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20131212 salford royal experience an epr 10 years on, implementing ep rs at salford royal motivation and outcomes

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Madeleine Neve, IM & T lead at Salford Royal Hospital presents at Health 2.0 Manchester meeting. See http://www.htmc.co.uk/pages/pv.asp?p=htmc0519 to watch talk

Madeleine Neve, IM & T lead at Salford Royal Hospital presents at Health 2.0 Manchester meeting. See http://www.htmc.co.uk/pages/pv.asp?p=htmc0519 to watch talk

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  • The EPR journey in Salford Royal started in 1998. Quality Improvement (QI) was a hospital priority, identified as a mechanism for increasing efficiency as well as effectiveness. The burden of generating clinical quality performance monitoring data to support QI was quickly becoming unsupportable despite investment in about eighty independent, specialty specific, stand-alone clinical system
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    • 1. Implementing EPRs @ Salford Royal: Motivation and outcomes Salford Royal NHS Foundation Trust
    • 2. Salford Royal NHS Foundation Trust • • • • • Large teaching Trust in Greater Manchester Approx 800 Beds Serves population 220,000 Over 6000 Staff Provides: - General Acute Services - Community Services - Tertiary Services across GM
    • 3. Salford Royal NHS Foundation Trust The Trust prides itself on delivering care for patients by aspiring to be: •The safest hospital in the country as measured by mortality and harm rates. •Viewed as the leading hospital for Quality Improvement and the hospital of choice for patients in the North West. •Focused on improving the patient experience, requiring respect, compassion and the right attitude to patients as our customers. •Ensuring the highest standards of environmental cleanliness.
    • 4. Patient Records in the NHS
    • 5. Salford Royal…….
    • 6. Functionality Currently Available • Results Viewing • Electronic ordering • Recording of allergies and significant events • Clinic letters • Clinical Documentation • Electronic Prescribing • Medication Administration • Recording of Diagnosis & Procedures • Immediate Discharge Summary
    • 7. The Salford EPR Journey…. • Started in 1998 • Quality Improvement (QI) was a hospital priority, • Clinical quality performance monitoring data to support QI was becoming unsupportable despite investment in 80 independent, specialty specific, stand-alone clinical systems • GPs were dissatisfied with the content, legibility and timeliness of discharge summaries • Management of patients admitted as emergencies was compromised by delays in access to their records • Reinforced by two Institute of Medicine publications ‘To Err is Human’ and ‘Crossing the Quality Chasm’ and by visits to successful EPR implementations in the USA
    • 8. Salford Royal EPR • 7000 current active users • 200 users concurrently logged in • 160 GPs at 55 surgeries have access across Salford • 28,000 records accessed daily • One complete record • 1 Million Patient Records • 100 Million Diagnostic Results • 2.3 Million Pharmacy Orders
    • 9. The Next Stage of the Journey……………… • Current system 10 years old and used to optimum benefit • No further developments being made on the system • Senior Leaders could see more potential • Demand for new Capability • Demand for improved usability • Needed a new system to serve us well into future and has potential for future innovation, eg patient portals • Above all – better and safer for patients, who can be confident their records are being held in one central, secure location
    • 10. The Next Stage • Went out to Procurement on12th August 2011 • Preferred Bidder Selected December 2011 • 12 Months of preparation and migration of over 1 million patient records! • Trained 7000 users! • Phase 1 Big Bang Go-Live 8th June 2013!
    • 11. EPR Benefits – Legibility/Reduction in errors (Drug Charts)
    • 12. EPR Benefits – Legibility/Reduction in errors (Drug Charts)
    • 13. Prescribing & Medication Errors: Benefits • Increased Legibility • Reduced Dose Errors due to predetermined dosages • Control of certain drugs • Rapid Identification of new patients and new drugs items by Pharmacists • Timely Medication Administration • Corrections to drug charts can be made remotely • Loss of Drug charts has been abolished • Reduced transcription errors when re-writing drug charts
    • 14. EPR Benefits – Secondary Use of Information (Waterlow Scores)
    • 15. EPR Benefits – Secondary Use of Information (Waterlow Scores)
    • 16. EPR Benefits – Secondary Use of Information (Waterlow Scores)
    • 17. EPR Benefits – Availability of Information Anytime! Anywhere! Concurrently! This has allowed us to: • Offer remote Site Clinics for Tertiary Services • Multidisciplinary Record • Removed issues with lost notes and embarrassing consultations • Enhanced GP Communication • Email patients • Complete Clinical Coding directly from the electronic record
    • 18. Patient Interaction • • • • • Informed/Personalised Consultations Patients Spend Less time repeating information Supports Patient Education More time with Patients Remote Consultation
    • 19. EPR Benefits – Changes in Clinical Practice • More effective, multidisciplinary ward rounds • Virtual Ward (ward rounds) • Opportunity for senior oversight remotely • Guided practise – Pre–Set dosages, clinical guidelines • Education tool with patients
    • 20. Lessons - IT • Base Infrastructure platform – PCs, Network etc • Integration – The EPR never stands alone • Performance & Reliability • Support • Conflicting priorities for development • IT Resource to Support
    • 21. Lessons – Adoption & Implementation • Senior Organisation support is essential • Quick wins/benefits breed adoption – Results reporting as first function • User Driven Gradualism • Keep it simple • One size does not always fit all • Training & IT Skills of staff are essential
    • 22. Lessons – Adoption & Implementation • Take the enthusiasts with you but don’t forget about the rest. • Electrifying paper is not enough • Customisation has is benefits and also its challenges • Departmental systems v.s. greater good. • Expectation increase. Continuous development is required
    • 23. The Next Chapter…………
    • 24. Evolution of Electronic Patient Records Retrospective Manual Reporting Paper Retrospective Automated Reporting Current EPR Concurrent Synchronous Care New EPR Prospective Predictive Care
    • 25. Where HIT Lives Beginning CDS Advanced CDS: Intelligent
    • 26. • Is the NHS Ready? • Are Patients Ready?
    • 27. Improved Prophylaxis 97.4% Reduced Alerts (p<.001) Improved Phophylaxis 30000 145.3% Increased Assessments (p<.001) 3000 139.6% Improved Assessment Rate Alerts for Missing Assessment 25000 (p<.001) 2500 20000 2000 15000 1500 VTE Assessments No Assessment 10000 1000 5000 500 0 With CPOE and traditional CDS 1 2 3 4 5 6 7 Missing Assessment Alert 0 With Outcomes Toolkit incl. Advanced CDS Order Sets 8 9 10 11 12 13 14 15 16 Month
    • 28. DVT/VTE Rate per Bed Day Intelligent Order Set 95% Confidence Interval 62.6% decrease in mean DVT/VTE rate (p<.001). From mean rate of .431 to .161. 59.4% decrease in variation (p<.001) Mean Rate 95% Confidence Interval 1 3 5 7 9 11 13 15 17 19 21 That’s approximately 302 fewer patients Week suffering from VTEs each year * • • 23 25 27 29 £ 725,400*reduced variable costs (p<.001) 0.8 Days reduced mean LOS (p<.001) 31 33 35 37 39

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