NHS England aims to bring the NHS into the 21st century by requiring all NHS organisations to be paperless and have electronic medical records in place at the point of care by 2020.
For many, the prospect seems daunting and there remains a long way to go for most NHS organisations. North Middlesex University Hospital NHS Trust is not one of them. Ahead of the curve, the trust is aiming to be fully digital by the end of 2017 at the very latest.
It’s an ambitious project, but Musadiq Subar, the trust’s IT programme manager and clinical technical architect, believes it’s achievable.
It already has several systems in place to get there, including a clinical portal; a new electronic document management system (EDMS) from Fortus; and its Sectra picture, archiving and communications system (PACS). The glue holding it all together is its supplier-neutral archive from Bridgehead.
The trust is about to embark on a large scanning project, digitising all its paper records. Any paper records coming into the trust from other organisations will also be scanned and become part of the patients’ electronic records as soon as it reaches North Middlesex University Hospital NHS Trust.
The road to digital
It hasn’t always been a given that North Middlesex NHS would go digital ahead of the government’s target. As part of the National Programme for IT, it received its old PACS but, because the programme was delayed, the trust never got to replace its patient administration system (PAS) and ran its legacy McKesson Totalcare PAS for 25 years, almost until the support contract ran out.
Last year it replaced the legacy system with the Medway PAS from System C, a substantial project in itself, which included migrating eight million records from the old system.
In 2012, the trust went out to buy a new PACS, radiology information system and an independent archive through the NHS Supply Chain.
Archive as infrastructure
Musadiq Subar, the trust’s IT programme manager and clinical technical architect, said it was a conscious decision to go with separate providers for the PACS and supplier-neutral archive.
“We decided to do two solutions, one of the reasons was that we didn’t want just a datacentre just for our PACS. We didn’t want to be held back by a supplier that would end up restricting us in doing what we need to as the needs of the organisation change,” he said.Because there are millions of medical images, it could previously take a couple of minutes for the images to download. Now it only takes seconds, Subar said.
“Clinicians are used to having everything online and available within seconds and, if it takes too long, they get annoyed,” he added.
The supplier-neutral archive was originally meant to be used as a storage facility for its radiology images. But soon after it had signed the contract with Bridgehead for its Healthstore archive, the trust decided that, as it was also implementing an EDMS using money it received as part of NHS England’s technology fund, it made sense to use the archive as a repository for the EDMS too.
The archive will effectively act as an enterprise-wide datacentre, holding all of its radiology images and patient notes. The operational go-live of transferring all its medical records to the archive will begin in November 2015, with paediatrics being the first to move all its records.
Portal to be proud of
Five years ago, the trust created a clinical portal as a central point of access for clinicians, which they already have access to the portal on iPads and secure mobile devices.
The portal will provide an interface to the archive, meaning staff can look at everything from the electronic patient record system to patient demographics, attendances, outpatient letters, correspondence, images and a range of clinical applications and specialist systems such as cancer and cardiology, with a single point of access. It doesn’t matter if the clinician is looking at two different data locations, there is still only a single point of view.
The trust has a lot of different IT systems, that don’t necessarily talk to each other. Putting all the data into a structured repository removes the headache of having to log in to a number of different systems.
“One of the bug bears for clinicians was that they had 20 different passwords so we are giving them access to all this information and we connect it using the archive,” Subar said.
The government’s mandate for organisations to be digital by 2020, includes the integration of data between providers. Whether it’s between hospitals and GPs, community, mental health or social care, the aim is for staff to be able to look up a patient’s records at the point of care.
North Middlesex University Hospital NHS Trust is working with other care providers to understand what data they need and how they can access it.
“Our approach has the capability to push data from source to the applications and/or individuals that need it, when they need it,” Subar said.
“We want to create integrated solutions with other organisations. To do that we need an interface that can talk to all the other systems.”