The Trust is using Alfresco Process Services business process management (BPM) software as a platform to help hospital staff create electronic records. David Walliker, CIO at Liverpool Women's NHS Foundation Trust, says this kind of digitisation programme helps sponsor life-changing advances in healthcare, even when NHS funding continues to be constrained:
“The only way that we're going to resolve that gap in funding, apart from getting lots of new money, is to be more efficient – and to drive that efficiency, you need digital transformation. Rather than making arbitrary 10 per cent cuts across the board, your move to improve efficiency has to be driven by digital.”
Putting the power of data into the hands of staff
Liverpool Women’s NHS Foundation Trust is one of only two hospitals in the UK dedicated to the care and treatment of women and their families. As well as being CIO at the Women’s Hospital, Walliker also splits his working week between being CIO at another hospital in the city, the Royal Liverpool and Broadgreen University Hospital NHS Trust.
Walliker – who joined Liverpool Women’s in April 2013 and assumed the CIO role at the Royal in January 2015 – is using his experience to drive a digitisation programme at both institutions. While he has access to in-house development talent at the Royal, Walliker has more limited IT staffing resources at the Women’s Hospital.
He was keen to find a platform that would help hospital staff create their own electronic forms (e-forms). After assessing the market, Walliker chose to implement Alfresco Process Services business process management (BPM) technology in 2014 and is now using its open automation engine to support the creation of custom e-forms by staff:
“We were using very junior admin and clerical staff, with no IT programming experience at all but who, within a matter of weeks, had brought e-forms into the emergency room, for telephone triage and escalation, and into genetics for the management of referrals. So, for us, from the Alfresco perspective, that was the hook that got us started.”
Prior to the creation of Alfresco-supported e-forms, nurses responding to emergency telephone calls created hand-written paper triage forms as a record of the call. This legacy way of working meant potential delays in the clinical pathway, as clinicians were unable to get a timely view of the data collected prior to the patient’s arrival.
Now, staff in the Women’s Hospital Emergency Department can use the custom e-form to capture information from each patient touch point electronically. In fact, Walliker says the e-form system is so easy to use that staff in all parts of the hospital are using the technology to create tailored forms, with specific questions for individual patients:
“We realised you didn't need to be a programmer to develop e-forms. And because Alfresco includes the business process mapping in the background, we can process the information from a mandatory question for a patient – such, as do you smoke? – more effectively. That information will only be useful to a select group of healthcare professionals. If you’re a nurse, and a patient is in hospital with a fractured wrist, you don’t necessarily need to know if they smoke.”
Using data to improve organisational processes
The Women’s Hospital’s e-forms support a consistent approach to data collection that allows staff to collect and process information quickly. Walliker says the lesson for other CIOs is that digitisation shouldn’t simply replicate existing legacy paper-based processes. Healthcare IT leaders must use digital transformation to improve business processes:
“What you don’t want to do is create a dynamic form that suddenly includes all these additional, unrequired elements because a patient answered ‘yes’ to a specific question. If you do that, you’ll end up with a big form that people have to stroll up or down – they get turned off. Healthcare staff want the information they need at the point of care.
“We realised we could use the Alfresco business-processing elements as a trigger to then initiate the right kind of documentation for the person who needs to see it, while retaining the integrity of the record for everyone else. From a medical perspective, what staff need to know are the bits of patient information that are important to them. That means we can be much more targeted.”
Walliker gives an example of how the power of digitally collected information can help with the crucial work of monitoring patients with sepsis. Patients with sepsis have to be given antibiotics immediately. Walliker is now exploring how Alfresco’s open BPM technology can be used to help collect information on patients electronically, to analyse the risk of sepsis and to push alerts to clinical staff around the hospital as quickly as possible:
“Should nurses be logging on to a dashboard to find out whether a patient potentially has sepsis, or can they be out and about on the ward and get a push message to their phone in a secure messaging environment that says a patient needs antibiotics immediately? That approach gives the news to the nurses that they need and it’s something that we’re actively exploring right now. It’s not about re-engineering everything we've done, but it’s about improving everything we already do by making use of Alfresco’s business-process elements.”
Therefore, Walliker continues to explore new ways to make the most of his Trust’s progress around digitisation. Yet it’s also important to recognise his digital transformation efforts are not just limited to the partnership with Alfresco at the Women’s Hospital. Walliker is pushing digitisation efforts in his other role as CIO at the Royal, with the Trust selected as one of NHS England’s Global Digital Exemplars. Walliker says further healthcare innovation is reliant on vendor partners and healthcare organisations supporting openness:
“I'm quite confident I can do that at the Royal and the Women’s Hospital, but how do I do that with the related organisations that have their own systems, standards and vendors? Until all the vendors make their systems completely open, we’re always going to face an underlying challenge.”