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University Hospitals South Manchester NHS Foundation Trust (UHSM) wants to leave paper records behind as it aims to become a top 10 NHS provider in England, but for a large acute teaching hospital trust going digital is easier said than done.
Like most NHS trusts up and down the country, UHSM relies heavily on paper-based health records, fax machines and an ageing IT infrastructure. But the trust’s CIO Mark Hutchinson and his team are working to change that.
“We’re keen to make sure clinicians at the point of care have access to all the information they need, so the whole strategy is that we can provide clinicians with a comprehensive electronic patient record,” Hutchinson tells Computer Weekly.
In October 2014, NHS England published its Personalised Health and Care 2020 framework, which set out a mandate for the NHS to be paper-free at the point of care by 2020.
Preparing for electronic patient records
Hutchinson came to UHSM in June 2015 from another trust down the road, Salford Royal NHS Foundation Trust, where, as director of IM&T, he led the procurement, deployment and go-live of its Allscripts electronic patient record (EPR) system, which went live a month ahead of schedule.
When he arrived at University Hospitals South Manchester NHS Foundation Trust, it had already put out a tender for an EPR, together with two other local trusts. Earlier this year, however, the trusts agreed to procure separately. In October, UHSM announced it had picked the Allscripts system as its EPR of choice.
The trust plans to go live with phase one of the system in January 2017, says Hutchinson. That will include all the core functionalities of the EPR, such as order communications, results reporting, nursing documentation and some clinical pathways. Before then, however, UHSM has a lot of work to do.
Read more about electronic health records in the NHS
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- Taunton and Somerset NHS Foundation Trust the first to go live with the openMAXIMS open-source EPR in a landmark deal.
- Salisbury NHS Foundation Trust the latest NHS trust to implement the Lorenzo electronic patient record system.
- Basildon and Thurrock University Hospitals NHS Foundation Trust has completed an electronic medical records system to digitise patient records.
“We’ve got some reliability issues with the wireless network which we need to fix. Our datacentre doesn’t have enough cooling or electricity to support the infrastructure we have now, so we need to build a new datacentre,” he says.
An upgrade of its Citrix environment for virtual desktop access and improving the reliability of user devices are also on the cards.
“We need a new storage area network [SAN], and we’re also doing some work on Microsoft Active Directory and a raft of interfaces linking up all the systems,” says Hutchinson.
The digitisation effort could seem overwhelming – the trust has 15 enabling projects on the go at once, in readiness to embrace a digital way of working – but it has already begun much of the work.
Hutchinson and his team have started looking for a new location for the datacentre and writing the detailed specifications so it can go out through the HeathTrust Europe (HTE) Framework. UHSM has also begun a wireless survey to figure out its requirements.
“Clinicians need all the information at their fingertips, so regardless of what they are looking for, they will find it in the EPR system”
Mark Hutchinson, University Hospitals South Manchester NHS Foundation Trust
The trust plans to build its own interfaces, which are particularly important to connect its EPR with other systems to ensure information can transfer smoothly across the organisation and beyond.
One of the systems the trust is not replacing is its picture archiving and communications system (Pacs). The trust is part of the Greater Manchester Consortium, which under the National Programme for IT received a Pacs from GE. In 2012, the consortium extended the contract.
But UHSM will make sure clinicians only need to use one system. “If clinicians want to request an x-ray, they do that in the EPR and it will send the request to the radiology system, says Hutchinson.
“The EPR will be the only system clinicians use, and they will no longer have to act like a detective to find the right system or login. Implementing technology doesn’t help clinicians if they have to use lots different systems with lots of different logins. They need all the information at their fingertips, so regardless of what they are looking for, they will find it in the EPR system.”
A new set of skills
But doing a whole range of transformational work requires UHSM’s IT department to have the right people with the right skills. “As part of the business case to implement the EPR, the organisation recognised that we need to be investing in people,” says Hutchinson.
The trust is planning to begin recruitment imminently, and is looking to fill around 15 new posts. “We’re looking for people who have experience with configuring clinical IT systems, people with experience in business process redesign, people who understand clinical environments, tech roles like developers, people who can write interfaces and infrastructure engineers,” says Hutchinson says, to mention a few.
“In general, we are looking for people with the right skills and values, who want a challenge and who want to help improve patient care at UHSM.”
The trust is also heavily involving clinicians in creating pathways and workflows that work well for them as part of the IT projects. These include consultants, pharmacists, allied health professionals, pathology and nurses.
Sharing across the health economy
Doing work only within the trust won’t help it achieve its goal of being digital at the point of care, as patients usually have interactions with other care providers such as GPs, mental health and social care.
UHSM will also be affected by the Greater Manchester Devolution, a groundbreaking programme which includes the devolution of a £6bn health and social care budget for the region. The programme includes joining up primary care, secondary care, the city council and providers of social care and mental health care to deliver integrated health and social care, says Hutchinson.
“To support Devolution Manchester we will need to be able to provide caregivers with a view of the patient that understands all of the different interactions the patient has across the city and make that available at the point of care,” he says.
“What we’re keen to try to do is not just replicate that in little pockets. We’re leading the IT workstream for the Living Longer, Living Better programme to make sure we have the solution to have that across the city.”
Pilot projects are already underway in parts of Manchester, using the Graphnet CareCentric patient record to create an integrated record of key information such as summaries on primary care interactions, acute outpatient, inpatient and A&E attendances, summary social care records, mental health information and discharges for patients “at risk” across care settings.
The system will need to allow for care plans for the patients to be shared by the clinicians across the city.
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