Transcript Slide 1
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 – 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 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 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 What does that mean? NNB Choose &Book i.PM/ PAS Scorecards Maternity Data Warehouse/ABC Theatres E-PSB Pharmacy TIE Pathology RIS PACS i.CM/EPR KCH developments A&E Payroll PICU Specialty NHS Mail Finance systems ESR E-Rostering ELearning How paperless are we? Paperless Hospital Elements & Completeness Progress Status Completeness Progress on 08/02/12 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Completeness Progress on 28/02/13 Outstanding Pre-requisites • Reliable and stable Infrastructure – Wireless and wired – Enough equipment – Right equipment • Committed and dedicated people – Executive – Clinical Users – ICT staff Hardware 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 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 Civica WinDIP Key Successes • • • • EPMA Continuation Notes Vital Signs Wardview Electronic Prescribing Drug Charts EPMA – What is it good? • Prescribing process the same as ordering a test • Legibility • Availability • Administration monitored • Analysis/audit available • Decision support • Safety 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 Continuation notes Continuation notes - Good • • • • • Legibility Availability Easy to use Meets national standards More structured Continuation notes – Not so good • • • • • Free Text – hard to analyse Lack of drawing Re-entry of data “Too much information” More devices/screens Vital Signs Vital signs – good • • • • • Easy bedside entry Calculates Early warning scores Draws graphs Accessible from wherever Nurses extremely positive – want to use tools for more 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 Using the data to improve care Quality Indicators 22 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 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 Any Questions? [email protected]