Allscripts Enterprise EPR
Strategies for the NHS: An Incremental Approach
Gary Mooney
Solutions Director, Europe
Copyright © 2013 Allscripts Healthcare Solutions, Inc.
Challenges for NHS Acute Care
• Flat-line funding with increasing cost base
• Increasing burden of chronic illness from an ageing population
• Potential reduced revenue generation for acute care
• New and expensive clinical technologies
• Increasing public expectations
• Ever present demand to ‘balance the books’
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Clinical sophistication / capability
Clinical Performance / Outcomes
Systems support (paper / electronic)
Rate Limiting
Affect
Digital computing
Innovation
Time
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Our Age of Anxiety is, in great part, the result of
trying to do today's job with yesterday's tools and
yesterday's concepts.
Marshall McLuhan
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4
Recent Barriers for EPR Adoption
• Focus on PAS – linked to revenue generation
• Systems capability
• Too much emphasis on ‘what’ as opposed to ‘why’
• Commercial models / supplier relationships
• Big-Bang or nothing
• Integration / interoperability
• National programme
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5
Allscripts Strategy for the NHS
• Enterprise EPR platform
• Focus on clinical services and outcomes
• End the battle between best-of-breed or monolithic choices
• Integration and interoperability across services
• Strategic Customer Relationships
• Shared vision of and commitment to success
• Joint risk and reward
• Pragmatic flexibility from all parties
• Flexibility in Deployment
• Operational and commercial model to reflect customer requirements
• Big-Bang, Phased, Incremental models
• Underpinned by strategic relationship
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6
AN INCREMENTAL ENTERPRISE EPR
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One Platform: A Complete, Integrated Solutions Portfolio
Financial
Clinical
Administrative
Electronic Health Record
Community
Solutions
Payerpath
Analytics
Services
CQS
Management Consulting
Analytics
Education
Speed to Value (Ready)
ePrescribe
Practice Management
Acute Care
Patient Financials
Emergency Care / ED
Financial Manager
Pharmacy
Acute
Solutions
(Sunrise)
Access Management
Record Manager
Enterprise Identifier
EPSi
Outsourcing
Patient Flow
Remote Hosting
Clinical Analytics
Management Consulting
Laboratory
Network & Desktop
Knowledge-Based
Charting
Education
Speed to Value
Acute Content
Identity & Eligibility
Knowledge-Based
Medication
Administration
Radiology
Care Management
Homecare / Hospice
Post
Acute
Solutions
Health
Economy
Solutions
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Analytics
Referral Management
Management Consulting
Education
Community Exchange
Community Record
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Helios
8
Portals
Clinical (acute & community)
Patient
Enterprise Integration Gateway
ED
CLMM
OCRR
CDS
Speed to Value ™ Deployment and Outcomes Toolkits
Existing Analysis
Admin
&
Systems Reporting
Patient Flow
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Clinical
Docs
ICU
3rd Party Clinical Solutions
Analytics
Existing PAS
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+++
Mobility Platform
Integrated Modular Clinical Platform
Web Portal
Platform
Incremental EPR Structure
Allscripts Speed to Value ™
• Implementation methodology based on 000’s of deployments
• Provides a baseline EPR configuration enabling efforts to be
focussed on local operational and clinical practices and priorities
• Enables ROI to be delivered in a shorter period of time
EPR
Preconfigured EPR
Prebuilt Hardware
Configurations
Prepackaged
Specialty Content
Plug & Play
Interfaces
Best
Practices
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Advanced Client Portal
Example Outcomes Toolkit
Central Line Acquired Blood Stream Infections
• Configuration bundle
Catheter Related Blood Stream Infections
• Real-world outcome measures
• 64.9% reduction in CLABSI (NYHP)
• 69.6% reduction in CLABSI (Morgan Stanley Children’s)
• 50.5% reduction in CRBSI (Piedmont Hospital)
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RN
ED Triage Note
initiated
Central line
present on
admission?
YES
Document present
on admission
Central line
inserted?
YES
NO
NO
Initiates Admission
Profile
Central line
present on
admission?
YES
END
Document present
on admission and
insert date if
known
Central line
inserted?
NO
END
YES
Document
Insertion on
Assessment and
Care FS
Document removal
on Assessment
and Care FS
NO
System
MLM: Is specimen
collection date and
time within 48
hours of
admission?
YES
MLM populates HI:
visit problem
catheter-associated
blood stream infection
999.31 with Status:
PENDING REVIEWPOA
MLM populates HI:
visit problem
catheter-associated
blood stream infection
999.31 -Status:
PENDING REVIEW
NO
Provider
• Central line documentation and insertion date in
Admission Profile
• Central line documentation insertion and removal times
in Assessment & Care Flowsheet
• Central line bundle elements in Assessment & Care
Flowsheet
• Blood Culture order
• Clinical decision support for alerts and calculations
Emergency Dept
9/17/2010
Document Line
inserted in ED with
type, size and
other details
recorded in free
text field
Orders Blood
Culture
Reviews HI with PENDING
REVIEW STATUS.
Changes status to
INACTIVE, ACTIVE, OR
ACTIVE POA to confirm
Present on Admission
Calculates
Line Days onto
A&C flowsheet
Improved Clinical Quality Outcomes
Compliance with Evidence-Based VTE Prophylaxis
DVT/VTE Rate per Bed Day
Intelligent Order Set
95%
Confidence
Interval
Improved
Outcomes
95%
Confidence
Interval
95%
Confidence
Interval
1
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
Week
• 62.6% decrease in mean DVT/VTE rate
• Approximately 302 fewer patients suffering from VTEs each year (for hips at risk only)
• $736,578 reduced variable costs; 0.8 days reduced mean LOS
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39
95%
Confidence
Interval
IN SUMMARY…
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Allscripts Europe
• Focussed on establishing meaningful strategic customer
relationships
• Structured to support big-bang and incremental EPR
deployments
• Will work with existing suppliers to protect and enhance
existing investments
• Has committed to a long-term regional presence to support
the NHS to overcome key challenges and deliver improved:
•
•
•
•
Clinical outcomes
Patient Safety
Operational efficiency
Fiscal performance
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