With the introduction of these guidelines, the hospital had to again, renew its IS strategy and this led to further set backs in implementing the systems specified by the document. By the time that approval for the computer room had finally been given there were new issues which had arisen- the previous system of Regional Health Authorities had given way to the new system of Hospital Trusts, this led to more confusion as to who should deal with the approval of St Mary’s IS scheme. The proposals for the PAS system, in particular had to be re-costed for approval by the new authorities and later, the LAN approval was withdrawn pending a re-submission of a new proposal for both LAN and PAS systems.
It was not until 1994 that these LAN and PAS systems were both approved, and not until 1995 was the work on the LAN completed due to further costs and delays. This substantial delay in the implementation of the HIS can be linked almost entirely to the problems of changing roles played by the government and the changes in internal NHS structure. In 1995 a new strategy was put forward by the PAS manager at St Mary’s, this new scheme tried to address the problems with the old strategy but ultimately led to more confusion. The Case Mix program was abandoned due to its cost which meant that all of this information would continue to be processed using text files and spreadsheets downloaded manually from existing systems rather than being part of an ongoing automatic system, this meant that only a few staff members could perform these processes.
The proposed NIS system was also abandoned in favour of a traditional card index file system which was cheaper but far from ideal in the hospital. By 2000 this system was still in operation and the full integration of hospital information systems had still not been completed. Review of Implementation The system at St Mary’s has been flawed from the outset. A combination of many factors has stopped a series of systems being implemented on schedule and in many cases these systems have been integral to the whole process. Whilst it seems that the hospital has been able to function properly throughout these problems it must be recognised that by refining the current plan there can be a huge increase in productivity and reduction in costs and time wasted.
The main problems with the original strategies were that they were too ambitious to start with, ultimately leading to corners being cut and ideas being dropped. There was no focus in the strategy either and the plans were very much aimed at the short term rather than looking to the future. Generating Future Strategic Options There are two distinct methods which could be undertaken by St Mary’s in order to improve their Information Systems handling. These are an E-Business approach to hospital work and the use of outsourcing.
Outsourcing “Many firms have adopted outsourcing in recent years as a means of governing their information technology (IT) operations” (Bahli and Rivard, 2003). Outsourcing “is the practice of contracting Computer centre operations, telecommunications networks, or applications development to external vendors” (Laudon and Laudon, 1998). It is becoming used more and more in Pubic sector organisations as a way of reducing costs and maximising value for money. “Although the term outsourcing may be relatively new… Historically, numerous businesses have enlisted the help of outside experts to assist with tasks too cumbersome to complete in-house.” (Hozmozi et al, 2003).
Benefits Outsourcing can be used to control the costs of an Information System setup. Since an outsider is undertaking most of the work and owns the systems being used then the client only needs to pay for what they use. It is also said that outsourcing “may help clients achieve major benefits such as cost savings, increased flexibility, higher quality services and access to new technology” (Bahli and Rivard, 2003).
In the case of St Mary’s hospital, this could mean more money could be spent on the improvement of other services. The fact that the physical systems are controlled by the 3rd party ensures that there is no maintenance costs to pay on the equipment which again would save time and money for the hospital. Outsourcing can also reduce complications in managerial tasks and eliminate tension in the hospital between medical staff and IT staff. It would also reduce the amount of training the staff would need in order to work.
If St Mary’s had outsourced it’s IS when it first produced an IS plan then many of the problems which have plagued its development would not have occurred. Since all of the IT would be controlled by external sources then there would have never been any of the regional politics problems which occurred when deciding who should deal with what part of the IS system. It would not have cost the hospital any money to upgrade the existing system since the equipment would have been owned by the service supplier and training would be conducted by the supplier or would not be necessary. Outsourcing is especially suited in applications where there is a poor system already in place or where the client’s IS capability is limited – This is exactly how the hospital is currently running.