Our journey in delivering digital care

1. Our journey in delivering digital care
Musadiq Subar
IT Programme Manager and Clinical Technical Architect
it.integratingcare

2. About Us
North Middlesex University Hospital (NMUH) is one of London’s busiest acute
hospitals, serving more than 350,000 people living in Enfield and Haringey and
the surrounding areas, including Barnet and Waltham Forest
Every day we see approximately:
• 500 patients in A&E
• 450 inpatients on our wards
• 50 patients in major or minor surgery
• 970 outpatients
• 200 women in maternity
• 14 newborn babies.
it.integratingcare

3. Our Vision
• The Government has adopted a “Digital by Default” Strategy which will
revolutionise public services by delivering significant improvements
• In healthcare, these advances in technology will lead to better health,
better care and better value by enabling people to do things quicker, safer
and more efficiently
• The vision statement for the Trust IT Strategy :-
“To create a digital healthcare organisation that provides secure on-
line access to the right information, to the right person, to the right
place”
it.integratingcare

4. Key Principles
• Patient Safety
• Quality of Care
• Security
• Efficiency
• Carbon Footprint
• Cost Savings
it.integratingcare

5. Case Study
North Mid’s digital journey so far
it.integratingcare

6. The Challenge
• Lack of clinical engagement
• Fragmented user experience
• Increased training costs
• Low staff morale
• Expensive to correct
• Achieving business buy-in
it.integratingcare

7. Clinical Engagement
• Clinicians across the trust were becoming
increasingly frustrated by the lack of time
they were able to spend with patients and
the length of time it was taking them to find
the information they needed
• There was an immediate realisation amongst
the clinical community that things needed to
change
• This was not an IT-led decision, it came from
the heart of the business
• From the outset, a working group of clinicians
was established
it.integratingcare

8. Winning clinical confidence was Key
The challenge: information prioritisation and presentation
• patient information presented and stored in multiple systems
• Demonstrate existing paper based system could be replaced with an electronic one without impacting
operations and overall care delivery
• Winning the confidence of the clinicians was paramount.
Review discharge summary
• Single sheet of paper, plus multiple carbon copies
• Notes often illegible and GPs would need to make contact for clarification
• Clinicians did not want to log into multiple systems from multiple locations
• Required the ability to log in on any device and be presented with the information they needed
Implementing a clinical information portal (CIP):
• Enabled a single log-on and view to discharge summaries
• Replaced the paper and carbon copy
• Resulting in a more structured patient care summary,
with detailed information for GPs and other care providers
it.integratingcare

9. The (not so) technical challenge
• Version one of our portal was almost like a band aid – it fulfilled a purpose, but it
could not be a permanent fix…this is where so many trusts make mistakes
• The drive for many care providers is to get everything on screen, focus on the
application and then worry later about how they are going to present a holistic
view of a patient
• For us, our real focus from the outset has been on patient data and ensuring we
had a data management approach that would not lock patient information
away, but would make it available to the applications and the clinicians as and
when required
it.integratingcare

10. The (not so) technical challenge
• In 2012, our national contract for Picture Archiving and Communications (PACS) came up for
renewal and this was an opportunity for the trust to totally re-engineer how we store data
• A separate Independent Clinical Archive (ICA), often referred to as a next generation Vendor
Neutral Archive (VNA), can hold all sorts of data – medical images, scanned documents,
video files, word documents – and it can work seamlessly with our portfolio of application
vendors
• With over half a million records within the portal from multiple clinical systems, but now
created from a suite of CIP apps data handling was becoming critical in information
presentation
• The ICA approach lent itself well to our vision of providing all information about patients to
the clinicians that need it at the point of care. Our data is now stored centrally, securely and
can be made available via the CIP or any other applications
it.integratingcare

