EPR is driving paperless systems at flagship new hospital

The outpatients department at the new Queen Elizabeth Hospital Birmingham is on track to become virtually paper free following the introduction of electronic patient records (EPR).

The huge department, which opened at the new hospital in July 2011, has become one of the first in the country to record patients’ clinical information electronically, rather than using paper notes.

The trust has developed its electronic patient record by enhancing the functionality in its Prescribing Information Communication System (PICS), which enables clinical data capture, electronic prescribing and clinical decision support. A home-grown clinical portal system has pulled together several systems in which patient information was stored into one easy-to-use application which has formed the core patient record. Both systems were entirely created and developed in-house within University Hospitals Birmingham NHS Foundation Trust.

We used to move around 3,000 patient records every day within the trust. We have reduced this by 70% and now only provide notes by exception where clinicians have identified the need to access the paper record

Deborah McKee, electronic patient records programme manager, said: “We used to move around 3,000 patient records every day within the trust. We have reduced this by 70% and now only provide notes by exception where clinicians have identified the need to access the paper record.

“Consultants are still looking at the patient records, but they are doing it electronically rather than on paper. It’s a new and innovative way of working that the clinical teams have embraced and which ensures that patient information is readily accessible at the point of need.”

She said the need for a new approach came after the failure, last year, of the Government’s centralised NHS National programme for IT, adding: “The failure of the programme to deliver an integrated electronic patient record presented the trust with a significant problem. It was acknowledged in 2009 that there would not be sufficient storage space for patient records at the new Queen Elizabeth Hospital Birmingham (QEHB). Therefore, in the absence of a national solution, we took the decision to develop our own EPR system which would enable us to track patients around the outpatients department, access clinical information easily and, in a ground-breaking move, electronically capture clinical information in the outpatient setting in real-time for the first time.”

The trust initially created an application called the Outpatient Tracking Information Management System (OPTIMS), which was used to manage the flow of patients through the hospital’s outpatient areas.

“We moved from multiple reception areas across two sites to one main waiting area with several sub-wait areas so it was really important that we knew exactly who was waiting where,” said Ms McKee.

OPTIMS was successfully piloted at Selly Oak Hospital and the old Queen Elizabeth Hospital before the move to the new QEHB site. The system is based around the patient letter, which carries a barcode unique to the individual. Patients who turn up with their appointment letter are asked to follow a series of instructions on the self check-in kiosk screen and, once checked in, are then asked to wait until their name appears on one of the wall-mounted TV screens. There are also volunteers to readily assist anyone who needs help.

Once this was in place, the trust’s EPR was then developed. The initial pilot of the clinical portal was undertaken in the maxillofacial surgery department by consultant surgeon, Ian Sharp, and the team. Six months later the rollout started and there are now more than 800,000 records within the system, each containing the patient’s unique hospital registration number, their demographics and a wealth of clinical information including all clinical correspondence such as outpatient letters and discharge letters, results, operation notes, emergency department attendances, radiology reports, medical photography and a record of appointments and inpatient attendances.

McKee said: “Quite quickly, you can access the patient’s clinical information at the point of need in order to manage your patient safely and plan their continuing care. It is already a comprehensive record of each patient’s history with the trust and continues to grow in information and functionality.

The introduction of a new paper-light way of working has transformed the way we work in our outpatient clinics, reduced the risk of information not being available, and enabled the trust to continue to deliver the best in care to all of its patients

“Once they have reviewed the patient information and seen the patient, medical staff can then update the record electronically instead of writing into the notes, including updating any diagnoses or allergies and writing an electronic prescription.

“All clinical correspondence is produced using digital dictation provided by Winscribe, which allows us to manage our production of clinical correspondence in a standardised way that ensures correspondence is saved electronically into the patient’s record as soon as it is authorised by the clinician.

“We see on average 40,000 outpatients a month in the new outpatient facility at QEHB. The introduction of a new paper-light way of working has transformed the way we work in our outpatient clinics, reduced the risk of information not being available, and enabled the trust to continue to deliver the best in care to all of its patients.”