This document discusses the experience of implementing a paperless system in the intensive care unit (ICU) at the Royal Berkshire NHS Foundation hospital. It describes the barriers faced, such as staff being uncomfortable with computers. The system now allows access to patient records from anywhere, interfaces medical devices, and includes notes, prescriptions, observations and more. The author discusses the need for IT support, dedicated resources and overcoming barriers to create a successful system. The future goals are to use informatics to address care gaps and use data to improve care and reduce adverse events.

1. D R I A N R E C H N E R
C O N S U L T A N T I N T E N S I V I S T
R O Y A L B E R K S H I R E N H S F O U N D A T I O N
H O S P I T A L
Paperless ICU-our
experience

2. Contents
 Conflicts of interest
 What is needed
 Our situation
 What we had
 What we have now
 Barriers to change
 What we would like to do

3. Conflicts of interest
 My personality is “process”
 Hate stupid time
 Have no computer degrees/qualifications
 Been using ICU electronic record since 2003 (2000)
 Hamilton Medical & Phillips

4. Hind sight
There are known knowns. These
are things we know that we
know. There are known
unknowns. That is to say, there
are things that we know we
don't know. But there are also
unknown unknowns. There are
things we don't know we don't
know.

5. Why do we need this?
 Computers everywhere
 Data management & analysis
 Able to view in more than one place
 Archive
 Closed loop systems
 And many, many more

6. Problems of healthcare and computerisation
 Different teams work in silos
 Not patient focused – in general
 Write the same thing down several times
 Lack of joined up thinking
 No real time information

7. When
I
grow
up I
want
to be..

8. How we join the two
 Difficult to explain benefits
 iPhone 3 vs iPhone 5
 Windows 95 vs Windows 8
 Map vs satnav
 Colour vs black and white TV
 Horse vs motor car
 IT worker and healthcare worker in one
 Ways of doing things

9. My situation
 Intensivist since 2005
 1997 RBH - Eclipses
 Feb 2010 – went live with Philips
 Oversaw this project
 Introduced prescribing
 Interfaced
 Blood results
 Infusion pumps
 Reporting

10. Royal Berkshire NHS FT
http://www.healthcare.philips.com/main/products/patient_monitor
ing/products/intellispace_cca/

11. How we used to do it

12. What you need
 IT support within the hospital
 Hardware – interfaces & backup
 Work stream processes
 Healthcare workers who work together
 ICU IT support team to keep it maintained
 Support contracts

13. In reality
 Dedicated individual – 10 hours per week – 1 year
 Supportive management group
 ICU and IT workers to configure
 Wheeling and dealing
 You help me, I help you
 Demonstrate adverse events

14. What you need
“3 o’clock in the morning test”
2013

15. Flow sheet of system

16. What you need
 Configuration
 User friendly
 Bound data – stops silly results
 Identification tags – right results – right patient
 Overview of patients – dash board
 USER BENEFIT

17. Barriers to success
 Staff poor with computers
 Can’t touch type/navigate
 “have to write down to force them to check”
 People not acknowledging they can’t do something
 Budgetary – mainly adverse events overcame this

19. What we have now
 Access anywhere
 Interfaced
 Blood results – microbiology, histology, ABG, etc
 ECG
 Infusion pumps
 Ventilator observations
 Notes – typed and scanned
 Prescriptions
 Lines
 ICNARC

20. Overview

21. Monitoring interface

22. Observations & comments

23. Observations & comments

24. Interface observations - ventilators

25. Line & tubes

26. Laboratory results

27. Microbiology

28. Notes – multi disciplinary notes

29. Prescriptions

30. Money, money, money - CCMDS

31. The future
 Building the smart ICU
 Medical devices
 Informatics to address care gaps
 Information to reduce adverse events
 Information to demonstrate affects of care

32. ICU Care gaps
 Can't find something - nurse, defib, drug, etc - can
use RTLS - real time locating system. Bar code/chip
which can then use to locate via wireless
 Data overload, background noise, alarms - how can
we reduce the number of alarms? Switch to delivery
& filter alarms - only select a-systole and VF, rest of
ECG alarms ignore? Fused alarms - low BP and high
HR for e.g.
 The electronic record has holes in it - devices and
data not associated with patient, time delay. Link
device to a patient or link device to a room.

33. The future
 Future proof - build so it lasts and built to grow
 Mainly used to store and keep a record of what care
is given - we don't look at pattern recognition,
disease process, data mining to improve global care
 Mining is expensive and the medical world do not
have the knowledge of patient care.

34. Thanks and questions