal Surrey, Royal Cornwall Equipment on order for: NOC, North Hampshire, Maidstone & Tunbridge Wells, Plymouth, Brighton & Sussex (frozen), East Somerset, UHCW (NWWM Cluster), Medway PACS Deployment – Overall Status – 4th November

© Fujitsu Services Service Status

© Fujitsu Services Mission The role of Fujitsu as a Local Service Provider (LSP) is to enable healthcare organisations to improve and maintain health.

© Fujitsu Services Health productivity – the critical quotient $ max

© Fujitsu Services Health productivity – the critical quotient € max

© Fujitsu Services Health productivity – the critical quotient ¥ max

© Fujitsu Services Health productivity – the critical quotient £ max

© Fujitsu Services Healthcare productivity The people of the UK should not be asking, “How many events for the pound?” but rather, “How much health for the pound?” Donald Berwick - President, Institute for Healthcare Improvement, Cambridge MA Measuring NHS productivity - BMJ Vol th April 2005

© Fujitsu Services Healthcare productivity “In five years’ time, you will be your data.” Prof. Martin Severs – Chairman, Information Standards Board

© Fujitsu Services Enabling change - achieving health benefits Smart deployment of IT systems Service redesign Realisation of health benefits

© Fujitsu Services Enabling change - achieving health benefits Smart deployment of IT systems Service redesign Realisation of health benefits Modernisation

© Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Standardisation Interconnection Personalisation

© Fujitsu Services Future trends Standardisation vs. Localisation

© Fujitsu Services Future trends Localisation “Our National Health Service is also a very local health service – and therein lies one of its key strengths. …what works in one place may not necessarily work in another. The local challenge is to shape services to match the characteristics, needs and priorities of the communities they support….” John Reid, Secretary of State for Health Our NHS – Where Next? South West Peninsula Strategic Health Authority 2004

© Fujitsu Services Future trends Standardisation Patient confidence Medical risk Medico-legal risk Transfer of data Care across different settings and by different providers

© Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Standardisation Interconnection Personalisation

© Fujitsu Services Future trends Interconnection vs. Fragmentation

© Fujitsu Services Future trends Fragmentation of providers Purchaser/provider split Paid-for (but not necessarily provided- by) the NHS NHS as a commissioner Increased competition

© Fujitsu Services “If you don’t like change, you’re going to like irrelevance even less.” General Eric Shinseki, Chief of Staff, US Army

© Fujitsu Services Future trends Interconnection Home-care, primary, secondary and tertiary care Scheduled and unscheduled Urgent care and planned care Healthcare, social care and education

© Fujitsu Services 2005 Royal College of Radiologists PACS & Teleradiology Group 15 th November 2005 Standardisation Interconnection Personalisation

© Fujitsu Services Future trends Personalisation vs. Commoditisation

© Fujitsu Services Future trends Comparative clinical outcomes analysis Away from block contracts Towards Payment by Results (PBR) - really payment by activity Through Practice Based Commissioning (PBC) To payment by outcome

© Fujitsu Services Future trends Commoditisation Robust measures of quality Quality comparisons Value-for-money approach to commissioning Personal health choices driven by quality

© Fujitsu Services Future trends Personalised care Away from secondary care organisations’ menu-driven approach Towards primary care organisations, as a proxy for patient-driven care To patient making choices – including out-of-hospital care

© Fujitsu Services National and regional healthcare The enduring functional unit of the NHS is the referral network which surrounds the patient.

© Fujitsu Services Key point summary 1.Standardisation – Consistency of service, transferability of data. 2.Localisation – Services which are responsive to local needs. 3.Interconnection – Care is deliverable in different settings. 4.Fragmentation – Competition amongst providers. 5.Personalisation – Care packages tailored to the individual. 6.Commoditisation – High quality, low cost, high modularity.

© Fujitsu Services Advances in technology Ray Kurzweil NewScientist.com 24 September 2005

© Fujitsu Services Advances in technology “We won’t experience 100 years of technological advance in the 21 st century; we will witness in the order of 20,000 years of progress when measured by the rate of progress in 2000, or about 1,000 times that achieved in the 20 th century” Ray Kurzweil, Inventor and writer

© Fujitsu Services “..and that’s why we need a computer.”

© Fujitsu Services