Smartcare Clinical System Integration
A group of Trusts were seeking to collaboratively procure a high value and complex integrated clinical information system. The system needed to include robust procurement documentation, a highly granular scoring methodology and a suitably tailored contract that would support the implementation of a genuinely integrated patient care record.
The Trusts (Gloucestershire Acute Hospital NHS Trust, Northern Devon Healthcare NHS Trust and Yeovil District NHS Foundation Trust), sought our legal input in order to collaboratively procure a high value and complex integrated clinical information system. The arrangements needed to:
- Facilitate joint decision making whilst at the same time maintaining the independence of the parties to govern their own contracts
- Support integrated working
- Satisfy the requirements of a central assurance body known as the Southern Acute Programme (SAcP)
This procurement was important for several reasons:
- The legacy system that the Trusts are currently using is coming to the end of its supported life and, therefore, it was imperative that the Trusts replaced it before their existing arrangements expired.
- The new solution would be much wider in scope and complexity than the existing system.
- In terms of financing the purchase, the Trusts had been informed that they would need to comply with certain required central assurance processes of SAcP to obtain funding, as well as submit a satisfactory business case to the Department of Health to obtain central funding. The Trusts are one of a group of six collaborations of Trusts which did not participate in the National Programme for IT in the NHS.
The Trusts were particularly keen to ensure consistency throughout the procurement. From a legal perspective, this meant producing a comprehensive suite of procurement documentation with early legal input, including an OJEU (which acknowledged that flexibility in developing the system over time would be required), pre-qualification questionnaire, invitation to tender, output based specification, evaluation model, financial model and various other peripheral procurement documents. It was also important to the Trusts that they all played a very active part in assessing and evaluating the potential solutions and this was facilitated by the production of an evaluation handbook for use by the teams performing the assessment process. This invaluable aid helped to ensure that the process was very fair and transparent.
The complexity of this project was such that it required the development of a tailored contract based upon OGC model ICT contract v2.3. We worked closely with the Trusts' key project leads to create this bespoke contract The contract detailed the key functional areas required by the Trusts (pathology, enterprise-wide e-prescribing and medicines management, clinical decision support, clinical documentation and reporting) as well as requirements relating to design, build, test and implementation, intellectual property ownership and ongoing delivery of the operational service including a highly tailored service level agreement and service credit regime.
By taking care to consider with the Trusts the various practical uses to which the solution will be put, the arrangements were structured so as to permit use of the solution not only by the contracting entities but also by certain key associated third parties so that information relating to each patient's journey through other care settings is able to be fully and comprehensively captured and recorded.
Overcoming the challenges
Working with multiple parties – it was clear that this project was a genuine collaboration and could only be considered a success if all of the Trusts felt that the process was as inclusive as possible and that its outcomes were fully supported by all. To that end, we learned that it was important to take the time work together to identify our respective roles and responsibilities and the levels of co-ordination required as well as regularly reviewing progress against each key stage of the procurement.
Complying with external assurance processes - we participated in enabling the Trusts to work within the assurance processes mandated by the SAcP in connection with their application for an element of central funding for the procurement, which was subject to rigorous quality review and business case approval. On occasion this required us to justify a particular position taken which provided valuable opportunities to test understandings and check assumptions and take into account differing views. Ultimately, some of the findings of SAcP's review included that the standard of procurement documentation was felt to be good and that throughout the review it was evidenced that robust operational and governance processes necessary to launch and manage the procurement were in place.