Papworth Hospital prescribes digital for its own village-to-city transplant

SUMMARY:

Ahead of its proposed move to Cambridge, Papworth Hospital is looking to get staff accustomed to electronic ways of working.

Papworth Hospital  has come a long way since it first opened in 1918 as a tuberculosis colony in a village 12 miles west of Cambridge, UK – much further than the ageing and cramped buildings it currently occupies might suggest.

SONY DSCIn 1979, it was the venue of the UK’s first successful heart transplant. In 1984, surgeons performed Europe’s first successful heart-lung transplant there, following up their achievement two years later with the world’s first heart-lung-liver transplant. Over the years, it has built a worldwide reputation as a specialist cardiothoracic centre.

Now, staff at Papworth are preparing themselves for yet another pioneering transplant: the move to a brand new, £165m site on the Cambridge Biomedical Campus, where Papworth will become next-door neighbour to two other hospitals (Addenbrooke’s and the Rosie) and to Cambridge University’s medical school.

Papworth’s move to Cambridge has been many years in the planning and dogged by delays and controversy, but with HM Treasury approval granted in May 2014, it now looks highly likely to go ahead. Construction is expected to get underway next year and will take three years.

For David Wilcox, the hospital’s business change and information management and technology project manager, the run-up to the move will largely be spent bringing some order – and a hefty dose of technology – to the way that Papworth Hospital handles medical records, because there won’t be a library for paper-based records at the new site.

Long term plan

Digitisation of these records has been something he’s been weighing up for some years, in common with many other colleagues within the UK’s National Health Service (NHS).

Back in 2010, and expecting the move to Cambridge to happen sooner, he had already worked up a proposal to back-scan Papworth Hospital NHS Foundation’s Trust’s existing store of paper-based records. But delays to the proposed move gave him the opportunity to rethink that strategy, he says:

The idea now, in the time we’ve got left before the move to Cambridge, is to start reducing the paper we generate today, by producing as much of it electronically as we can.

Instead of scanning legacy records, Wilcox and his team are instead focusing on digitising the start of a patient’s journey at Papworth – the point at which they are referred to the hospital, either by their family doctor (a general practitioner, or GP) or by doctors working at another, less specialist hospital.

With that in mind, Papworth Hospital went live two months ago with a new e-referral system, based on technology from document management software company CCube. So far, this has only been rolled out to the hospital’s cardiology area, but it’s the largest area in the Trust, Wilcox points out. It will be rolled out to the rest of the Trust by Christmas 2014.

The referrals process is an important one. In the UK, all NHS patients are promised by the government that they will start consultant-led treatment within a maximum of 18 weeks from referral. NHS Foundation Trusts can be fined (and are) for missing that target.

The trouble is, because of the specialist treatment that Papworth offers, many patients are already some way along that 18-week pathway by the time they are referred to the hospital, says Wilcox:

We’re sometimes a long way down the chain. It’s actually quite difficult to work out where people are on that pathway and the amount of paperwork involved is phenomenal… so the clock is already ticking.

Now, all referral letters are scanned into the electronic medical records (eMR) system on arrival at Papworth. Immediately, two workstreams are created – one clinical, one administrative.

This way, clinicians can see those letters in the eMR system, with all supporting notes, allowing them to document the treatment they propose for that patient, which clinic should be involved, and whether that patient should be added to a waiting list or fast-tracked, either to themselves or another colleague. Their secretaries, meanwhile, can see what’s happening, so that they can arrange appointments.

On the administrative side, the health records team can check out the patient referral and register that patient, checking ‘clock start’ dates and the patient’s progress along the 18-week pathway status.

The introduction of this system, according to Wilcox, kills a number of birds with stone. Most importantly, it introduces new efficiencies that are better for patients – but it also gets Papworth staff accustomed to working electronically. That will be important as Papworth makes the move to Cambridge.

Stepping stone

 

In late October, Addenbrooke’s Hospital became the first hospital in the UK to go live on the Epic electronic patient record system, used by many hospitals in the US. When it joins Addenbrooke’s on the Cambridge Biomedical Campus, Papworth hopes to use that system, too – and the digitisation of the referral process now offers it a clear pathway to doing so.

But it also means that Papworth might be free to relocate, unencumbered by years of paper-based records, says Wilcox:

The combination of CCube and the [proposed] implementation of the electronic patient records system that Addenbrooke’s has got – those two things together should mean that, by the time we move the hospital to Cambridge, we could be paper-lite or paper-free.

At Papworth, as at most NHS Trusts, the digitisation of patient records is far from complete – but this is a significant stepping stone along that path.

A major priority for Wilcox now is to extend digital patient information to the hospital’s team of transplant co-ordinators. When a donor organ becomes available, often through sudden, tragic circumstances, it’s vital that they are able to quickly check whether a Papworth patient might be an appropriate recipient for that organ. Right now, on-call transport co-ordinators are forced to carry around “two huge, metal cases” of documents relating to potential recipients.

Sometimes, donor organs will match with Papworth patients. Sometimes they won’t – but they’ll be suitable for other UK patients, waiting for them in other NHS units around the country.

Either way, digital patient records, easily accessible to authorised medical personnel from wherever they happen to be, will go a long way to making sure that precious donor organs reach the right person, at their most urgent hour of need.