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

1. Implementing EPRs
@ Salford Royal:
Motivation and outcomes
Salford Royal NHS Foundation Trust

2. Salford Royal NHS
Foundation Trust
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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…….

7. 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

8. 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

9. 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

10. 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

11. 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!

12. EPR Benefits – Legibility/Reduction
in errors (Drug Charts)

13. EPR Benefits – Legibility/Reduction
in errors (Drug Charts)

14. 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

15. EPR Benefits – Secondary Use of
Information (Waterlow Scores)

16. EPR Benefits – Secondary Use of
Information (Waterlow Scores)

17. EPR Benefits – Secondary Use of
Information (Waterlow Scores)

18. 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

19. Patient Interaction
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Informed/Personalised Consultations
Patients Spend Less time repeating information
Supports Patient Education
More time with Patients
Remote Consultation

20. 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

21. 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

22. 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

23. 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

24. The Next Chapter…………

25. Evolution of Electronic Patient
Records
Retrospective
Manual
Reporting
Paper
Retrospective
Automated
Reporting
Current
EPR
Concurrent
Synchronous
Care
New
EPR
Prospective
Predictive
Care

26. Where HIT
Lives
Beginning
CDS
Advanced CDS:
Intelligent

27. • Is the NHS Ready?
• Are Patients Ready?

28. 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

29. 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 *
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25
27
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£ 725,400*reduced variable costs (p<.001)
0.8 Days reduced mean LOS (p<.001)
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33
35
37
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