the paperless hospital is it achievable colin sweeney director of ict
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The paperless hospital – Is it achievable? Colin Sweeney Director of ICT. Agenda. Background How paperless are we? EDMS v active record The Pre-requisites What have been the big achievements? Rolling out EPMA across the hospital

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Presentation Transcript
agenda
Agenda
  • Background
  • How paperless are we?
  • EDMS v active record
  • The Pre-requisites
  • What have been the big achievements?
    • Rolling out EPMA across the hospital
    • Making continuation notes electronically to increase accuracy and legibility
    • Developing new methods of digitally viewing vital signs using mobile devices
    • Utilising electronic data to audit department\'s performance and improve patient care
  • What is missing?
  • Obstacles and issues
king s epr milestones
King’s EPR Milestones
  • 1999 Implemented pilot of the initial EPR vision
  • 2002 Completed roll out of orders and results as first stage of EPR
  • 2000-2 Discharge notifications and TTA drugs
  • 2003 Replaced old IRC PAS with i.PM
  • 2004/5 PACS
  • 2005 First attempt at inpatient prescribing
  • 2007 Moved i.PM to CSC as part of iSOFT7
  • 2009 Inpatient noting
  • 2008-2010 Inpatient prescribing roll out
  • 2010 to date – KSSF to help move to paperless/light hospital
  • 2012 Wardware to calculate Early Warning Scores
  • 2012 Assessed by HIMSS as a level 5 EMR
  • 2013 Acquired Princess Royal Hospital
slide4

Vision and Tactics

Our Vision

A single point of access to information about individual patients in electronic real-time format

How do we get there?

An EPR is a Strategy not a System

what does that mean

i.CM/EPR

RIS

KCH develop-ments

PACS

NNB

Score-cards

Maternity

Choose &Book

i.PM/ PAS

What does that mean?

Data Ware-house/ABC

Theatres

TIE

Pharmacy

E-PSB

Pathology

Finance

A&E

Payroll

PICU

ESR

Specialty

systems

E-Rost-ering

E-Learning

NHS Mail

pre requisites
Pre-requisites
  • Reliable and stable Infrastructure
    • Wireless and wired
    • Enough equipment
    • Right equipment
  • Committed and dedicated people
    • Executive
    • Clinical Users
    • ICT staff
edms pros
EDMS-Pros
  • Provides a complete record
  • Availability
  • Saves on storage space
  • Savings on folders
  • Potential savings on prep clerks
  • Potential savings on archive/retrieval
  • Ad hoc scanning is prone to error
edms cons
EDMS - Cons
  • Quality of original documents
  • Volume – do you need everything?
  • Are you duplicating information that is already available?
  • Speed of access
  • Continuous paper generation
  • Needs initially to be an industrial scale process
  • Cost
key successes
Key Successes
  • EPMA
  • Continuation Notes
  • Vital Signs
  • Wardview
epma what is it good
EPMA – What is it good?
  • Prescribing process the same as ordering a test
  • Legibility
  • Availability
  • Administration monitored
  • Analysis/audit available
  • Decision support
  • Safety
epma what is it not so good
EPMA – What is it not so good?
  • It doesn’t look like a drug chart
  • Some of the complex prescribing is not available
    • Chemotherapy
  • The infrastructure needs to be reliable and perform and easy to use
    • Wireless network
    • Computers on Wheels
    • Other devices
  • Patient flows
  • Time to implement
continuation notes good
Continuation notes - Good
  • Legibility
  • Availability
  • Easy to use
  • Meets national standards
  • More structured
continuation notes not so good
Continuation notes – Not so good
  • Free Text – hard to analyse
  • Lack of drawing
  • Re-entry of data
  • “Too much information”
  • More devices/screens
vital signs good
Vital signs – good
  • Easy bedside entry
  • Calculates Early warning scores
  • Draws graphs
  • Accessible from wherever
  • Nurses extremely positive – want to use tools for more
vital signs not so good
Vital signs – not so good
  • Although available from EPR data is not currently shared across systems
  • Access to chart while writing a note
  • More equipment/devices
  • Coping with demand/decisions about what goes where
what are we missing
What are we missing
  • Free flow drawing capability
  • Forms – although we have a form builder
  • Consent and patient access
  • Non-PACS images
  • Historic notes
  • Information from outside
obstacles and issues to going paperless
Obstacles and Issues to going paperless
  • Paper is easier/quicker to use ?
  • What are people used to?
  • Dependence upon a reliable, stable and high performing network and devices
  • The number/variety of devices required
any questions
Any Questions?

ColinSweeney@nhs.net

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