EHI Awards 2010: The ‘all but only’ principle

EMIS Web was the joint winner of last year’s production innovation award.

Inadequate information flows between patients, technology and carers are a major barrier to improving healthcare, according to EMIS Group chief executive, Sean Riddell.

For instance, those treating patients outside surgery hours often have no information other than what they are told on the spot. Riddell claims this is just one of many problems solved by EMIS Web, a cross-organisational healthcare system granted full roll-out approval by NHS Connecting for Health in 2010.

It’s all down to interoperability

“A big problem is the historic resistance to interoperability within healthcare IT,” Riddell says. “Niche departmental systems generally do their job really well, but once you start replacing them with more generic systems you begin to lose the value and finesse that enables specific healthcare software to save lives.”

He ascribes the positive uptake of EMIS Web to its inherent interoperability and his company’s strategy of aligning it with the Medical Interoperability Gateway (MIG), developed jointly with competitor INPS, which gives users of other software systems access to patient data.

“As their ‘cradle to grave’ ‘health CV’, an individual’s Electronic Healthcare Record contains lots of Electronic Patient Records, each representing episodes of care, some of which are hugely granular and only required within that particular episode,” says Riddell.

“At EMIS, we believe in the ‘all but only’ principle - in other words, clinicians should be able to share all, but only the information relating to the care of a patient during any particular episode.

“EMIS Web simply captures clinical intervention and makes everything flow out from that. Its key differentiator is that it’s centred around shared patient records, as opposed to a single patient record. It allows you to switch between ‘my record’ and ‘shared record’ to find the right data.

“A podiatrist treating a diabetic patient, for instance, doesn’t need to know about any psychological assessments that patient may have previously undergone, as it’s unlikely to have any bearing on their diabetes. Sharing information is important, but only if it’s going to improve patient care and save money.”

One of the outcomes of delivering cross-organisational healthcare - in other words, having data follow patients in their journey through healthcare - is that you get rid of paper and simplify workflows, he adds. “EMIS Web saves NHS staff precious time by integrating many of the process-intensive flows that happen within healthcare.

“In the case of repeat prescriptions, for example, it allows patients to reorder medication via the Internet or digital TV. Their request goes into a workflow manager for authorisation by the GP, then on to the pharmacist for collection by the patient.

“It simplifies the whole process for those involved and reduces the time from request to receipt of medication often from days to hours.

“Another beauty of the system is that no information is added to the core record without the GP’s consent, yet GPs can add information they wish to add. What GPs and those involved in extended, community and secondary care want is joined-up technology that makes the right information available just when they need it.”

Instant impact

Riddell claims EMIS Web is already having a positive impact on patient care in over 40 different types of healthcare setting. At NHS Liverpool, for example, waiting times for minor surgery have been cut from nine months to one day in some cases thanks to new ways of working supported by the system.

At NHS Tower Hamlets, administrators supporting the physiotherapy team are saving seven hours a week by no longer having to manually input information. While in Gateshead, out of hours clinicians now have instant access to 206,000 primary care records in the event of patients requiring unscheduled care.

St George’s Surgery in Blackburn, one of the first to go live with EMIS Web, also reports a highly successful transition. Practice manager Margaret Baines says the move from EMIS LV to EMIS Web went smoothly and claims the system is already proving speedier for users.

“Of course, it wasn’t without its teething troubles,” says Baines. “Changing an IT system is always going to throw up issues, but we were able to run a normal surgery on our first day and the system has bedded in well.

“Although it’s still early days, we’re already seeing the advantages. An obvious benefit is the speed of EMIS Web - information is available quickly, you don’t have to go looking for it, and it’s easy to find what you need.”

The practice switched off its EMIS LV system at the end of one working day and went live with EMIS Web the following morning. “On go-live day, we limited appointments so that GPs had more time for their consultations,” says Baines. “But by mid-morning they were calling us to say they were fine and to release new appointments.”

Partner Dr Nicholas Buckley says: “We had far fewer problems than anticipated with the change of system. Once I learned how to use it, I’ve found EMIS Web much easier to navigate than LV. It’s far easier and quicker to flick between different modes - I honestly don’t know how I’d cope if I had to go back to the old system.”

Primed for shake-up

With over 1,000 practices already registered for the EMIS Familiarisation Service, Riddell believes EMIS Web is well placed to benefit from the imminent shake-up in the NHS.

“It’s now at the heart of changes being implemented by several GP commissioning groups and will enable them to securely share patient data in a time-efficient, cost-effective manner, which is fundamental to improving NHS frontline services.”

London GP Dr Kambiz Boomla, who has been testing EMIS Web from its early development days, says: “Until now, each time EMIS has tried to deliver a straightforward Windows-based system, the technical platform hasn’t really been good enough. This time the IT architectural platform is brilliant, so I think EMIS has cracked it.”

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