Dr Rhidian Bramley
Chief Clinical Information Officer
Director of Radiology
Using open source at
the Christie
CCIO Open So...
Open Source at the Christie
Christie Clinical Portals
Christie Clinical Web Forms
Christie Clinical Web Forms
• Clinical noting
• Nursing & AHP assessments
• Clinical observations and results
• Care plans...
Christie Clinical Web Forms
Form Status Total
Concept 12
Design 73
Test QA 78
Live 162
Retired 23
Christie Clinical Web Forms
Structured clinical data
Real time clinical coding
Secure role based access
Record locking, au...
Medical care
• Provide patient care
• Record care given
And now…
• Collect clinical outcomes data
Dilemma
• Who has time to collect the data?
• Who is able to collect meaningful accurate
data?
Solution
• Integrate data collection so completely into the
workflow that it becomes part of the workflow not
extra to it....
Clinician completes disease specific web forms
Recording Clinical Tumour Stage
• Christie (2011) 41%
• Christie (2014) 90%
Overall survival by other factors
Electronic nursing
Previous nursing process
1. Admit patients, formulate care plans and complete
care plans on paper
2. So...
Electronic nursing
Problems
• Data collected up to 4 times
• Much of the data collection is distinct from patient
care
• A...
Electronic nursing pilot
Feb 2014
49 nursing assessment forms created for pilot
• Forms were easy to use
• Saved time over...
Electronic nursing pilot
Quotes
Nurse: “Fewer interruptions when completing with patients”
(compared to completing at a sc...
MDT data capture
Pathway
MDT
Referral
• Patient and provisional diagnosis
• Clinical details for rad and path review
MDT
Meeting
• Confirm ...
Conclusions
• Develop a system that allows the users to
directly interact and dictate design
• Work closely together to re...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
Using open source at the Christie and how it supports agile software development; projects completed to date and current p...
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Using open source at the Christie and how it supports agile software development; projects completed to date and current portal developments, Dr Rhidian Bramley and Dr Jac Livsey, CCIO and Consultant clinical oncologist, The Christie NHS Foundation Trust

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Using open source at the Christie and how it supports agile software development; projects completed to date and current portal developments, Dr Rhidian Bramley and Dr Jac Livsey, CCIO and Consultant clinical oncologist, The Christie NHS Foundation Trust

  1. 1. Dr Rhidian Bramley Chief Clinical Information Officer Director of Radiology Using open source at the Christie CCIO Open Source Conference Dr Jac Livsey Clinical Outcomes Unit Lead Consultant Clinical Oncologist and how it supports agile software development projects completed to date and current portal developments
  2. 2. Open Source at the Christie
  3. 3. Christie Clinical Portals
  4. 4. Christie Clinical Web Forms
  5. 5. Christie Clinical Web Forms • Clinical noting • Nursing & AHP assessments • Clinical observations and results • Care plans and actions • Order communications • Clinical referrals • Discharge letters and TTOs • Clinical outcomes • MDT meetings • Clinical audit • Clinical research • Staff & patient surveys
  6. 6. Christie Clinical Web Forms Form Status Total Concept 12 Design 73 Test QA 78 Live 162 Retired 23
  7. 7. Christie Clinical Web Forms Structured clinical data Real time clinical coding Secure role based access Record locking, audit and version control Clinical workflow Clinician and patient worklists Simple and flexible design Form and field templates Build reusable questions and tables Performance & analytics Data quality reports and charting Notifications Messages and reminders Set rules logic Dynamic on data entry Show/hide questions Calculate risk Customise care plans Show alerts Custom data model Load and persist patient data Clinical safety Risk assessment scoring Point of care decision support Data display options Tables, charts, journal, timeline Easy and intuitive to use Forms designed by clinicians Logical relevant questions. Click and select
  8. 8. Medical care • Provide patient care • Record care given And now… • Collect clinical outcomes data
  9. 9. Dilemma • Who has time to collect the data? • Who is able to collect meaningful accurate data?
  10. 10. Solution • Integrate data collection so completely into the workflow that it becomes part of the workflow not extra to it. • Making data collection replace the previous normal record of patient care • Designing intelligent, intuitive, clinically relevant processes
  11. 11. Clinician completes disease specific web forms
  12. 12. Recording Clinical Tumour Stage • Christie (2011) 41% • Christie (2014) 90%
  13. 13. Overall survival by other factors
  14. 14. Electronic nursing Previous nursing process 1. Admit patients, formulate care plans and complete care plans on paper 2. Some data (CQUINS) entered electronically 3. Some data used for paper referrals 4. Some data collected by regular “walk arounds” and spot checks
  15. 15. Electronic nursing Problems • Data collected up to 4 times • Much of the data collection is distinct from patient care • Almost all the data recorded is not usable for analysis • No real time data • Very labour intensive • Perceived as ‘box ticking’ waste of time by staff
  16. 16. Electronic nursing pilot Feb 2014 49 nursing assessment forms created for pilot • Forms were easy to use • Saved time overall • Increased time spent with patients • Helped clinical decision making • Improved data quality • Allowed real time data capture
  17. 17. Electronic nursing pilot Quotes Nurse: “Fewer interruptions when completing with patients” (compared to completing at a screen were people can ask you to do other things and you get distracted). Nurse: “We don’t want to go back to the old way”. Nurse: “I want to give the patient as much information as possible, now I can’t forget anything as I’m prompted on screen”. Nurse: ”(We’ve) come back to the days where we know our patient”. Nurse: “There’s more patient involvement”. Patient: ”The nurse told me so much more” (compared to a previous appointment at the hospital, the patient felt that the nurse told them more information and had more time to speak to them).
  18. 18. MDT data capture
  19. 19. Pathway MDT Referral • Patient and provisional diagnosis • Clinical details for rad and path review MDT Meeting • Confirm information • Confirm diagnosis, staging and treatment Clinic • Review patient • Agree management and treat
  20. 20. Conclusions • Develop a system that allows the users to directly interact and dictate design • Work closely together to refine and improve • Produce a tailored, user friendly, efficient system that both improves patient care and seamlessly collects the evidence to prove it

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