Guest editorial Wednesday 6 June 2012: The Top Ten (and a half) Chart of PLICS Pitfalls

Assista Consulting, reviews the top ten (and a half) pitfalls of patient-level information and costings systems - PLICs.

Patient Level Information and Costings systems (PLICs) has hugely increased the ability of NHS finance departments to accurately capture their organisation’s costs.

......................................................................

Click here for details of 'Comrade Sir David's Great Leap Forward', the new issue of subscription-based Health Policy Intelligence.

......................................................................

However, PLICS is a complex methodology and, based on our experience of implementing it across the NHS, we list out below, in no particular order, 10 ½ of the most common pitfalls:

1. I Can See Clearly Now - feeder system review (do one FIRST!)
Before embarking on PLICS many Trusts do not have a full picture of all of the different information systems that they’re running. In addition to the main patient administration system there are many other systems in existence with major areas such as Radiology, Pathology and Pharmacy having patient data on their own individual systems as well as smaller, more specialist areas such as Audiology.

PLICS requires that the data in each of these individual systems is fully traceable to patient level. However, some of these systems may not have adequate patient level data within them and so a plan will need to be developed to improve the quality of the information.

Even where adequate data exists some clinical systems are not designed with the export of data in mind.

The above factors mean that a full review of the organisation’s information systems is necessary before implementation of software, as the functionality of the software will need to be tailored to the available data and vice versa.

2. Message In A Bottle(neck)
The feeder system review should not be rushed. Some of our clients have dived headlong into getting their PLICS software set up and have neglected to adequately assess information feeds.

This can lead to bottlenecks further down the project timeline.  Additionally, the perceived lack of quality information can cause the embedding of PLICS to grind to a halt just when it needs to pick up momentum.

3. Making Your Mind Up - choosing the right software
Some of the more straightforward software packages offer the ability to get outputs soon after initial implementation, but may not be able to produce the granularity of information required going forward.

These packages tend to be less transparent in their scripting and so if changes are required then they need to be done by the developer rather than the user. This can cause delays to users as there is a reliance on the developer to be able to do this promptly.  The potential time lost due to these scripting issues can add up and lead to frustrations when reporting deadlines are looming.

Other packages which are perceived as more complex may take longer to set up initially, but often offer increased granularity of information in the long run. In contrast to many of the more simple systems, the increased time needed for the initial setup and training can be offset by the flexibility which they offer. As the scripts are often more transparent with these systems, it is easier for a user to make changes to the scripts themselves and not have to rely on the developer as much.

4. Livin’ On A Prayer - don’t underestimate how long it’s going to take and how many pairs of hands you’ll need
There are different areas of the implementation which require adequate resourcing and many Trusts do not properly address this point until the project has faltered.

The time necessary to complete the initial review and further development of the organisation’s systems should not be underestimated. This can be a process that takes several weeks to finish and should ideally be undertaken by someone with experience in both the financial and informational sides of the system as it can be useful to know which information fields can potentially be used for driving costs.

The calibre of person required means that the individuals of this level within the Trust would need to significantly restructure their other duties for the duration of the review.

5. When Will I See You Again? - use your consultancy days wisely
The resourcing of the initial implementation is interrelated with how the organisation chooses to use the consultancy days which the software provider includes as part of the purchase. If the feeder system review is not completed then this can mean that the implementation is not done fully and, therefore, the consultancy happens on a piecemeal basis. This can cause wasted time and yet more bottlenecks.

6. You Never Give Me Your Money – the hidden costs of software providers
What are the implementation costs? What are the on-going maintenance and software support costs?

7. Under Pressure - server and PC issues
Do you have existing server capacity to support PLICS?  Are the PCs of your end users up to the job?

8. OK Computer – how does PLICS fit with your IT strategy?
Sometimes PLICS can conflict with the Trust’s overall IT strategy in that PLICS is concerned with  recording everything as soon as possible, but IT may want to put this on hold to make sure it fits with the overall strategy.

9. He Ain’t Heavy, He’s My Brother - don’t overstretch your team
The resources attached to the ongoing operation of the software are an area where some of our clients have come unstuck - the operation of the PLICS system has been treated as an additional quarterly task for an already overworked finance manager etc.

However, we have always believed this approach to be unrealistic due to the variety of data feeds into the software. Trusts have discovered too late that a single individual cannot cope and it’s only then that they have realised that additional resource is needed, typically in the form of an information analyst.

10. I’d Like To Teach The World To Sing - don’t forget to get organisational buy-in
Too many Trusts still treat PLICS as a desktop exercise and fail to properly engage the wider organisation.  A PLICS implementation group that meets regularly and is chaired by a senior medic is a great way to get the ball rolling.

10½. We All Stand Together – at what point do you share PLICS with the whole organisation?
This is an associated point, but an important one nevertheless.  There’s a fine balance between releasing figures that need operational input and releasing figures that bear no credibility.  This must be judged on a case-by-case basis.

James Wilson is MD of Assista Consulting