1. Developing shared systems
around patient journeys
Dr Deblina Dasgupta
Medical Director designate
Homerton University Hospital
NHS Foundation Trust
2. Homerton: Our Digital Journey
2004
EPR Go
Live
2011
Communit
y Merger
(RiO)
2014 HIE
2015 ACE
(EPR
Upgrade)
2018 OP
Trans-
formatio
n
2003 Project Kick
2005 Code
Upgrade
2007 Supporting
Hardware Upgrade
2009 Additional
Clinical
Documentation
2012 Data Centre
Migration
2013 Software
Upgrade
2014 Child
Protection
Information Sharing
2016 CMC go live
2015 HAS (upgraded
PAS)
2015-18 Change
Board
2016 Sepsis and AKI
Flow
3. 2004
EPR Go
Live
2011
Communit
y Merger
(RiO)
2014 HIE
2015 ACE
(EPR
Upgrade)
2018 OP
Trans-
formatio
n
2003 Project Kick
ED
Inpatients
Maternity
ePrescribing
Whiteboards
Bed Mx
Care planning
Safety alerts
Device
integration
HIE
Child
protection
Electronic
results and
docs to GPs
Mobile working
Admin flows
And more…….
Homerton: Our Digital Journey
15. Uptake of Voice Recognition
• Additional stats:
• 25 full services
live
• 300 Users now
live
• Letter
turnaround time
to 2 days down
from 17.7 days
1,607
1,903
1,792
2,670
3,005
2,819
3,999
4,183
4,370
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
#MINUTES
Total Minutes
2.85
5.84
8.59
12.75
18.43
23.60
32.56
40.91
49.42
0.00
10.00
20.00
30.00
40.00
50.00
60.00
Auto-Text Time Saved (Cumulative Hours)
Cumulative Time Saved (Hours)
16. Patient story: Ali
• Seen in
Gastroenterology
• Diagnosed with
Cancer
• Information sent out
on the same day to
all relevant clinicians
enabling support
2004 Go Live (PAS ( patient administration system), ED, Pathology, limited documentation – discharge summaries etc)
2015 ACE (All IP documentation, whiteboards, prescribing, devices)
All clinical documentation, nursing documentation, care planning as well e prescribing.
Big bang!! Exciting planning and actual implementation – in July.
Currently well embedded into routine practice
Challenges – care planning – a clunky and suitable for American healthcare predominantly which was difficult to make fit for purpose for NHS.
Not live in ITU, NICU, O & G – has K2
Community merger – 2011 which led to its own challenges of a different system RIO
HIE – 2014 and we shall spend some time talking about it later
Other opportunities 2015- 2018 – safety – Sepsis and AKI flows
Change board to facilitate small changes to keep the momentum and maintain clinical interest and decision making capabilities
This is where we are currently. Main focus at out outpatient transformation program
Linking with the wider world and outpatient transformation
Connections with wider world to make information flow clinically relevant
Previously we’ve used patient stories based on Bill and Edna – well known statues in a Hackney park.
You may have seen ‘Debbie’ and ‘Ali’ – artwork on the Homerton site.
We are using Bill, Debbie and Ali as examples of our patients’ journeys.
The Homerton approach is to develop systems that are clinically led – rather than a series of IT projects
We are using Bill, Debbie and Ali as pegs for this journey and will come back to these examples in the next session.
HIE was one of the first big integration projects
Health information exchange is a hub that allows us to link patient information from our local health economy.
Further linkages with Waltham forest and east London neighbouring CCGs information exchange
For eg: Information available for us to see from Barts Health, ELFT, Hospice as well as OOH teams as well as GP practices EMIS.
Potential of growth is exciting as future further connectivity maps are easily visualised although not in action yet.
We have discussed challenges in 2011 with 2 systems with acute and community – here we have HIE which offers solution for us to link up within and outside our organisation.
It’s a no brainer for the clinicians to have this data available not just for efficiency gains but for clear clinical gains.
