Sixteen months ago, Blackpool Teaching Hospitals NHS Foundation Trust became the first trust in the North, Midlands and East of England to use the Additional Supply Capability and Capacity framework to procure an electronic patient record.
In doing so, it also became the first trust in the region to reject iSoft’s Lorenzo system, as offered by local service provider CSC under the National Programme for IT in the NHS, and the first NHS customer for the Portuguese company Alert.
Creating a Vision
With so many firsts under its belt, the trust now admits that it was over optimistic about the go-live date for the product, which layers clinical functionality over its IMS Maxims patient administration system.
It told eHealth Insider that it would go live with early elements of the Alert EDIS system last summer. But the go-live was delayed until November 2010; something the trust puts down to needing to get major A&E building works completed.
When the go-live happened, though, it went smoothly. Over the last four months, details of patients presenting in A&E have been sent into it via interface messages from the primary care-run urgent care centre gateway.
More than 470 staff have also been trained to use the system to triage patients, record treatments and procedures, request investigations and view the results, track patient status and record discharge dates and outcomes.
Dr Victoria Ellarby, vision programme director tells EHI: “The success of this has been the clinical leadership from the beginning; this project sits within the trust’s strategic development, not just with the IT team.”
Vision is the name given to the project by staff at the trust, who seem to have taken to the idea; even though the IT department was initially sceptical about how clinicians would react to moving to a paperless environment.
Dr Simon Tucker, A&E consultant, says: “When we first started the project, we sent an email out asking people if they wanted to get involved. We had a dozen responses within an hour saying ‘yes’. People were crawling over themselves to get involved.”
From the outset, the trust had and continues to hold fortnightly meetings where members from all specialities attend to provide their feedback.
In addition, when the trust first contracted Alert one of the company’s functionality analysts was brought in to discuss how staff actually work, and to make sure that the system was “Blackpool flavoured.”
Ellarby adds: “All the clinical content and the drop down menus had to reflect what clinicians wanted. There was also a lot of interface development required, which was tough. But we had an integration engine in place, which really helped with that.”
Although the system comes from Portugal, the trust says Anglicisation was not a problem. Nor did it struggle with the majority of the Alert trainers being Portuguese.
Alert has already implemented the system in several private hospitals in the UK, including CircleBath, which helped with the Anglicisation process. However, Roger Wallhouse, managing director of Alert, says building the system for the NHS was very different.
“Building this model for Blackpool was building this solution for the rest of the NHS for us. The size and data collection for hospitals in the NHS is very different to that of private hospitals; there is a lot more functionality that needs to go into that.”
Wallhouse adds: “Having everyone onboard for go-live was important as although this was initially for the A&E department, it’s a hospital system. Everything that has been done in A&E is going to be replicated across the trust.”
The big bang theory
When the trust first bought the system, it planned for a big bang implementation. Again, however, it revised the plan to make it functionality based.
Helen Mainon, the ALERT programme manager at the trust, explains: “We asked staff if they would like to go home on Friday using paper and come in on Monday using computers; and they all say ‘no’.”
Instead, Blackpool went live with registering, tracking and order communications during the first week, and followed that up with clinical documentation.
“That enabled the staff to be more confident and take small steps. We strongly recommend that approach and will continue to do it ourselves for the rest of the roll out, as it has served us so well,” Mainon adds.
The trust admits there was a small amount of panic when the system went down for a couple of hours on the second day, and business continuity plans had to be put in place.
Tucker says: “That led to one or two people digging their heels in and refusing to use it. But we haven’t had any unplanned downtime since then, and those few people who were most against it are now the system’s biggest advocates.”
Increasing efficiency – but losing staff
The trust expects the biggest benefits to be realised when the system is rolled out more widely. It is, for example, expecting to see a reduction in clinical incidents and in the length of inpatient stays.
However, it is already seeing “big wins in terms of faster clinical decision making and simultaneous, multi user access.” Or as Dr Tucker puts it: “The system has the ability to do what we were doing before but much more quickly.
“We used to have to constantly log in to check if results were available now it lets us know when they are there. We’ve only had it for four months, so it’s a diamond in the rough, but now we’re just working on polishing it up.”
In addition to clinical benefits, the trust’s business case signalled that it could result in financial savings, not least through the loss of as many as 400 posts across administrative staff, medical secretaries, medical records staff, and audit and data entry staff.
Graham adds: “Some of those redundancies are taking place anyway due to financial constraints being put on the trust - but we anticipate 400 out of our 4,500 staff going across all groups.”
Meanwhile, the trust has not employed any additional IT staff to support the go-live. Six to 15 Alert staff have been on site at different times.
And the trust ran a dedicated helpdesk with staff trainers on duty 24 hours a day for one month that included clinical change facilitators and members of the project management team. It is planning to employ three IT staff to complete the roll-out.
