St Helens NHS Trust – Using digital records as a platform for better patient care

SUMMARY:

As director of informatics at the NHS Trust, Christine Walters, is getting doctors and nurses to use their keyboards and away from mounds of paper.

NHS HealthSt Helens & Knowsley Teaching Hospitals NHS Trust is combining the digitisation of patient records with pioneering innovations in other areas of healthcare technology to boost operational efficiencies and patient experiences.

As director of informatics at the Trust, Christine Walters manages a shared informatics service that provides technology to a range of organisations, including two hospitals, a mental health trust, GP practices and local councils. Walters says she engages with senior business peers and clinical staff to implement technology that changes healthcare for the better:

To be successful at leading an IT organisation, you need to have a visionary board that is prepared to invest in technology and which recognises what it can do. The key to being successful as a CIO in healthcare is that you need to have a genuine passion for the role.

Walters was appointed to her board-level position at the end of September 2015 and continues to push digital transformation at the Trust. One of the key foundation technologies supporting this work is an electronic document management system (EDMS). The Trust first implemented a customised version of CCube Solutions’ EDMS in 2010, becoming the first NHS organisation to stop using paper records in operational practice. Walters has overseen the recent system improvement to CCube EDMS v.4, which provides a range of benefits:

We’re the first Trust in the country to run the upgrade and it’s made a big difference. The new version offers better workflows for our staff as they move towards a paperless future. There’s also a focus on structured data collection because there’s no point in just bringing together information without strong categorisation. The new system supports better forms of data analysis and has been designed to work across a range of mobile devices and operating systems.

About 130,000 medical records were digitised at the time the EDMS was originally implemented around the turn of the decade, which produced £1.4 million in annual savings for the Trust. Walters says the updated version of the platform enables her team to meet the aim of delivering electronic health records to the point of care in every setting to every patient. She says the reason EDMS is helping to produce such clear benefits for the Trust and its patients is due to strong organisational buy-in:

The system was designed and built with the clinicians in a way that suits how they want to work. I think that’s a key lesson to be learnt from an EMDS implementation. It’s very easy to go on the web and find lots of healthcare IT failures and it’s not so easy to find the success stories. I can honestly say that in the two years I’ve been here, we haven’t had one email about the EDMS system – and usually your in-box is a good barometer of how your system is performing.

Benefits

Walters says EDMS has helped in three key areas – clinical engagement, efficient and robust processes around the scanning of paper, and providing information to staff in a timely manner. She says the associated implementation of a scanning bureau at the Trust has helped staff to move away from a reliance on paper and towards a recognition that digital transformation can help boost organisational effectiveness:

Any paper that is generated, we collect if from the wards twice a day and it’s scanned and available for clinicians and patients within 24 hours. That fast turnaround means our clinicians know that the information is going to be available to them when they go into the EDM and they know it will be up to date. The system is not just about scanning paper, either. It’s a solution to help us capture results, investigations and any reports. It’s provided a confidence factor for staff, who all use the system – it’s the first port of call clinicians go to look for patient information.

The EDMS mirrors the old paper medical file and displays key information, such as patient name, appointment time and last doctor’s letter. The information in the system is organised in a series of 140-or-so chapters that help clinicians delve into a patient’s medical history quickly. During the EDMS implementation process, more than 500 doctors and 130 medical secretaries were trained, with the technology gradually rolled out over 22 months. Walters says clinical staff have been crucial to the introduction of EDMS:

The system was designed by them and for them. I’ve been to hospitals all over the country and I think the Trust now benefits from the most efficient scanning bureau I’ve seen. When you walk around the hospital, there’s hardly any paper because new information is scanned as quickly as possible. The whole process is very impressive.

A broader scope

Walters says development work around EDMS has provided the foundation for a broader digital transformation across the Trust. She refers, for example, to the recently introduced electronic modified early warning system (EMEWS), which helps alert clinical staff to the patients that require priority treatment. When a patient is discharged from hospital, their observational information is automatically placed in the EDMS and is immediately available for other healthcare organisations in the Trust, such as GPs. New systems like EMEWS, says Walters, are linked to – and integrated with – the EDMS:

It’s enabled us to bring in new technology much more easily because clinical staff are used to working with the services every day. One of the hardest things to do when you bring in electronic patient records is to get the clinicians to stop using paper and to start using keyboards.

Work on creative solutions to business challenges continues apace. Walters is currently developing the business case for the introduction of a ‘smart apps’ development team. The initiative will focus on the creation of applications for phones and tablets that help with issues of patient management, such as directing people to the right services at the right time. Once again, Walters says this type of innovation is being considered because the shared service supports joined-up thinking:

A collective and collaborative approach allows us to think about areas of innovation that might otherwise be outside the remit of an individual hospital. It’s a very exciting project. I hope we are going to get the funding. We’re trying to build a business case that both demonstrates the benefits and justifies the investment.

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    1. Boris Bard says:

      I observe and participate, in different capacities, the transfer of paper medical records to electronic from 2000. It is, indeed, a very progressive move that can bring a lot of benefits. Yet, it is important to buy a right software. Otherwise, you may end up with millions spent and your staff busy with up to 25% of the time trying to input the data that they can’t use / extract latter on.
      There are few principals you must have:
      1. Structural (not narrative) impute of information.
      2. One place to enter all information (assessment and intervention).
      3. Dynamic representation of patient’s abnormalities
      4. Capacity to easy customize personal risk flagging based on a customized abnormality.
      5. Total time you nurses spend with a software during their shift should be no more then 5% of the time.
      Do not trust your software vendor on it. Check it physically yourself.
      There are not that many specialists there who have both front-line nursing (the main source for the information volume is nurses) and software/database knowledge and experience. Usually you have a team of a people with different skills and for whatever reason IT people always end-up leading the show to their direction.
      Generally speaking there are two main data based structure on the market: 1 – multiple forms based and 2 – flow sheets based. Only second can provide you with above principals.
      More about it here: http://shalva.ca/media/ecc6759db0a214d5ffff8630ffffe41e.pdf
      Boris.

    2. Tim Haynes says:

      This information is well received and found to be interesting. As many of the comments in the article are sound, the article falls short of discussing the overall benefits and current problems.

      The benefits are falling short of what is needed relative to improved patient care. As an RN that works with EHR/PM software there has been very little discussion about the information that is contained in all EHR’s. Each EHR vendor touts themselves as the best software program as each one offers unique functions both similar and different from others.

      Although the Federal Government has as usual put themselves square in the middle of this discussion, they have done nothing to increase better patient care. In reality their intrusion to this facet of healthcare has harmed patient care. Providers are so against the governmental intrusion, their unhappiness and inefficiencies of their practices has been an impediment to improved patient care.

      Where documentation has improved, why hasn’t the ability to share this information among different formats of each of the software vendors? Where Federal controls have gradually increased, patient care has not improved appreciably through the last many years. The Federal carrot and stick was supposed to influence providers to adopt EHR’s. It did indeed serve that purpose yet after the fact, the government realized too much money was paid out and began the expected pull back of monies paid out.

      We all fought our way through the confusing and many times last minute changes of the MU program by CMS. Their process reminded many of us that it was run and managed by smart 1st graders. Now we have another program (MIPS/MACRA) that makes the current Tax laws look transparent. Again all of this under the guise of better patient care. I can’t even say this with a straight face – it is laughable.

      When efforts and funds are put into improved efficiencies of physician’s practices and the better ability to have patient data shared between practices all of this is for naught and will continue to be a waste of time and especially money!

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