Paper-light Out Patient Services at the Queen Elizabeth

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….?!!
• 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
• Methodology for data capture – how are we going to do
• Organisational Culture – rooted in paper
• New PFI Hospital opening in June 2010 – Designed to be
Paper-light in OPD….
• 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
• 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,
• 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
Key Components of UHBFT EPR in OPD
• Out Patient Tracking:
Self check-in
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
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,
• 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
– 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
• UHB clinicians have mobile
access to NORSe on their
Webalo – Addressing mobile solution challenge
– Challenge: Provide KPI dashboards to senior stakeholders and
provide access to live applications to support clinical and operational
– 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
– 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%
• 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
• 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