Starting small, thinking big
The trust now plans to deploy e-prescribing and medicines administration across A&E and to develop a URL link that will allow one click access to PACS images by the beginning of June.
By the end of the year, it also plans to have trust-wide order communications in both the inpatient and outpatient modules, clinical documents in cardiac outpatients’ clinics, and clinical documents in clinical decision units.
It expects the full deployment of clinical documentation across remaining specialities, and for e-prescribing, medications administration and patient monitoring to be layered in and trust-wide, by the end of 2012.
One area the trust seems to be particularly excited about is how the system can be used from a performance perspective. Dr Tucker says: “We have our key performance indicators coming out. We have a whole tariff system in the emergency department. So there’s a potential here for lost revenue if we don’t get things right.
“The information is captured in this system and we configure it. So instead of just using it to record when we can do things, we a looking at using it to tell us when we’re about to breach something.”
The trust says it is already able to track progress against the four hour treat or discharge standard for A&E with relative ease.
“You can set up a protocol, make sure it is followed. Then, when the patient ready to leave A&E, it makes sure that they are all done,” Tucker says. “This isn’t Map of Medicine rehashed; this is much more in depth than that. It is interpreting results, guiding you through the decisions; it’s something quite fantastic really.”
Graham says that this is one of the things that has really set the Alert product apart from a Windows-based green screen system.
The easy option?
Arguably, the trust has taken the easy option by leaving its IMS Maxims patient administration system well alone and layering the clinical functionality over the top.
Graham says: “When we started, it wasn’t the PAS that we wanted to change. We just wanted to get the benefits of the clinical functionality - and quickly.”
Wallhouse acknowledges that a foreign company trying to implement a PAS might have faced more hurdles. “Because this is fundamentally a clinical solution, we’re not dealing with many of the other issues that the other organisations have to deal with at the PAS level,” he says.
“Clinical functionality does travel the world quite well; whereas PAS doesn’t.” Although Blackpool has never formally declared itself outside of NPfIT, it doesn’t appear to be looking at Lorenzo as a viable option for a PAS change.
Graham adds: “A lot of people say ‘all you’ve done is go-live in A&E.’ That’s true; but we have a full EPR in A&E and we are now about to roll that out across the trust.
“It’s a different approach to what others have taken but it’s worked. If you look at Morecambe Bay [which has been trying to implement the latest version of Lorenzo for at least two years], they’ve been trying to get this right for an incredibly long time and they’re still not there.”
Congratulations to Blackpooljjameswalk123 209 weeks ago
Congratulations to all the key staff 'clinicians & managers' who had the 'Vision' to take this route. The idea of layering EPR over the existing PAS is delivering real results.
I really like the way Blackpool have decided to implement 'Evidence Based Care' starting with the NHS tool, the Map of Medicine and getting clinicians to review their approach, complete a gap analysis on existing practice and develop Blackpool pathways and embed them into the Alert EPR workflow & scheduling.
This localisation and consultation gives ownership to Blackpool clinicians, a key element of the culture change required to delver changes in culture, practice & clinical outcomes.
It looks like Blackpool are well on the journey to delivering the Clinical Five and to mainstreaming 'evidence based care. This approach provides the platform for delivering QIPP and the deliverables of the White Paper 'Equity & Excellence' Congratulations once again to Blackpool!
Smart DecisionDaniel Defoe 210 weeks ago
I'm pleased you said "PAS wraparound", stueym, rather than "Build your Own EPR from a PAS". That's appears to be what some Trusts think they might be able to do - but if that were possible, we would have done it years ago.
As you rightly surmise, keeping (or in some cases acquiring) a credible PAS is important in order to look after the information necessary to get the required income from the activity a Trust is performing.
As EPR functionality is implemented over time, the "bells and whistles" functionality of a traditional PAS becomes unnecessary until all you're left with is ADT - which any EPR worth its salt is perfectly capable of. But until then, anybody who is thinking of ditching its existing PAS without considering how its existing PAS functionality is covered by the EPR it's proposing to implement is on a hiding to nothing.
Kudos for smart decisionsstueym 210 weeks ago
More trusts should strongly consider the PAS wraparound approach rather than throwing the baby out with the bathwater. The challenges of trying to bend an unsuitable administrative component of a solution to fit the NHS requirements built up since before Edith Korner's time are huge.
Rock on Blackpoolyoda 210 weeks ago
It's always good to hear of projects that provide benefits to staff on the frontline as well as patients and the trust as a whole. It's maybe another indication that tightly focused smaller projects with high levels of commitment from all parties tend to produce the best results. Of course integration has to be high on the list of priorities and this is maybe just as a big hurdle to overcome as getting a system to fufill it's key departmental objectives.