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QEQMH stand alone system on 2 lap top computers. Clinics held in 2 different out-patient ... Mr Donald Duck 632767. D day. IT @ EKHT and 4S both brilliant. Manual ...

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Merging of two v6 dawn databases l.jpg

Merging of two v6 DAWN databases

Joanna Nightingale

Head Biomedical Scientist

East Kent Hospitals NHS Trust


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East Kent Hospitals NHS Trust

  • QEQMH – stand alone system on 2 lap top computers

  • Clinics held in 2 different out-patient areas

  • Clinic also held at primary care site

  • 1700 patients on DAWN

  • DAWN not used for letter generation


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  • Kent and Canterbury hospital

  • Networked DAWN

  • Used remote user license for PCT sites

  • 3500 active patients on DAWN

  • Approx 2000 patients not on DAWN


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  • William Harvey Hospital

  • Pharmacist led out-patient appointments

  • Paper based system

  • Approx 1700 patients being anticoagulated


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Models of service delivery using DAWN

  • Out patient clinics

  • Postal service

  • Patients self testing

  • In patient dosing

  • INR’s entered manually and via an interface


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The vision

  • One database for seamless patient movement across Trust sites.

  • Upgrade to V7.

  • Introduce DAWN V7 onto WHH site.

  • Equilibrate services for patients which ever site they visit.


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Local issues:

  • Ensure all aspects of service from QEQMH could be delivered across a network

  • Printing issues A4 letters / label

  • Merging of databases. Patient data on both systems

  • Different practices

  • How to train users


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Pre merger and upgrade considerations

  • Data cleansing

  • Training

  • Printing

  • Clinic flows

  • Process maps


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Data cleansing

  • Drugs with duplicate descriptions

  • Organisations with duplicate descriptions

  • Patients with DOB requiring investigation

  • Patients with duplicate hospital numbers

  • Patients with duplicate name / DOB combinations

  • Patients with >1 result on same date


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Data cleansing 2

  • Patients with no prime AC reason

  • Patients with start dates in need of investigation

  • Patients without a dosing regime

  • Patients without a target range

  • Treatment dates in need of investigation


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  • KCH deemed controlling site

  • Master lists from KCH

  • All QEQMH data appended or amended to fit the master list

  • All duplicate patients had to be assigned to one site only. Data from subsidiary site had to be entered onto record manually.


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Pre merge / upgrade data checks

  • Required 2/3 people

  • Slow

  • Managed 2-3% of database over 10 working days

  • V6 not as well formed / clean as hoped

  • Many notes typed in V6 inserted in strange places!

  • V7 not intuitive


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Training on V7

  • Delivered by 4S

  • On site

  • Via IT link sharing desk top with 4S - using BRIDGIT software


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Trial conversion data

  • Initially thought number of patients going up did not match number of patients arriving back

  • Data copied into practice system for training

  • Interface difficult to test. Flat field also being upgraded to HL7

  • Letters needed to be tested


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Show stoppers for EKHT

  • Letters / printing

  • Further data take off to validate patient numbers and records


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  • 17/08/2006 INR 1.7 Sun Mon Tue Wed Thu Fri Sat

  • 4 3 4 3 4 3 4

  • Warfarin mg/day

  • NEXT TEST 1 WKS Aug 24Mr Donald Duck 632767


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D day

  • IT @ EKHT and 4S both brilliant

  • Manual system for 2.5 days in total

  • Un-anticipated problems with firewall to get the sparkly product back in.


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Advantages

  • V7 is well loved product

  • Information on screen is much more visual

  • Deemed a robust and modern product by IT @ EKHT

  • IT felt very successful software merge and upgrade


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Disadvantages

  • Looking forward to software upgrade

  • More mouse strokes on V7, some RSI

  • Errors with new users not accepting dosages correctly

  • Batch dosing not available – using customised list views. Process is slower but less errors in lab

  • Printing always seems problematic!


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Look at us now!

  • So now we have 1 database for QEQMH and KCH

  • WHH ready to go live in pharmacy / pathology

  • We have our first PCT site dialling in as second organisation and recording their clinic information on the database


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The future

  • All in patient activity recorded on all 3 sites

  • WHH about to go live using DAWN – awaiting printing solution from IT @ EKHT

  • Further PCT sites (GP practices and PCT hospitals) to dial in and share database

  • PCT pharmacy practices need coded connection roll out for access


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