HC Colposcopy by mikeholy


									Implementing scanned health
records in NHS community
and hospital services

     Philip Scott MSc MBCS CITP
     Head of IT Projects & Development
     Portsmouth Hospitals NHS Trust

    Introduction
    The problem with paper...
    Portsmouth’s EDM programme
         Procurement and deployment
         Strategy and governance
         Lessons learned and applied
         Dependencies
         Surprises
    Conclusions
    Questions
21 April 2008              Slide 2 of 21

    Head of IT Projects & Development
         Shared service but mostly hospital for clinical IT projects
         Working with PCTs and GPs for discharge/clinic letters
         Major EDM programme for patient records
    Member of HL7 UK Board
         Broad interest in interoperability
         Chair of HL7 UK 2008 conference programme committee
    PhD research student
         Interest in effects of IT on clinical time and behaviour
         Investigated factors underlying clinician information usage
    All references in proceedings and my website

21 April 2008                 Slide 3 of 21

    “Paperless” working in healthcare
         General practice is far ahead of acute hospitals
         Paperless practice legally permitted in primary
          care since 2000 (Farrar, 2000)
         Most NHS hospitals have specialty EPRs, some
          have corporate EPR, all have PACS
         Generally, paper is still the hospital patient record
         Primary care perceives secondary care as stone
          age in information management (Vaughan, 2007)

21 April 2008              Slide 4 of 21

    Moving to electronic records...?
         “ICRS” was original goal of NPfIT in 2002
         National programme has had its goals shifted
         CFH deployment of hospital EPR/CRS very slow
         Paper records remain outside scope
         Additional service available from LSPs for EDM
    Portsmouth health community began
     formulating EDM strategy in 2005

21 April 2008            Slide 5 of 21
The problem of paper...

    How big is the problem?
         Estimated 2.5 trillion printed pages a year worldwide, 45%
          thrown away within a day (Smith, 2007)
         UK: estimated 120 billion pages a year (about 5% world)
         About 150 million paper records in NHS hospitals in
          England, perhaps over 10 billion pages (Branzcik, 2003)
               Significant proportion need 25-30 years retention (maternity,
                paediatric, research trials, cancer and chronic diseases)
               Even with hospital EPR/CRS eventually, the paper does not
                quickly go away

21 April 2008                     Slide 6 of 21
The problem of paper
 Storage space for records is necessarily
 limited and we were told frequently that the
 storage of records was a serious and ever
 growing problem

    Tunbridge, 1965

21 April 2008     Slide 7 of 21
The problem of paper
    Why aim to reduce paper dependency?
         Cash-releasing savings
               £1-6m/year/acute Trust (McIndoe, 2007)
               Admin staff, storage, stationery, transport
         Process efficiencies
               Remove duplication, reduce time wastage
         Safety improvements
               Information sharing/security, legibility, structure
         Environmental benefits
         Facilitate audit and research

21 April 2008                     Slide 8 of 21
Portsmouth’s EDM programme

    Procurement and deployment
    Strategy
    Governance
    Lessons learned and applied
    Dependencies
    Surprises

21 April 2008      Slide 9 of 21
EDM programme: procurement and
    May 2005: initial clinical workshops
    Sept 2005: OBC approved for EDM strategy
    Competitive procurement using OGC
     framework (S-Cat, now Catalist)
    Compared against LSP offering
    Jan 2006: pilot FBC approved, contracted
     with IBM (partners: Blueware, Graphic Data)
    Mar 2006: pilot in PCT children’s services

21 April 2008       Slide 10 of 21
EDM programme: procurement and
    Dec 2006: hospital FBC approved, contract
     novated to acute Trust
    Spring 2007: hospital workflow analysis
    Feb 2008: trial EDM-based clinics
    April 2008: first hospital deployment
     (ophthalmology, started 14 April)
    May 2008: further small specialties
     (colposcopy, disablement services)
    30 June 2008: main hospital records
21 April 2008       Slide 11 of 21
EDM programme strategy

