ABSTRACT

The goal of the Foundation Healthcare Group (FHG) Vanguard model was to develop a sustainable local hospital model between two National Health Service (NHS) Trusts (a London Teaching Hospital Trust and a District General Hospital Trust) that makes best use of scarce resources and can be replicated across the NHS, UK. The aim of this study was to evaluate the provision, use, and implementation of the IT infrastructure based on qualitative interviews focused mainly on the perspectives of the IT staff and the clinicians’ perspectives. Methods: In total, 24 interview transcripts, along with ‘Acute Care Collaboration’ questionnaire responses, were analyzed using a thematic framework for IT infrastructure, sharing themes across the vascular, pediatric, and cardiovascular strands of the FHG programme. Results: Findings indicated that Skype for Business had been an innovative and helpful development widely available to be used between the two Trusts. Clinicians initially reported lack of IT support and infrastructure expected at the outset for a national Vanguard project but later appreciated that remote access to most clinical applications including scans between the two Trusts became operational. The Local Care Record (LCR), an IT project was perceived to have been delivered successfully in South London. Shared technology reduced patient traveling time by providing locally based shared care. Conclusion: Lesson learnt is that ensuring patient benefit and priorities is a strong driver to implementation and one needs to identify IT rate-limiting steps at an early stage and on a regular basis and then focus on rapid implementation of solutions. In fact, future work may also assess how the IT infrastructure developed by FHG vanguard project might have helped/boosted the ‘digital health’ practice during the COVID-19 times. Spreading and scaling-up innovations from the Vanguard sites was the aspiration and challenge for system leaders. After COVID-19, the use of IT is scaled up and now, the challenges in the use of IT are much less compared to the pre-COVID-19 time when this project was evaluated.

摘要

Foundation Healthcare Group (FHG) Vanguard 模式的目标是在两个国家卫生服务 (NHS) 信托（伦敦教学医院信托和地区综合医院信托）之间开发可持续的本地医院模式，充分利用稀缺资源和可以在英国 NHS 中复制。本研究的目的是基于主要关注 IT 人员和临床医生观点的定性访谈，评估 IT 基础设施的提供、使用和实施。方法：使用 IT 基础设施的主题框架分析了总共 24 份访谈记录以及“急性护理协作”问卷答复，共享 FHG 计划的血管、儿科和心血管领域的主题。结果：调查结果表明，Skype for Business 是一项创新且有益的发展，可在两个信托基金之间广泛使用。临床医生最初报告说，国家 Vanguard 项目一开始缺乏预期的 IT 支持和基础设施，但后来意识到远程访问大多数临床应用程序（包括两个信托基金之间的扫描）已经开始运作。本地护理记录 (LCR)，一个 IT 项目被认为已在伦敦南部成功交付。共享技术通过提供本地共享护理减少了患者的出行时间。结论：经验教训是，确保患者受益和优先事项是实施的强大驱动力，需要在早期阶段和定期确定 IT 限速步骤，然后专注于快速实施解决方案。实际上，未来的工作还可能评估 FHG vanguard 项目开发的 IT 基础设施如何在 COVID-19 时期帮助/促进“数字健康”实践。从 Vanguard 站点传播和扩大创新是系统领导者的愿望和挑战。在 COVID-19 之后，IT 的使用得到了扩大，现在，与评估该项目的 COVID-19 之前的时间相比，IT 使用方面的挑战要小得多。