Susan Greenhill - eHospital Head of Information Systems (outpatients), Cambridge University Hospitals NHS FT

1. eHospital – changing
everything we do
Susan Greenhill
Head of Clinical Information Systems
(outpatients)

2. Our largest ever investment in improving healthcare quality
Cambridge University Hospitals (CUH)
• 100,000+ ED attendances
• 73,000+ in-patient episodes
• 115,000+ day-case attendances
• 570,000+ out-patient episodes
• 40,000+ surgical operations
Two hospitals:
• Addenbrooke’s
• The Rosie
5 clinical divisions –
women’s healthcare
fully integrated
• 5,700+ births
• 12,000 staff
• 1,150 beds
• £704m turnover

3. Our largest ever investment in improving healthcare quality
eHospital – the journey
Digital transformation programme at CUH to deliver high quality patient care
• 2010 – strategic outline case “Towards an EPR”
• 2011/12 – invitation to tender & competitive dialogue
• 2012 – preferred bidders selected (Epic & Hewlett-Packard)
• 2013 – 10-year contract signed with Epic & Hewlett-Packard
• 2013/2014 – Trust-wide network upgrade and IT infrastructure refresh
• October 2014 – Trust-wide go-live of Epic electronic patient record system

4. Our largest ever investment in improving healthcare quality
Hardware
Background (I)
Before eHospital
• No wireless network
• Ageing PC / infrastructure
• Low resilience
• Limited remote access
With eHospital
• ‘Infrastructure as a service’
• Network refresh & wireless
• Desktop refresh and new
devices (6750 PCs, 500
laptops, 395 WoWs*)
• Remote access & ‘bring your
own device’
• Handheld devices (420 ‘Rovers’
iPod Touch with Honeywell
barcode sled)
*WoW: Workstation on Wheels

5. Our largest ever investment in improving healthcare quality
Software
Before eHospital
• 1994 PAS* system, support
ending March 2015
• No ED or critical care
systems
• Pathology system upgrade
required
Background (II)
With eHospital
• Tender process, weighted to
clinical quality
• NHS Spine connected system
• Extensible / supported LIMS*
• Epic used Trust-wide
(3,200 concurrent users at
peak times)
• Bedside device integration
• 1000 staff using Haiku / Canto
mobile Epic apps*PAS: Patient Administration System
*LIMS: Laboratory Information Management System

6. Our largest ever investment in improving healthcare quality
• PAS, bed management
• Case note tracking
• Enterprise scheduling
• Prescribing & formulary mgt
• All I/P & O/P care
• Care plans & pathways
• Clinical documentation
• Standard clinical terms &
coding
• Workflow management
• Reporting dashboards
• Cardiology
• ED
• Genetics
• Intensive care
• Maternity
• Ophthalmology
• Oncology
• Pathology
• Pharmacy
• Radiology
• Respiratory
• Theatres & anaesthetics
• Transplant
• Orders & results
• Patient kiosk
• Patient portal
• GP access
• Medical devices
• Remote access
• Mobile access

7. Our largest ever investment in improving healthcare quality
2013 2014
Q2 Q3 Q4 Q1 Q2 Q3 Q4
Training Managed print / network “refresh”
Workflow
validation
Virtual desktops
Configure & build
Testing
Training
Go-live
Timetable

8. Our largest ever investment in improving healthcare quality
Workflow validation
• 1,000+ clinicians validated modules
• 75% of analyst builders were clinicians seconded for 18 months
Training
• > 95% of staff trained (12,000 people)
• > 175,000 hours of training over 9 weeks
Operational
• 120, 90, 60 & 30-day pre go-live eHospital assessments
• Parallel divisional operational assessments
• Specialty-level risk assessments
• Dress-rehearsals including inter-departmental high-risk pathways
• Increased focus on high-risk prescribing & WHO checklist at go-live
• Go-live final decision made by full executive
Go-live preparation