    Bulk scan records active within 18 months
     plus specialty-held records
    Scan on demand for all other records
    File preparation to sort, remove some
     redundant content, identify special handling
    Core electronic content replicated into EDM:
     lab results, radiology reports, patient letters,
     MAU discharge summaries

21 April 2008         Slide 12 of 21
EDM programme strategy

    Bar-coded temporary paper notes for current
     admission/appointment for most areas initially
     (scanned on discharge)
    Electronic forms in development for Top 20
     hospital forms, trial in selected clinical
    Plan to trial with digital pens, tablets, COWS
    Constraint: Wireless on main site only; also
     have to support five peripheral sites and
     mobile access
21 April 2008        Slide 13 of 21
EDM programme governance
    Programme Steering Group chaired by Trust finance director
      Reports to Transformation Board chaired by CEO

    Clinical engagement group chaired by a clinical director
    Full-time programme manager with three project managers
    Four change facilitators
    Workstream leads for:
      Clinical process change

      Training

      Infrastructure

      HR

      Communications

      Information governance

      Logistics

      Technical integration

21 April 2008              Slide 14 of 21
EDM programme: Pilot lessons learned

    Scanning workload for newly created or received
     paper was underestimated and not properly built
     into revised job specifications.
    Initial clinical workshops did not elicit true functional
     requirements largely because clinicians were unable
     to visualize the system or the implied workflow
    Insufficient attention was given to agreeing standard
     working practices, consequently the system was
     used inconsistently by different teams and
21 April 2008            Slide 15 of 21
EDM programme: Applying lessons learned

    Hospital deployment working closely with HR
    Demo system used to help clinicians visualize
    Standard working practices being developed
     through clinical engagement group and
     information governance
    Bar-coded forms and electronic forms being
     developed to minimize new paper and simplify
     scanning process

21 April 2008         Slide 16 of 21
    IT infrastructure
         Utility, portability, ubiquity, mobility, security
         Single sign-on and patient context synchronization
               Independent business case but programme dependency
               Separate procurement via OGC framework
               Contract awarded to Sentillion
               Strategy to increase apps in SSO environment
               Deployed so far in CCU, this week in MAU, ED next
               Allows global audit of access

21 April 2008                 Slide 17 of 21
    Records management standards (content and
         Workflow reform, job specification changes
         Scanning file prep highlights problems with paper records
          management (Tunbridge, 1965)
         RCP recently published standards on medical record
          keeping: http://hiu.rcplondon.ac.uk/clinicalstandards/
    Interoperability (HL7 CDA, IHE-XDS, archetypes)
               Avoid “islands” like current PACS and C&B
    Navigation capability must be at least as good as
     familiar physical signposts of paper record (colour,
     texture, handwriting, form type)

21 April 2008                   Slide 18 of 21
    Clinical demand for eForms
    Consultant reading aloud from screen
    Unforeseen benefits
         Second opinions made easier
         Contemporaneous record of advice from home
    Scanned ophthalmological images good
     enough for diagnostic purposes
    Expect the unexpected! (Plsek & Wilson,

21 April 2008           Slide 19 of 21
    One of the most extensive EDM implementations we can
     identify in the NHS, but several in the pipeline and we
     are keen to share experiences and learn
    The business case for scanning historical paper records
     is robust
    No fixed timetable for becoming paperless
    LSPs have varying approaches, disparate solutions
    SPfIT contract reset may reduce barriers to CRS
     integration, if it ever happens
    EDM is not EPR

21 April 2008           Slide 20 of 21

    Contact: philip.scott@ports.nhs.uk
    Trust website: http://www.porthosp.nhs.uk/
    Research website: http://userweb.port.ac.uk/~scottp
    HL7 UK website: http://www.hl7.org.uk/

     Portsmouth Hospitals NHS Trust
     Queen Alexandra Hospital
     Portsmouth PO6 3LY

21 April 2008            Slide 21 of 21

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