The SmartCare
Procurement and its
Vision for Evaluation
The Key to Breakthroughs in Patient Care
SmartCare
Gareth Evans – SmartCare Programme Manager - GHT
What is SmartCare?
SmartCare is the collaborative procurement and implementation of
a Managed Service for an Integrated Clinical Information System
Gloucestershire Hospitals NHSFT
Northern Devon Healthcare NHST
Yeovil District Hospital NHSFT
Background
All three Trusts are operating on legacy systems of 20+ years (HP
Swift/Swift+).
All lack functionality to capture true clinical information.
Limits the Trusts ability to progress with Clinical Pathways in an
integrated manner and satisfy NHS vision.
All have a history of aborted attempts to provide a full clinical
solution.
Vision
• Provision of current and sustainable systems and technical
infrastructure to support the Trusts to provide high quality patient
care.
• The collaborative will enjoy strategic benefits of better quality,
improved patient safety and efficiency.
• One patient, One record’ accessible wherever it is needed.
The Requirement
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Clinical Administration
Pathology
Pharmacy & Pharmacy Stock Control
Emergency Department
Theatres
Women’s & Children’s (Maternity + Neonatal + Paediatric + Gynaecology)
Oncology e-prescribing & Oncology management
Order Communications
Electronic Prescribing and Medicines Administration
Clinical Documentation, Decision Support and Reporting
Collaboration – Why?
££££’s – 4-Years of Central Funding offered for a collaborative
procurement.
Shared Vision
Shared Risk
Same starting point
Collaborative Procurement – How?
Joint Executive Sponsorship – CEO level
Joint Governance
Joint Requirements Development
Joint Clinical Leadership
Excellent Working Relationships
Excellent levels of understanding – Clinical & Business
Joint desire to succeed!
Procurement - The Restricted Procedure
Traditional route of Competitive Dialogue no longer approved for
Central Government backed procurement.
Specific & detailed requirements agreed by all – even clinicians!
OGC IT Services Contract to be applied – puts the restrictive into
Restricted!
Single Lot procurement with three Trust contracts
Clear procurement process, well managed.
Legal Involvement
Probably the Most Important investment!
DAC Beachcroft (other legal advisers are available)
• Excellent advice
• True collaborative working saves cost
• Experienced (on both sides of the fence)
• Investment saves time and money!
Evaluation – How we did it…..
Innovative Approach
Strong Clinical Engagement
Usability is key
Over 200 evaluators
• ITT response – 6-weeks
• Virtual Hospital – 5x Clinical Teams for a week
• Demonstrations – Multiple teams per day
• Finance – Lower weighting than usual!
Evaluation – What was different?
Virtual Hospital
Designed to enable evaluators to assess usability of a clinical system by means
of training and use.
Enabled subjective evaluation to be carried out in a structured manner
Full clinical involvement
Excellent vendor platform for demonstrating real usability
Virtual Hospital
A common problem with systems selected by OBS response and demonstration
is that staff will not have a clear view on how usable the solution is. This will
effectively alienate key staff groups, especially clinicians and result in a poorly
used and potentially unsafe solution.
Dr Michael Richards’ vision for resolving this issue was to create the Virtual
Hospital as a key part of the systems evaluation.
Virtual Hospital takes advantage of many system suppliers claim to provide
initial training in just a few hours for clinical and non-clinical staff.
Virtual Hospital
The objective of the Virtual Hospital process is to evaluate the usability of the
system in simulated real life.
In order to achieve this, a minimal hospital structure with clinical areas is
required to be pre-programmed into a training system.
Virtual Hospital - Structure
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ED: reception area, 12 bays and 2 resuscitation areas.
Medical Ward: reception area, 20 beds in 5 bays
Surgical Ward: reception area, 20 beds in 5 bays
Maternity suite: 10 beds and 10 delivery rooms
Theatres: Two main theatres and an emergency theatre – with the ability to
manage a real time waiting list for the emergency theatre list and schedule
cases to the elective theatres.
