Electronic Prescriptions, Dashboards and University Hospital Birmingham

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Shonda Holmes
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1 Electronic Prescriptions, Dashboards and University Hospital Birmingham Thursday 25 th July 2013 Digital Health: design: develop: deploy: evaluate

choice, administration and supply of a medicine through knowledge and decision support and

2 Electronic Prescribing & Medication Administration The utilisation of electronic systems to facilitate and enhance the communication of a prescription or medicine order, aiding the choice, administration and supply of a medicine through knowledge and decision support and providing a robust audit trail for the entire medicines use process (NHS Connecting for Health)

3 eprescribing UK Context PRIMARY CARE ep is Universal Few core systems SECONDARY CARE 12% fully implemented 1/3 putting in systems Spectrum of systems

4 Our System Development Process Queen Elizabeth Hospital, Birmingham Locally Developed Hospital-wide Electronic Prescribing System More than just eprescribing Specialty specific rules Developed by Wolfson Computer Lab Long history of highly generalised healthcare IT systems Continuous development for over 10 years Always in conjunction with UHB clinical staff Core design, development, implementation, 7 staff Currently 12 staff in PICS team

history of highly generalised healthcare IT systems Continuous development for over 10 years Always in

5 In prescribing terms - From this to this using these

6 PICS a developing Electronic Clinical Record Laboratory Flow Sheets Urinalysis Charts Fluid Balance Infection Control Operation Noting Clinical Flags Physiological Observations

7 Clinical Decision Support Defined as: Process for enhancing health-related decisions and actions Using pertinent, organized clinical knowledge and patient information to improve health delivery Produces basic benefits through to expert error detection

organized clinical knowledge and patient information to

8 SECONDARY USE OF DATA & CLINICAL DASHBOARDS

9 PICS Audit system Inappropriate to run audit queries alongside live operation Daily automated export of PICS content to data warehouse on separate server Currently ~180 Gb Microsoft SQL Server Allows: Routine weekly/monthly reports Automated distribution Ad-hoc reports (clinical audits) Modelling impact of proposed changes Accessible by informatics and research teams

Server Allows: Routine weekly/monthly reports Automated email distribution Ad-hoc reports

10 Clinical Dashboards Average LOS Four Hour Wait Targets MRSA -ve +ve

11 Clinical Dashboard Turning data into information

12 Antibiotic - % Missed Doses Date Intervention A 15 April 2009 Pause function for doctors B 04 August 2009 Missed Doses go live on clinical dashboard C D * D * 15 December February 2010 Introduction of coloured indicators to show due / overdue drugs NPSA Rapid Response Alert 30 March 2010 Chief Executive Missed Dose Root Cause Analysis meetings Step change in % missed doses when information shared with clinicians / managers Further highly significant change when CEO started RCA meetings

overdue drugs NPSA Rapid Response Alert 30 March 2010 Chief Executive Missed Dose Root Cause Analysis meetings Step change

13 PERSONAL ACCESS TO DATA: NO (DIGITAL) CARE ABOUT ME, WITHOUT ME

14 Screenshot of the homepage

Records of all current and historical medication records held by the hospital are displayed. The patient can also add their own medication, or notify QEHB of any changes.

15 Records of all current and historical medication records held by the hospital are displayed. The patient can also add their own medication, or notify QEHB of any changes. Lab results held by the hospital are displayed. The patient can submit their own external blood and other test results (e.g. blood pressure). BP measurements entered by the patient are presented in a graph Recent and historical inpatient history is displayed. Relevant Web links (e.g. BNF) are listed here. Hospital appointments are listed and patients can add other events (such as appointments). Patients can add GP details, QEHB and other hospital contacts. Patients can choose to upload health documents to their portal and keep them private or share them with QEHB. Screenshot of the myhealth@qehb My Records page

BP measurements entered by the patient are presented in a graph Recent and historical inpatient history is displayed. Relevant Web links (e.g. BNF) are listed here.

16 All letters held by the hospital are displayed. Patients can use this page as a journal function to record whatever they choose. They can record daily occurrences that may impact on their health. This can be kept completely private or shared with their clinician. Screenshot of the myhealth@qehb Communicate page

choose. They can record daily occurrences that may impact on their health.

17 SUCCESS IN DIGITAL HEALTH

Safer Hospitals, Safer Wards of critical importance that any digital solutions proposed for use by NHS hospitals are clinically led with comprehensive buy-in from everyone using them Clinical

18 Safer Hospitals, Safer Wards of critical importance that any digital solutions proposed for use by NHS hospitals are clinically led with comprehensive buy-in from everyone using them Clinical leadership and technical advances need to be in step the one enabling the other entire NHS can learn from the organisations that have taken small or large steps on this journey ensure that knowledge is shared and leveraged

technical advances need to be in step the one enabling the other entire NHS can learn from the

19 Looking to the future Digital records are not quite as intelligent as Amazon!

Electronic prescribing: Delivering the Information Strategy. Tanya Pankhurst Jamie Coleman

Electronic prescribing: Delivering the Information Strategy Tanya Pankhurst Jamie Coleman The brief Implementing the information strategy locally eprescribing Where electronic prescribing fits into EPR