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The paperless hospital – Is it achievable? Colin Sweeney Director of ICT

The paperless hospital – Is it achievable? Colin Sweeney Director of ICT. Agenda. Background How paperless are we? EDMS v active record The Pre-requisites What have been the big achievements? Rolling out EPMA across the hospital

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The paperless hospital – Is it achievable? Colin Sweeney Director of ICT

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  1. The paperless hospital – Is it achievable?Colin SweeneyDirector of ICT

  2. Agenda • Background • How paperless are we? • EDMS v active record • The Pre-requisites • What have been the big achievements? • Rolling out EPMA across the hospital • Making continuation notes electronically to increase accuracy and legibility • Developing new methods of digitally viewing vital signs using mobile devices • Utilising electronic data to audit department's performance and improve patient care • What is missing? • Obstacles and issues

  3. King’s EPR Milestones • 1999 Implemented pilot of the initial EPR vision • 2002 Completed roll out of orders and results as first stage of EPR • 2000-2 Discharge notifications and TTA drugs • 2003 Replaced old IRC PAS with i.PM • 2004/5 PACS • 2005 First attempt at inpatient prescribing • 2007 Moved i.PM to CSC as part of iSOFT7 • 2009 Inpatient noting • 2008-2010 Inpatient prescribing roll out • 2010 to date – KSSF to help move to paperless/light hospital • 2012 Wardware to calculate Early Warning Scores • 2012 Assessed by HIMSS as a level 5 EMR • 2013 Acquired Princess Royal Hospital

  4. Vision and Tactics Our Vision A single point of access to information about individual patients in electronic real-time format How do we get there? An EPR is a Strategy not a System

  5. i.CM/EPR RIS KCH develop-ments PACS NNB Score-cards Maternity Choose &Book i.PM/ PAS What does that mean? Data Ware-house/ABC Theatres TIE Pharmacy E-PSB Pathology Finance A&E Payroll PICU ESR Specialty systems E-Rost-ering E-Learning NHS Mail

  6. How paperless are we?

  7. Pre-requisites • Reliable and stable Infrastructure • Wireless and wired • Enough equipment • Right equipment • Committed and dedicated people • Executive • Clinical Users • ICT staff

  8. Hardware

  9. EDMS-Pros • Provides a complete record • Availability • Saves on storage space • Savings on folders • Potential savings on prep clerks • Potential savings on archive/retrieval • Ad hoc scanning is prone to error

  10. EDMS - Cons • Quality of original documents • Volume – do you need everything? • Are you duplicating information that is already available? • Speed of access • Continuous paper generation • Needs initially to be an industrial scale process • Cost

  11. Civica WinDIP

  12. Key Successes • EPMA • Continuation Notes • Vital Signs • Wardview

  13. Electronic Prescribing Drug Charts

  14. EPMA – What is it good? • Prescribing process the same as ordering a test • Legibility • Availability • Administration monitored • Analysis/audit available • Decision support • Safety

  15. EPMA – What is it not so good? • It doesn’t look like a drug chart • Some of the complex prescribing is not available • Chemotherapy • The infrastructure needs to be reliable and perform and easy to use • Wireless network • Computers on Wheels • Other devices • Patient flows • Time to implement

  16. Continuation notes

  17. Continuation notes - Good • Legibility • Availability • Easy to use • Meets national standards • More structured

  18. Continuation notes – Not so good • Free Text – hard to analyse • Lack of drawing • Re-entry of data • “Too much information” • More devices/screens

  19. Vital Signs

  20. Vital signs – good • Easy bedside entry • Calculates Early warning scores • Draws graphs • Accessible from wherever • Nurses extremely positive – want to use tools for more

  21. Vital signs – not so good • Although available from EPR data is not currently shared across systems • Access to chart while writing a note • More equipment/devices • Coping with demand/decisions about what goes where

  22. Using the data to improve care Quality Indicators

  23. What are we missing • Free flow drawing capability • Forms – although we have a form builder • Consent and patient access • Non-PACS images • Historic notes • Information from outside

  24. Obstacles and Issues to going paperless • Paper is easier/quicker to use ? • What are people used to? • Dependence upon a reliable, stable and high performing network and devices • The number/variety of devices required

  25. Any Questions? ColinSweeney@nhs.net

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