• Simple future outpatient appointments diary for each doctor in the Virtual
Hospital.
Virtual Hospital - Evaluation
The evaluation consisted of 5-teams of 10 people being trained in each system
and undertaking the Virtual Hospital scenarios:
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Ward Clerk: 1 acting for all areas
3 Nurses: 1 for each area ED, Medicine, Surgery
1 Midwife
4 Doctors: 1 each for ED, Medicine, Surgery and Maternity (1 Obstetrician)
1 Pharmacist: 1 to cover prescribing activity in all areas
Virtual Hospital – System Requirements
The evaluation system is pre-populated with patient demographics and clinical
information provided by the Trusts.
Basic functionality includes a basic clinical record per patient (Demographics,
Diagnosis, Allergy recording, Scheduling of Intervention/theatres).
Alert management; basic order comms; the ability to enter clinical vital signs
and results manually in response to orders; and to record prescriptions and
drug administration (including fluids).
Prescribing clinical decision support (allergies, drug-drug interaction) should be
included.
Virtual Hospital – System Requirements
Certain clinical assessments must be available with appropriate alert generation
to clinicians when the clinical data entered creates an identified patient at risk.
E.g. VTE, DVT, Pain Score Assessment, GCS, EWS with alerts.
Clinical Decision Support for prescribing must include Drug – Allergy interaction
alerts; Drug – Drug interaction alerts; and, as possible, Drug – Results
alerts/CDS and Drug/Disease alerts.
Virtual Hospital - Results for Orders
It is required that results for any orders placed need to be captured by the
system in the patient’s record.
This will be entered by a member of the supplier’s team acting as an ‘Agent
Provocateur’ (AP).
At any time after an order is placed the AP will select a pre-define flash card
from a pack representing the order placed (ie U&E flash card from the U&E
pack if a U&E test is ordered).
The ‘results’ on the flash card will be entered into the system in the patient’s
record.
Virtual Hospital – Clinical Data
Most of the clinical data to be entered by clinicians is pre-generated and is
available on flash cards to ensure all systems are exposed to the same core set
of data values.
There are two sets of flash cards:
• Clinician
• Results
Virtual Hospital - Clinician Flash-Card
Will provide data values for data captured directly by the role players: HT & WT,
VTE assessment, Vital signs, pain scores and these will be available to all
clinical role players.
When instructed by the scenario script or when the role player thinks clinically
indicated, the clinician should enter data into the patient record for the variable
set required (eg vital signs, HT & WT etc).
Any clinician can choose to enter clinical data anytime but should do so using
data from the clinical flash card.
Virtual Hospital – Results Flash-Card
Test investigation results are entered by the supplier’s Agent Provocateur (AP).
These cards are not available to the clinical role players.
The AP will select the flash card for the results of the test ordered by the
clinician and enter these into the system for the appropriate patient sometime
after the order is placed.
The role player will not be able to predict when this will occur and will have to
consult the system regularly to pick up new and abnormal results or alerts.
This process simulates real life and the presentation of the data by the system
will be assessed for usability.
Virtual Hospital - Summary
• Clinical Training – half-day
• Simulated real-time use against pre-populated system and clinical
scenarios.
• Simulated result abnormalities/alerts
• Clinical Decision Support
• Clinicians making decisions and entering data
• Assessment of system usability
• Judged by Clinicians!
Virtual Hospital – Did it work?
Yes! Virtually all clinicians agreed this was a useful evaluation tool.
The process identified issues related to usability in all systems
evaluated. However, it is a subjective method and care must be
taken to ensure suppliers have the opportunity to ‘drive’ the solution
in an expert manner.
What was the result?
InterSystems TrakCare
The Future
Safe, Efficient and Patient Centric EHR
Three Trusts aiming for HIMMS Level 6 at full Go-Live in two-years
Vision and commitment to move to HIMMS Level 7