11. CIP v2 – Apps Store
• Electronic discharge summaries was the first
of data entry apps built for the CIP. This has
now been followed by –
• RMS – Every GP referrals (paper and
eReferrals) are scanned/imported into a
workflow for clinicians to vet and made online
• eOutcomes – All OP outcomes are completed
according to RRT guidelines and ensuring all
activity coding is recorded
• eTCI - all surgical procedures are booked
online and managed by the admissions team
• As well many others including AKI and
Diabetes management modules
it.integratingcare

12. it.integratingcare
* Test Patient

13. Still not paperless
• With all this advancement to electronic capture of
information, the trust was still circulating physical
patient notes between services
• Having successfully been awarded funding from
the NHS Tech Fund, we were able to bring
forward the electronic document management
system (EDMS) project by a year, which was part
of the IT strategy three year plan
it.integratingcare

14. Why Fortrus and EMC?
• Working with Fortrus and the Enterprise Content Division of EMC, we have begun a
programme to scan all these records and be part of the electronic patient record eco-
system already in place through the CIP
• We anticipate well over one million scanned documents will be uploaded into our EDMS –
therefore the technical and data structure was a priority to get right to retain clinical and
operational confidence
• It has taken just over a year to achieve an operational solution – Paediatrics Outpatient first
to go live – March 2016 (8000 documents scanned and viewable)
• Which has seen the review and redesign of document management and operational
pathways, including designing a very detailed technical
infrastructure and setting up a new scanning bureau
it.integratingcare

15. Why Fortrus and EMC?
• There has been a lot of enthusiastic and positive feedback from the clinicians regarding
the new system, they have been using Unity with intuition and discovering the features
and navigation
• There has been a number of challenges with the implementation, but with the hard
work of the project team and on going support from the Trust, it is projected that in a
year's time EDMS, together with the Clinical Information Portal will have replaced over
80% of physical notes used when treating their patients
• With our new systems in place, we are now enhancing the clinical portal to integrate
with our archive enabling our clinicians, and other authorised staff, to look at
everything from the patient record, to patient demographics, outpatient letters,
discharge summaries, medical images
it.integratingcare

16. Unity - an Intuitive Solution
it.integratingcare

17. Unity - an Intuitive Solution
it.integratingcare
• Clinicians can use additional information to
make better diagnosis
• Comprehensive patient record assembled
from fragmented systems
• Further improvement patient outcomes and
more informed clinical decisions with
integration with the CIP
• Clinical engagement in UX Design reduces
training and adoption time

18. Unity - an Intuitive Solution
it.integratingcare

19. The Challenges
it.integratingcare
• Health records
• Operational management of specialty
• Understanding documents used against each pathway
• Additional computers
• Access to notes outside the organisation
• Invest in time process redesign in the project
• Suppliers understanding each organisation is different

20. Achieving business buy in
it.integratingcare
• We reviewed the existing paper-based patient notes. It highlighted
we were repeating the same information in both inpatient and
outpatients; there was no single point to query for the most up-to-
date information and unless clinicians waded through every single
page of the patient’s notes, information was difficult to retrieve
• Experience in operational project management brought better
understanding in delivering change and improvement
• Key areas that won support: clinical coding – finance driver

21. The next 10 years
it.integratingcare
• For many, 2020 is the focal point; but for North Middlesex, we are focusing on
ensuring the right systems are in place to cater for a changing healthcare
environment 10 years from now
• There is no doubt going to be further consolidation within the healthcare space
• Pressures on budgets are not going away and competition with private
healthcare providers is likely to increase
• As one of the largest care providers in our community, it is our responsibility to
make sure patients are treated efficiently and effectively and care and recovery
remain top of the agenda
• To do that, technology has a critical role to play

22. Final Thoughts
it.integratingcare
‘Going paperless cannot be about sticking new technology over
old ways of doing things. It has to be about looking at our
businesses and understanding what processes could be
improved. Technology is, and always will be, just an enabler to
help us change for the better’.

23. Thank you
it.integratingcare
Musadiq Subar
IT Programme Manager and Clinical Technical Architect
musadiqsubar@nhs.net