9. Our largest ever investment in improving healthcare quality
• Run akin to ‘Internal major incident’
• 150 people on-site command centre, 24/7 for 6 weeks
• > 100 WTE CUH analysts, > 250 Epic staff, >50 HP staff
• > 22,000 ‘tickets’ in 5 weeks
• 4 weeks of CUH / Epic ‘at-elbow’ floor-walkers
• Regular communication with CQC, CCG, GPs, Monitor, HM
Coroner, governors and local MPs
• External assurance review in early December 2014
Go-live

10. Our largest ever investment in improving healthcare quality
• Daily executive meetings to review safety and take action
• Daily senior nursing ‘huddles’ to assess clinical safety
• Categorisation of ‘tickets’ to identify potential or actual safety
issues for action
• Tip sheets and alerts developed
• Existing paper notes available until October 2015
• Access to historic data (letters & results) through ‘LARDR’ web
based system
Clinical safety at Go-live

11. Our largest ever investment in improving healthcare quality
• Specimen label printers
• Emergency Department workflow issues
• Communication with GPs
• Complex prescribing
• Training
Challenges at go-live

12. Our largest ever investment in improving healthcare quality
HIMSS EMRAM & CUH
25 Oct 2014
15 Oct 2015

13. Our largest ever investment in improving healthcare quality
Clinical staff experience
Item April 2015 March 2016
Staff are able to find relevant patient info easily in Epic 81.4% 86%
Staff are able to access the reports or metrics in the Epic
system that are relevant to their role
79.7% 85.8%
Staff are satisfied with the support available/provided
for Epic issues/Epic changes that arise
60% 68.2%
Staff who are able to find information about eHospital 84.9% 89.6%
Staff who are confident, at the present time, that the
Epic system supports them in caring for their patients
77.2% 88.4%
Staff who are confident that, in 6 months time, the Epic
system will support them in caring for their patients
85.3% 89.6%
% of staff reporting neutral, agree or strongly agree

14. Our largest ever investment in improving healthcare quality
Pharmacy integration
• Preparing discharge medication
reduced from 90 to 45 mins
Antibiotic prescribing
• 100% recording of indication for
prescribing
Paediatrics
• Zero PICU sedation related drug
errors since go-live
• Barcode meds admin in general
paediatrics
Benefits (I)
Transfusion
• Full closed loop ordering,
preparation, supply & administration
Allergies
• approx. 51,000 alerts, approx. 8,500
led to a change in prescription
Hip fracture pathway
• Achievement of best practice care
rising from 66% to 82%
Increase in main theatre usage
• 1,319 cases increased to 1,554 a year

15. Our largest ever investment in improving healthcare quality
Virtual fracture clinic
• 4,500 appointments freed up
• £200k / year saving
Mobile devices
• Real-time information recorded at
the bedside
• £270,000 equiv. staff time saved / qtr
Integrated devices
• All physiological monitors & ventilators
in 40 theatres & 148 high-dependency
areas connected to Epic EPR
• £655,000 equiv. staff time saved / qtr
Benefits (II)
Notes retrieval
• 99% reduction for in-patients
• 97% reduction for out-patients
• £115k savings / qtr
Document handling
• 153k / year - discharge summaries
sent electronically
• 80% of clinical letters now sent to
GPs electronically
• Reduction in specialist stationary
• £157k savings / qtr
• 0.9m documents sent to GPs by
Summer 2016

16. Our largest ever investment in improving healthcare quality
Staff engagement
• Support link users programme – network of clinical leads / liaison
• Clinician ‘builders’ – devolved system configuration skills
External communication
• MyChart patient portal – live April 2016
• EpicCare Link for GPs, referring hospitals & others – Q3 2016
• Care Everywhere connection to:
• West Suffolk Hospital (Cerner) – Q2/3 2016
• CDA based discharge summaries to 1o care systems
Currently underway…

17. Our largest ever investment in improving healthcare quality