Comment: Going live at Liverpool Heart and Chest Hospital!

One trust's overnight journey to electronic patient records

As healthcare providers replace paper records with electronic solutions, they face a growing challenge of storing and accessing this data

In this article Dr Johan Waktare, consultant cardiologist and clinical lead for EMR at Liverpool Heart and Chest Hospital NHS Foundation Trust, talks about the deployment of technology at the trust and how it is transforming services

They said it couldn’t be done – but we did it!

Liverpool Heart and Chest Hospital has become a highly IT-enabled organisation, and it happened overnight.

It’s one thing becoming paperless; it’s another to use it to pro-actively transform workflows and efficiencies to provide better patient care

We set a go-live date for our entire EPR system on 26 June many months ago. We went live on 26 June – and for a major clinical implementation that’s not just good, it’s phenomenal.

One of the largest specialist hospitals of its kind in the country is now practically paperless - and we’ve lived to tell the tale!

We’re seeing the benefits across the hospital. I‘ve just got back from my outpatient clinic and I was amazed at how things have changed. In the past, I’d have had to search through files thick and overflowing with notes to find out a patient’s details. Files are now wafer thin, containing just a few labels and perhaps some ECG results. Hopefully soon there won’t be any paper files at all.

Of course, it’s one thing becoming paperless to address the Kelsey challenge and achieve HIMSS Stage 7; it’s another to use it to pro-actively transform workflows and 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 our Allscripts Sunrise system is OnBase, Hyland Software’s enterprise content management (ECM) solution. This has helped us 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. Although we are encouraging e-Referrals, the reality is that there will always be some paper – we don’t want to stop people sending us letters.

We’ll never again have an issue where notes are missing because someone else needs them. Records can now be viewed simultaneously by several people from different areas of the hospital

We know that some organisations use ECM just to scan in documents once they are finished. By taking it a step further and implementing workflow functionality, we can help improve the efficiency of clinical administration processes. Reports or diagnostic assessments that would have been printed in the past can be sent to our virtual print driver after they have been approved. They are then filed and available for our clinical staff to view in seconds. There’s no need for paper.

I would be lying if I said we hadn’t had challenges – the punishing timescale for a start, and managing the cultural change for some staff. We also had to develop a policy on what needed to be scanned and what could be left out. This might sound a relatively trivial decision, but considering that some files were 350-plus pages, it had a bearing on deadlines and budget.

My colleague on the project, the EPR programme director, John Coleman, tells me: “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 anytime from anywhere in the hospital.

“We’ll never again have an issue where notes are missing because someone else needs them. Records can now be viewed simultaneously by several people from different areas of the hospital.”

In the past the way IT was used in the hospital didn’t support our visions for staff and for patient care. We’re proud to say that it’s now helping us move swiftly in the right direction

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 we choose to go live with the entire system at the same time, but if this isn’t vital, a staged approach would help reduce stress levels. And don’t underuse your software; make the most of your investment. /

In the past the way IT was used in the hospital didn’t support our visions for staff and for patient care. We’re proud to say that it’s now helping us move swiftly in the right direction.

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