TrakCare Hosted Services Solution offers world class reliability, cost savings, and peace of mind to NHS Borders

NHS Borders decided to move its InterSystems TrakCare unified healthcare information system to a hosted services solution mid-pandemic in the summer of 2020, after a decade of managing the software and hardware themselves on-premise.

The strategic move was designed to help the health board overcome challenges with reliability and security that were exacerbated by ageing hardware and a lack of technical skills within its small IT team. Rather than undergo the challenging, long and costly exercise of upgrading the 10 year-old hardware or upskilling enough team members to keep the technology running 24/7/365, especially in the midst of the COVID-19 pandemic, the more progressive strategy was to move to a hosted services solution. This left NHS Borders’ IT team to focus on the more valuable task of front-end application configuration and user support.

Prior to the move, the team had been experiencing intermittent challenges with resilience and business continuity and recognised that without addressing the problems, they were only likely to increase. One significant outage resulted in the system being unavailable for 48 hours – putting a big strain on hospital administrators and clinicians as they ensured patients experienced seamless and uninterrupted care.
 

Security was another major factor in the move to a hosted services solution, with the IT team keen to experience the peace of mind that comes with knowing that patches and updates would be managed by InterSystems – while the data would be securely hosted across two data centres ensuring continuity of service and adhering to all the latest compliance requirements.

This was especially important in light of the WannaCry ransomware attack that brought the NHS to a standstill for several days in 2017, impacting more than 200,000 computers in over 150 countries. One of the reasons so many NHS devices were infected with the ransomware was down to supported, but unpatched, operating systems. Other high-profile attacks have followed more recently, including on the Scottish Environment Protection Agency (SEPA) on Christmas Eve 2020, which caused major disruption to its contact centre, internal systems, processes and communications.

With uptime guarantees of more than 99.95%, the hosted services approach is transferring the risk from a small IT team and delivering all the benefits that hosted services technology promises, all of which are essential when handling data critical for patient care. In addition to that, rather than have the ongoing cost of maintenance, repair and the risk of outages for maintenance, NHS Borders now simply focus on what they do best, support healthcare professionals to use and customise the features of the technology for the benefit of patients. They also no longer need to deal with multiple vendors when there is a failure, dealing with just one partner. Rather than negotiating with hardware and software vendors that are pointing their fingers at each other to find a solution, now if issues arise, NHS Borders now simply call InterSystems.

The appetite for adoption of new technologies across the healthcare space has grown dramatically since the start of the COVID-19 pandemic, amid the rapid need for people to work in different ways. Digital services rolled out across Scotland over recent months include remote monitoring for Long Covid patients as well as other long-term conditions, and business communications platforms, which became especially critical during the numerous lockdowns.

However, although it might be preferable and recommended by NHS directives for boards like NHS Borders to adopt a fully digital, cloud-first approach, with healthcare being such a complex industry, it is expected to take longer than anticipated to move to being fully hosted in the cloud and interoperable across every application. Often, prompts come from suppliers with cloud-ready products like TrakCare, rather than healthcare providers demanding them. In this case, by working closely with InterSystems when they had continuity and reliability issues, NHS Borders were advised that by taking a cloud first approach they would reduce risk, increase security and reliability while also having more visibility over long term costs.

The move to a hosted services solution for TrakCare, alongside Office 365, has been a big step for NHS Borders. Whereas, in the past, it would have purchased hardware as a one-off commitment and hosted it internally, with applications running on client servers until they were repaired or became obsolete, its technology is now increasingly moving to a subscription-based model. And in order to get the best value out of InterSystems’ subscription service, the board is exploring how to maximise its use.

NHS Borders is discovering a whole host of TrakCare functionality including ward and hospital at night handovers, active clinical notes, and ordered communications running for GPs to support community treatment and care centres. Even upgrading the software alone would have been a challenge prior to the move to the cloud. Now, with the new software, the ability to configure, implement and deploy new functionality to reap the full benefit of TrakCare, is critical to ensuring clinicians and administrators are getting the best bang for their buck.

NHS Borders’ recently appointed Chief Clinical informatics Officer (CCIO) went back to work on the high dependency ward during the pandemic, so has first-hand experience of how hard it can be on the front line and what hospital systems and processes could be improved for hospital staff. She is now feeding that back to the IT team, so that they can prioritise which TrakCare functionality to deploy next. She and the team are viewing the solution as one that will continually evolve to bring in new functionality in line with changing needs. With a hosted solution now in place, the small IT team can now focus on addressing these changing needs, such as reducing waiting lists, to bring benefits to patients and healthcare professionals, their most valuable area of expertise, rather than spending time on upgrading and managing infrastructure, hardware and software.

Having the latest version of TrakCare gives NHS Borders access to the potential to transform the way people in the hospital work, thanks to functionality like electronic patient records. Coupled with HealthShare Unified Care Record, it also has the potential to transform the flow of patients through the health and care system to make things seamless and far more efficient for everyone.

• The board benefits from the highest possible standards, without the need to manage the infrastructure, security compliance and skilling up technical staff.
• Access to technology with the potential to transform the flow of information through the system, ensuring that data follows patients seamlessly, in a way that improves outcomes.
• End-to-end, fully resilient, cross-site service guaranteed to all relevant caregivers and sites — and supported by all the necessary physical and digital infrastructure.
• Hosted in two, physically distant, data centres, guaranteeing near-instant failover and continuity of service.
• All patching, updates and upgrades are taken care of by InterSystems, leaving the small Borders IT team to concentrate on optimising and supporting the front end – transferring the risk to InterSystems.
• With a single provider and a single point of accountability, it’s easy to fix problems and address challenges at speed.
• Switching to a secure hosted service helped the board meet its targets for moving services into the cloud and off expensive on-site infrastructure.