Vs a massive centrally held data repository – forward thinking organisations have moved on to create local interconnected data systems with potential future viability and linkages.
HIE was one of the first big integration projects
Health information exchange is a hub that allows us to link patient information from our local health economy.
Further linkages with Waltham forest and east London neighbouring CCGs information exchange
For eg: Information available for us to see from Barts Health, ELFT, Hospice as well as OOH teams as well as GP practices EMIS.
Potential of growth is exciting as future further connectivity maps are easily visualised although not in action yet.
We have discussed challenges in 2011 with 2 systems with acute and community – here we have HIE which offers solution for us to link up within and outside our organisation.
It’s a no brainer for the clinicians to have this data available not just for efficiency gains but for clear clinical gains.
Vs a massive centrally held data repository – forward thinking organisations have moved on to create local interconnected data systems with potential future viability and linkages.
Use over time
Stressing utilisation by both GPs and the acute trust
As you are able to see – medication list, other clinic letters as well as all investigations are available to the admitting clinician efficiently.
Originally created by Royal Marsden – palliative Eol care plans
Storing of care plans across systems
Clinicians in all setting with privileges can alter the care plans as things change
Eol, multi morbidities , frailty as well as advanced care planning
Available to LAS recently.
Challenges – with fully embedding within HIE as a completely different platform. And requires separate individual clinician log ins
Challenge with embedding uniformly across the organisation with mobile clinical staff
However despite that …
C&H CCG has been the greatest proponent of this . Initial pump priming by CCG to enable kick start by all practices.
C&H CCG has been the greatest proponent of this . Initial pump priming by CCG to enable kick start by all practices.
Over the last 3 years our concentrated efforts with Treatment escalation planning, advanced care planning as well as learning from every death and mortality reviews have escalated clinicians engagement and appetite to use the CMC in a clinically efficient way
Incorporates eRS for managing appointments (best performing London Acute Trust – Paper switch off has happened) – collaborated with GPs CCG effectively.
Kiosks – checking in electronically, reducing queues embedding efficiencies
EPR in OPD –Wasn’t a solution from Cerner – managing the flow, enabling speedy documentation of relevant information within busy clinic settings.
In house system built – interactive clinic work list that also manages letter flow after clinic. It also manages follow up appointments and outcomes for RTT. ( referral to Treatment )
Voice Recognition supported by worklists and a full EPR flow
Phased roll out rather than big bang. – ring fencing within service , tailored support as well as learning and adapting as the roll out progresses.
Needed to be realistic of the impact of this massive change program on a large number of staff.
Rolled out from March to July 2018
-All main adult services either live or in go-live phase
Still to come paeds, fertility, HANS
Ali – the son-in-law
1 slide:
Getting the organisation to take it seriously- boards/ business cases/ project plans/ agile working
Identifying only those elements that add value – mainly to our patients, but also for our clinicians.
Process mapping- add value
Scoping
Project planning
Involvement of all key stakeholders – easier said than done however too costly to get it wrong
Greatest strength has been the ownership by the clinical teams and partnership between IT, project teams and operational teams.
1 slide:
But most importantly…..Getting clinicians involved – clinical leaders, involvement from all teams – reception/ secretaries/ management CIS
Using all sorts of strategies – one to ones etc…
Clinical lead
Clinical working groups to scope and key decision making, cajoled, persuaded and identified early adopters.
Testing by a wide group of clinicians – individual tasks to system checks
Corridor conversations, 1:1 s, difficult emails!! unbounded enthusiasm, pragmatism, and visible clinical leadership as well as supportive IT teams
Communication strategies – intranet, emails, blogs, tweets, team meetings
In summary – I have given you a very quick run through Homerton’s approach to digital change, including key stages on our digital journey.
Now we have to recruit, retain and develop leaders to have a ‘Millennial Mindset’ where ‘digital – use technology to create better outcomes, are curious and focussed on digital technologies’ as part of their mindset.
The key message is – we focussed on the clinical needs of patients to drive technological change – ‘it’s the patient journey that drives us – not a set of IT projects’.
