The NHS is still predominantly paper-driven. That’s a situation we tried to fix with the National Programme for IT, with not enough success – and now the NHS is working towards a vision of becoming paperless and digital by 2018. Various parts of NHS England are addressing that challenge in different ways. In this article, I’d like to talk about our approach at Pennine, which is delivering results for us.
Pennine wants to become paper light in a very short period of time – and what’s more, our ambition is far-reaching, extending to legacy and active case notes.
Let’s provide some context to give you some idea of what that means in practical terms. Pennine is one of the largest acute Trusts in the UK, with around 9,000 staff operating across four hospital sites in North East Manchester, serving a local population of 800,000.
As with most acute hospitals today, medical notes and files are held in multiple locations and sites: which means getting access to the relevant medical information can be difficult and time consuming – and ultimately risky for the patient, if information at the point of care is not immediately available. Ideally, clinicians need to have access to the relevant information without worrying about whether that file is at another location.
What’s more, the patient records are taking up valuable space; it’s expensive to maintain this amount of paper. Active case notes alone (that is, medical files for patients that have been seen or are about to be seen) currently run to 230,000 files, while inactive case notes (medical files for patients that have not been seen for the last two years) are now at the 450,000 mark.
That’s why we went to market to find a technology solution – the Evolve EMR (electronic medical records) platform from digital technology solutions company Kainos. We want to develop e-forms and workflow and to end the processes that are creating all that paper.
Our new processes will take some time to get bedded in. There is significant scanning work first: over 100 million images in the first year – a process to be followed by a substantial on-going electronic capture over subsequent years to ensure as much paper as possible is removed. In total, around 450 million images are expected to be compiled here over eight years.
The project was possible because we won £4.2m of NHS England’s 'Safer Hospitals, Safer Wards' Fund. We are using this to implement the Evolve platform which we selected after an 11-month open procurement process. We awarded the contract in February this year to Kainos and their data capture services partner, the EDM Group.
One of the appealing aspects of the Kainos solution is the fact that we have control over our workflow and e-forms, so we can be wholly self-sufficient, configuring the solution to meet our needs. We also value the information we get from other Evolve NHS users; there is an active Evolve user group, so Trusts can share best practice. Even better, the Evolve customer portal allows Trusts that use Evolve to publish e-forms and workflow details that they have developed. It functions like a kind of app store, where you can download forms, leave comments and so on – very useful.
The first couple of months was all about gathering requirements, making sure we understood the approach to the deployment, agreeing timescales, deciding which specialities would go live first.
We are now about to start the phase called Model Clinic, which is Kainos’s method of ensuring we get ‘buy in’ to the solution at an early stage. Model Clinic will run over a number of weeks and will provide an environment that will allow us to show our clinical staff how the system works. This will allow them to provide input into how Evolve will be configured, and will help them feel comfortable with it when it’s rolled out.
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That’s vital for any new IT systems, but particularly so in the NHS, which hasn’t always found it easy to adopt new technology. In the end, the clinicians are the ones that need to get the benefit from the system and use it on an everyday basis, so they really need to be comfortable with what we are building and be satisfied that it meets their requirements.
After the Model Clinic, there will be user acceptance testing and dress rehearsals (January 2015 is the expected launch date for the new system). There will be a gradual implementation across each speciality, during which we will analyse existing paper and processes and map these to e-forms and workflow in Evolve.
Improve patient safety and make efficiency gains
Why are we doing all this? It’s all about patient safety. When someone attends our hospitals or clinics, their clinician needs access to the relevant information at the point of care. And it’s not just as straightforward as digitising a 500-page paper: it’s about ensuring that each file is properly organised so our people can get to that information quickly.
What’s more, patient information needs to be consistent across our other systems, so that there is a single correct and complete patient record. This means that our new EMR must be integrated with other clinical and non-clinical data sources across the Trust, such as results systems, cardiology systems and PAS systems.
There will also be cost savings, of course, as we phase out our paper-based medical libraries, and related savings, such as reduced transport costs. However, the project is really about delivering better patient care.
Where do we want to go next?
The next phase of our programme will make our EMR truly portable. People primarily come into hospital to be treated, but increasingly doctors and nurses are going into the community to see their patients.
Mobility is already more and more of a feature of NHS life and we need to accommodate this. So instead of the district nurse having to load up all the paper records in the boot of her car, complete more paper after finishing her round, then file it all, we plan to use the Evolve iPad solution to allow her to access and update patient records even when she is offline and disconnected from a network.
The iPad is not all just about field work, incidentally. Doctors talk a lot about ‘the last five metres,’ i.e. the gap between the workstation at the corner of the ward and the patient’s bedside. Having the patient’s details at the bedside and capturing information then and there will eliminate that last five metres and will help everyone.
Beyond that, we want to help other parts of the NHS get paperless too. We have a very powerful data centre capability here at Pennine and we have a lot of confidence in Evolve – so much so that we are considering hosting and providing services such as Evolve to other Trusts. That’s what we – and a growing band of like-minded NHS IT professionals – see as the road to a paperless NHS.
Sourced from Christine Walters, Director of IM&T, the Pennine Acute Hospitals NHS Trust