Lessons from electronic medical records programme at Liverpool Heart and Chest Hospital

Cardiologist Johan Waktare talks about the Liverpool Heart and Chest Hospital NHS Foundation Trust's EMR scheme

As more healthcare providers look to replace their existing paper records with electronic ones, they must find ways to store and retrieve all patients’ data. 

At Liverpool Heart and Chest Hospital (LHCH), we chose to roll out OnBase enterprise content management (ECM) from Hyland Software at the same time as our Allscripts electronic patient record (EPR) system. 

We are now reaping the rewards of the implementation, which has helped us deliver better patient care and enhanced workflow and administrative processes, while at the same time driving cost savings across the hospital.

At LHCH, we’ve always taken the view that while it’s one thing becoming paperless to address the [Tim] ‘Kelsey challenge’ and achieve HIMSS [Health Information Management Systems Society] Stage 7, it’s quite another to use it to proactively transform processes with workflows and other efficiencies to provide better patient care. 

To put it another way, the full benefits of paperless will only be achieved by optimising the full capabilities of the IT surrounding it.

One of the modules of LHCH’s Allscripts Sunrise system is OnBase. The OnBase ECM solution has helped the hospital to capture the more than 25% of patient information that still resides outside the EPR: everything from letters to emails and information from clinical devices.

Add workflow to scanning

We know that some organisations use ECM just to scan in documents once they are finished. At LHCH, we are taking this a step further and implementing workflow functionality, which can then help improve the efficiency of clinical administration processes. 

Reports or diagnostic assessments that would have been printed in the past can be sent to a virtual print driver after they have been approved. They are then filed and available for clinical staff to view in seconds. 

There is no need for paper as a part of this newly streamlined and efficient process, which has also eliminated delays in making important information available.

The full benefits of paperless will only be achieved by optimising the full capabilities of the IT surrounding it

Johan Waktare, Liverpool Heart and Chest Hospital

It’s hard to say we will eliminate paper completely. Paper does have its place, for sending information out of system, but keeping as much information as possible in an electronic, complete patient file will help make better, more informed decisions.

Of course, LHCH has experienced some challenges in rolling out this approach – from the punishing time scale to the need to manage the cultural change for some staff. 

The hospital also had to develop a policy on what needed to be scanned and what could be left out, which considering that some files were 350 pages or more, had a significant bearing on deadlines and budget.

According to my colleague, LHCH’s EPR programme director John Coleman: “It’s a huge achievement and the results are well worth it. Nurses no longer have to spend their shift searching for lost documents. Doctors can log on at home the night before they hold their clinics or before doing their rounds and review their patients. 

"Notes aren’t hidden away in a filing cabinet but instead are available for any authorised person to view at any time from anywhere in the hospital. We’ll never again have an issue where notes are missing because someone else has them; records can now be viewed simultaneously by several people from different areas of the hospital.”

Plan ahead

So what advice would I give a similar organisation? 

Allow plenty of time to cost and plan, decide early whether to back-file or not, and buy scanners and equipment well in advance of going live so staff can get used to them. 

For various internal reasons LHCH chose to go live with the entire system at the same time, but if this is not vital, a staged approach would help reduce stress levels! 

And don’t under-use your software; make the most of your investment. In the past, the way IT was used at LHCH didn’t always support its visions for staff and for patient care. Undeniably though, it is now helping the hospital move swiftly in the right direction.

Dr Johan Waktare is a consultant cardiologist and clinical lead for electronic medical records at Liverpool Heart and Chest Hospital NHS Foundation Trust.

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