Paper-light Out Patient Services at the Queen Elizabeth Hospital Birmingham Tuesday, 2nd October 2012 Deborah McKee, EPR Programme Manager Organisational Introduction – University Hospitals Birmingham NHS Foundation Trust (UHB) is a leading university teaching hospital. – Staff of 7,500 people work across more than 40 disciplines. – On 16 June 2010 UHB’s new £545 million Queen Elizabeth Hospital Birmingham opened. This will be the largest single site teaching hospital in Europe. It has 1,213 beds, 30 theatres and the largest critical care unit in Europe with 100 beds. Organisational Introduction – The Trust has the largest kidney programme in the UK, is a major specialist centre for burns and plastic surgery, and neurosciences, and has a specialist cancer centre. – UHB is the major provider of NHS Research and Development in the West Midlands. Birmingham was the first designated Cancer Research UK Centre in the UK. – UHB has the largest solid organ transplantation programme in Europe. – Provides medical services to military personnel evacuated from overseas. UHB has the full range of medical specialties needed to treat the complex nature of conflict injuries, all under one roof. – In 2010/11 UHB saw 544,876 outpatients, >68,000 inpatients, >33,000 day cases, and >87,000 A&E attendances – a total of 734,924 EPR Status circa 2008/09 • Trust still looking to National Programme for integrated EPR solution • Reliance on paper-based medical records across all services • Mixed economy for clinical transcription – analogue tapes OR outsourced digital dictation • e-Prescribing and clinical decision support via PICS (in-patients only) • 189 disparate IT systems holding patient clinical data • EPR – what EPR….?!! KEY CONSIDERATIONS • Mandate for Project – we need one! • What makes an effective electronic patient record? • To scan or not to scan? 1.4 million records in off-site library >40,000 supra-regional specialty notes for transplantation • Methodology for data capture – how are we going to do this? • Organisational Culture – rooted in paper • New PFI Hospital opening in June 2010 – Designed to be Paper-light in OPD…. TIMELINE – DEVELOPMENT TO DELIVERY • December 2008 – Project Initiated to scope and develop Electronic Patient Record (Documentum document management system acquired) • Programme Manager appointed • Clinical Engagement – Requirements and Change Management Scoping (rules for data retrieval/data in-put) • Phase 1 Design, Develop, Test Clinical Portal - January 2009 to May 2009 Proof of Concept Pilot – May 2009 to November 2009 Roll out Trust-wide - January to June 2010 Parallel roll out of digital dictation (enterprise wide) • Phase 2 Design, Develop, Test - Clinical Noting in PICS August 2010 to March 2011 Proof of Concept Pilot – March 2011 to May 2011 (Renal, Respiratory, Maxillofacial Surgery) Roll out Trust-wide – June 2011 to September 2011 (aligned with phased move into QEHB out patient facility) Parallel roll out of in-house scanning application Parallel roll out of electronic operation notes in PICS TIMELINE – DEVELOPMENT TO DELIVERY • Pre-equipping of new OPD facility – new PCs and digital pens in every room (250 consulting rooms) • Training – huge programme of training aligned with phased move to QEHB • >2000 clinical staff trained (consultants, registrars, nurses) • Mixed mode training delivery • Dedicated on-going support in clinical areas post go-live • Enterprise-wide digital dictation fully rolled out • Out Patient teams weaned off paper-based medical record Key Components of UHBFT EPR in OPD • Out Patient Tracking: Self check-in OPTIMS e-outcome form • Data Retrieval: Clinical Portal Integration with digital pen and digital dictation • Data Input: Outpatient PICS • Document Management : Digital Dictation Direct upload from PICS – Discharge letters/out patient clinical noting/operation notes Scanning of in-bound correspondence Communicating with Other Providers – NORSE (neuro referral system) • Communicating with GP’s Electronic Document Transfer Directly to GP systems GP Practice Page • Communicating with Patients Patient Portal HARDWARE… A Journey from this - To this – Out Patient Tracking….. And this – Data Retrieval - Clinical Portal….. OPD PICS Electronic Clinical Data Capture • • • • • Consultation workflow Co-Morbidities (Quick Pick) Drug History & Prescribing Clinical Noting Clinical Observations (BP, Height/Weight/BMI/Urinalysis) • Concept of face-to-face or non face-to-face consultation • Integrated digital pen technology • Integrated with WinScribe Note free offices, digital dictation and digital pens ELECTRONIC WAITING LISTS – A solution developed with UHB partner “Airpoint” • Data can be accessed quickly by the On-Call Surgeon from their BlackBerry when they receive a call from the On-Call Transplant Coordinator regarding a donor organ • The Surgeon can navigate the list whilst speaking to the Co-ordinator • The BlackBerry application replaces the reliance on carrying a paper lists • Data is held securely on the encrypted BlackBerry device Communicating with other providers - NORSE • NORSe – Neurosurgery On-call Referral System. • An internally developed web application which allows clinicians at other trusts to submit referrals to UHB Neurosurgery. • UHB clinicians have mobile access to NORSe on their Blackberry Webalo – Addressing mobile solution challenge – Challenge: Provide KPI dashboards to senior stakeholders and provide access to live applications to support clinical and operational needs. – Solution: The use of Webalo to provide the enterprise-to-mobile infrastructure, data and functions on Blackberry – Benefits: Access to enterprise applications and data. – Significant reduction in development lifecycle compared to other approaches. – Secure and encrypted. – Robust, scaleable and reliable. – Easy to manage. – Reduces deployment and operation overheads COMMUNICATING WITH GPs Electronic Document Transfer to GPs • Live in 68% of South Birmingham GP Practices • >20,000 documents per month transferred Communicating with Patients…. Current Position • Routine provision of paper medical record ceased with final implementation: Average requests for OPD medical records pre-QEHB 7,400/week • Average requests to date post QEHB less than 2000 – 90% reduction • 1250 unique CP log-ins per day accessing >8,500 patient records (Jan 2010: 62 unique log-ins/day accessing >200 patient records/day) • All clinicians participating in electronic data input in OPD PICS • 88% Patients using self check-in • Standardisation of administration process , clinical workflow and patient flow around OPD • Launch of MyHealth Patient facing Portal Next Steps – enhanced electronic solutions • Continue to design electronic patient record solution in the “admitted” patient groups • Enhancements to support Research & Development portfolio • Next iteration Clinical Portal enhancements – enhanced patient tracking • Order Comms for Laboratories and extend IP Order Comms concepts into OPD • Results Tracking • Electronic Document Transfer from GP practices • Speech Recognition • Mobile Community working: VPN: BlackBerry • Electronic Consent Questions?