Feature / Getting e-nabled

Common standards hold the key to unlocking the benefits of e-procurement in the NHS, as NHS PASA’s Rachel Hodson-Gibbons explains

Healthcare is an information intensive environment and the availability of quality information is essential for the delivery of safe and effective healthcare services. Decisions based on poor-quality information provide ineffective healthcare services, which adversely affect the outcome of treatment for patients and provide the NHS with a significant and avoidable cost.

The healthcare service in the UK is provided by a large number of organisations involving the private sector, the NHS and increasingly the retail sector. An equally large number of suppliers of goods and services supply into this network of healthcare providers – an average trust could have several thousand suppliers. But across the NHS it is impossible to say how many as there is no common coding system.

Purchasing and supply is essentially about relationships between organisations and processes. Better processes and relationships provide a higher quality supply chain.

To achieve stronger and effective processes and relationships, within and between organisations, access to high-quality information is required. To enable the effective delivery of high-quality information, organisations on the buy and supply sides of the healthcare network must be able to share data. And this requires common data standards.

Fragmented information

The NHS has adopted a fragmented approach to the management of procurement and commercial information and systems, so the lack of common data standards has created many data silos. Data is available in volumes but quality information is in short supply.

An example from the English NHS illustrates this well. The NHS Purchasing and Supply Agency’s pharmacy database collates details of orders placed by NHS trusts. The database contains 130 different descriptions (a selection of which are shown overleaf) of a single product, cancer drug Bleomycin 15,000 unit powder solution for injection vials. 

The lack of common commercial and procurement data standards in the NHS means that the analysis of expenditure and demand requirements across organisations is costly in terms of time and resources. Either an organisation would simply not know how much of this product it was using or it would need to employ someone – in the case of Bleomycin, someone with clinical expertise – to map all the different descriptions together.

Without standards to accurately identify products and suppliers, accuracy can never be assured and visibility across the NHS is limited. Without a single description, traceability also becomes an issue, which could be significant if a product were recalled.

Effective information is the key foundation to an effective supply chain and effective healthcare. The implementation of common data standards across the procurement and commercial systems by NHS organisations and their suppliers also enables information to be easily transferred between systems. This enables interoperability between systems, allowing automation that reduces the resources required, removes errors, increases compliance and reduces risk.

Beyond the business benefits, the implementation of common procurement data standards enables traceability and this directly contributes to improvements in patient safety. This was shown in Coding for success – simple technology for safer patient care, a Department of Health document published in February 2007.

FIG 1: Supporting Procurement Through Technology

eEnablement technologies

Procurement eEnablement is the application of information and communication technologies to the commercial and procurement functions. Figure 1 provides an overview of this activity; the text inside the arrows describes the processes undertaken and the text outside the arrows describes the eEnablement technologies.

Procurement eEnablement technologies are important to the NHS as, to be effective, they demand common data standards across the NHS organisations and their suppliers. Implemented procurement eEnablement technologies give the NHS a big opportunity to manage procurement information better, improve commercial and procurement processes and remove waste and duplication.

Although the NHS has been using procurement eEnablement since the early 1990s, implementation has been fragmented. Consequently the NHS has a wide range of standards in use, limited interoperability between systems or visibility of its expenditure across the network. The NHS has also failed to exploit sensible, once-only opportunities that procurement eEnablement technologies offer, such as the management of product data for electronic catalogues and pre-qualification.

The NHS procurement eEnablement programme (NPEP) sets out to give the NHS the means to use procurement eEnablement more effectively. At the core of the programme is the implementation of common data standards for procurement and commercial processes.

The programme has four key outputs:

1. Direction To provide a clear direction for the NHS, its suppliers and technology providers on the requirements for NHS procurement eEnablement. This involves the provision of a strategy and then a model that describes the capability requirements.

2. Awareness and understanding To put in place a strong awareness and understanding in the NHS of the benefits available from procurement eEnablement. 

3. NHS standards To establish NHS data and business message standards and requirements for interoperability between procurement eEnablement systems and provide guidance.

4. NHS capability To significantly improve the capability of the NHS to implement and use procurement eEnablement technologies.

BLEOMYCIN: One Product, 130 Descriptions

Two levels

The outputs of the programme are delivered through a range of projects that have two levels of delivery. Level one projects establish common data and business message standards for commercial and procurement systems and provide guidance for the NHS. Level two projects will drive the delivery of procurement eEnablement capability into the NHS by providing resources to work directly with NHS organisations, suppliers and technology providers. This will aim to establish:

• The capability for all procurement eEnablement systems  to support NHS standards and interoperability requirements
• The capability within NHS organisations to make appropriate use of procurement eEnablement technologies
• The capability to co-ordinate investment in procurement eEnablement technologies
• A transfer of skills and knowledge into NHS organisations to ensure mature understanding of procurement eEnablement
• A once-only approach to the provision of product and pre-qualification data.

The NPEP projects were developed in consultation with NHS organisations, suppliers of goods and services and technology providers. The programme is focused on delivering pragmatic steps to implement procurement eEnablement technologies in the NHS and drive forward their adoption.

The level one projects are funded by the NHS Purchasing and Supply Agency and work on these commenced in mid 2008/09. The level two projects will be run over three years and require significant additional funding for which a business case has been presented to the Department of Health (October 2008).

Work this year has led to two important deliverables for NHS finance . The first relates to procurement data standards. The key building blocks of common data standards for NHS commercial and procurement processes are coding systems that enable the unique identification of suppliers and products and a classification system to enable the analysis of expenditure. The three main standards – providing codes for products, suppliers and a classification system to group products and services into logical categories (see box) – are already in place. The challenge will be to ensure NHS bodies, systems providers and suppliers adopt the standards. Further standards are also being developed for the structure and content of messages and documents such as invoices.

The second key deliverable will be a once-only prequalification system. Currently NHS bodies need to reassure themselves about the capacity, capability and eligibility of potential bidders. They do this by requesting pre-qualification information from possible suppliers. But this is a huge burden both for NHS bodies requesting and processing the information and suppliers responding to large numbers of requests from NHS bodies.

So a procurement is under way for a once-only approach to pre-qualification. This new service, with full integration to Dun & Bradstreet systems to validate Duns numbers and provide financial reports, will be available for the NHS in the spring of 2009.