EHI focus on: Chelsea and Westminster

Chelsea and Westminster Hospital

At the head of the escalators leading to Chelsea and Westminster Hospital’s new outpatients’ area there is a large fish tank with some very large goldfish in it.

“This whole area was built around the fish tank,” says IT manager Bill Gordon. Staff wanted the tank retained when lower ground floor offices were turned into new waiting and treatment spaces.

So it was carefully lifted out before work started and put back before the escalators opened earlier this year. Now, the hospital is planning a similar remove and replace trick with a core part of its IT.

The last word for LastWord

Back in the days before the National Programme for IT in the NHS was launched, Chelsea and Westminster implemented a patient administration system called LastWord from IDX Systems Corporation.

IDX went on to become part of the Capital Care Alliance, led by BT, that won the NPfIT deal for London. But it was subsequently dropped in favour of Cerner and its Millennium system, leaving Chelsea and Westminster in a near-unique position.

“We are the last site to have it, but we have kept it because it provides so much functionality and runs on non-stop technology, which means it never fails, basically,” Gordon says.

Now, though, the trust is planning to adopt a portal approach, so it can continue to give staff access to all of its existing systems, while removing and then replacing the PAS.

“We waited to see what would happen to the national programme, because it didn’t seem to be offering the functionality we already had with LastWord,” Gordon says.

“Now, we are about to take an IT strategy to the board that asks whether we have the right platform going forward, and whether we are going to go down the Cerner Millennium route, or whether we should go for a best of breed.

“At the moment, we are planning to go for a portal approach [so] we can take out our PAS and replace it with minimal effort.

“We are also about to go out to tender for an electronic document management system. We want something that makes the migration easy. We did LastWord as a big-bang, and we do not want to do that again.”

IT savings and investments

Chelsea and Westminster has hardly failed to invest in its IT in the 12 years that have passed since that ‘big bang.’ The hospital is well-known as a leader on e-prescribing, and has recently been cited as an exemplar for use of the NHS Number by the Department of Health.

At the moment, it is training staff ready for a BigHand digital dictation roll-out, and implementing single sign-on from Microsoft/Sentillion, using ‘tap and go’ card readers in busy areas, such as radiology and maternity.

Gordon says this level of investment is likely to continue, as the trust board is “committed to IT” and “understands that it is important for meeting some of the challenges ahead of us.”

Like most trusts, Chelsea and Westminster is looking for ‘efficiency savings’ to bridge the gap between funding and demand, which, across the NHS as a whole, will be around £20 billion over the next four years.

The IT department was asked to find savings of 10% last year, is expected to find 15% this year, and will be asked for more next year.

Yet, so far at least, Gordon has managed to avoid losing any of his 60 staff, some of whom were taken on from IDX. But he is looking at what really needs to be done in-house and what might be outsourced.

“We have been looking at virtualisation and automation, and looking for areas where we might get things out,” he says. “Integration, the data warehouse; these are the crown jewels and we are focused on them. In other areas, we are looking at shared services with other acute trusts.”

More broadly, Gordon says Chelsea and Westminster Hospital NHS Foundation Trust has taken a “strategic approach” to its position, that has avoided the kind of ‘black hole’ opening up that can lead to large, rapid and under-planned reductions in staff.

“We have been very aware of where policy is going, and that is more services out in the community, and more specialisation, and paying more attention to patient experience.”

IT to support change

Some of these issues have had IT implications. For example, Chelsea and Westminster is alive to PCTs issuing tenders for services it can provide; and the IT department has become practiced at delivering infrastructure to clinics and other sites away from the main hospital when it wins them.

Back at the hospital, the digital dictation and single sign-on projects are expected to improve staff efficiency, while the trust board is promoting service line management and patient level costing as a means to engage clinical staff in procurement and financial decision making.

“We have 60 systems linked into the data warehouse, so it is a near-real time match for LastWord and we want to really exploit that data,” Gordon says. “We want to be able to say to clinicians ‘this joint lasts for ten years; it might look more expensive than this one, but actually this one only lasts for two years.

“We are quite lucky, because we have got a high level of IT and that means we have IT knowledgeable people. We have people who say they do not want to change LastWord, because it works; what they want is more data from it. And we want to give them the data; that’s what we’re here for.”

Opening up access for patients

Back in the hospital’s new outpatient area, IT has also been used to make the process of registering for, attending and feeding back on an appointment more efficient and patient-friendly.

“Our old outpatients department was very old fashioned,” says Matthew Akid, the trust’s head of communications. “It looked like it hadn’t been touched for 20 years. In creating the new space, we really wanted to change the workflow, as well.”

Once they are down the escalators, patients can use touch-screen kiosks from Intouch with health to register that they have arrived for an appointment.

The kiosks integrate with the trust’s PAS and room scheduling system, and it is looking at adding bar-codes to its letters, so patients can simply scan them to complete this process.

Some services – such as the NHS sexual health clinic that the trust runs at 56 Dean Street in Soho – are also experimenting with text messaging for appointments and scheduling; and others may follow.

Once they have registered, patients at the outpatient department are directed to airline-style ‘gates’ to wait. Screens indicate when they will be called, but medical staff fetch their own patients and escort them to treatment areas.

“The space is very flexible,” Akid says; adding that the trust wants to see a similar, streamlined service introduced to other areas, “so patients get the same care everywhere.”

Patients can also use touch screens to access information about their condition and local support services, using a system from an independent social enterprise called StartHere.

Patients are also encouraged to feedback on their experiences; since the trust is only too aware that it is operating in an environment in which an increasing number of patients will actively ‘choose’ to use its services.

“One of our visions for the portal is applications that will allow GPs to interact with the trust, and we will be looking for the same for patients,” Gordon says. “At the HIV clinic [at 56 Dean Street], patients can already book directly.

“We want the same for outpatients; so people can go in and look at the scheduling system and book at a time that suits them and get information they need for their appointment at the same time.”