The Value of Achieving the Highest Level of EMR Adoption

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1 The Value of Achieving the Highest Level of EMR Adoption Dr Tony Newman-Sanders CCIO and Consultant Radiologist & Croydon University Hospital Charlotte Stockman Nurse Lead Informatics, Croydon University Hospital

2 The value of achieving the highest level of EMR adoption Dr Tony Newman Sanders, Chief Clinical Information Officer Charlie Stockman, Clinical Nurse Lead Informatics

3 About us Health Centres: 4 Clinics: 12 Patient Contacts: 553,874 Adult Services 323 Nurses, 123 District Nurses, 52 Specialist Nurses, 133 AHPs Paediatric Services 112 Health Visitors, 22 Specialist Nurses, 54 AHPs, 10 Consultants Community Annual Turnover Staff 220m Consultants: 122, SHOs: 17, Medical Juniors: 306, Nurses: 802 (Qualified), Health Care Assistants: 247 Outpatient Inpatients Outpatient Facilities: 3 Outpatient Visits: 342,267 ED Visits: 128,698 Inpatient Facilities: 1 Beds: 596 ICU Beds: 15 Operating Rooms: 14 Admissions: 45,381 Day cases: 23,825 Surgical Procedures 14,468 Births: 5,200

4 BIG BANG large and complex Emergency Dept Laboratory including Virgin Care Urgent Care Centre Outpatients Inpatient Microbiology General Laboratory Specimen Management Cellular Pathology GP communication Nursing Staff Medical Staff GP Ordering, Results Reporting and Electronic Discharges Order Communications Task management NAP (Waterlow, Nutrition, Activities of Daily Living etc.) RAP (Risk Assessment Performa, Manual Handling, Infection Control) etc. Admissions Clinical Clerking VTE Community Discharge including TTAs etc. Hospital at Night Clinical Analytics (7 th Oct) 12 services Outpatient Prescribing roll out (14 th Oct)

5 Where we started after Go-Live Ward rounds paperlite; ECGs, Nursing rounds; ED; challenges of operational targets; space constraints; impending new build CPOE (Ordercomms) BUT Clinical modules not completely integrated Cardiology Endoscopy Cancer Maternity PACS Drugs IV fluids, blood and O2 all on paper

6 Where we are now. A coalface healthcare enterprise with lots of challenges which has; A deeply embedded understanding of the importance of clinical leadership of IT enabled change especially the integration of acute and community services. Invested in a broadbased team of clinical informatic leaders drawn from across the operation. Achieved a complex EPR big bang Golive by virtue of focused senior leadership and daily Command Centre discipline. Maintained high levels of user engagement despite inevitable bumps in the road. Developed some transformative applications; Clinical Whiteboards, Algorithms to detect early sepsis etc. Learnt a great deal about what can improve our experience of the system. 10/03/20 15

7 What we are not. The most paperlite healthcare organisation in the country. Complacent Delivering all the safety and efficiency benefits expected of the investment in Clinical IT systems Unsparing searchlight on workflows, processes and behaviours Unprecedented data about what the organisation is and is not doing. Trade off between powerful functionality working on large data sets and system performance Anywhere near HIMMS level 7 Road map for document management based on a new Vendor Neutral Archive Nurse tech fund award to transform mobile working in Community services 10/03/20 15

8 Two major steps to level 6 Eprescribing A key element. Particular dialogue about closed loop process. Gateway process Engagement opportunity Frontline clinicians Senior nursing Clinical Decision support Stroke pathway Others to be developed Nursing Care plans Sepsis MPage

9 The benefits of E-Prescribing Improved Patient safety Elimination of illegible prescriptions Drug chart always available Warning & alert systems at the point of care Information governance: data protection Reducing time spent on phone calls and call-backs to pharmacies

10 Optimisation Evidence from our Time and motion study 1 minute & 20 second Per patient Per drug round Releasing time to care

11 Reporting & Auditability 10/03/20 15

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13 Documentation 10/03/20 15

14 Clinical Decision Support tools BMJ Action Set 10/03/20 15

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16 A view from the coal face

17 Conclusion The opportunity to achieve HIMSS level 6 was a welcome benefit of the first steps on our journey towards a genuinely integrated patient centred record. The discipline of engaging with HIMSS accreditation has focused the clinical informatic leadership on key aspects of that journey. We are under no illusions of the challenges that we face in living up to our level 6 status. A lot of endeavour will be required to get to level 7. We are committed to learning from our experience and to sharing that learning as widely and honestly as possible. 10/03/20 15