ECRI Institute, one of the leading patient safety and medical technology research organizations, places health technology cybersecurity at the top of its just-released 2019 Top 10 Health Technology Hazards.
HB Top 10: pursuing paperless
When NHS England announced its ambition to be paper free at the point of care by 2020 it highlighted the potential of full digitisation to generate billions of savings, essential to keeping the health service sustainable. In our penultimate Top 10 list of 2017, Health Business recognises the UK trusts that are leading the pack in pursuing paperless ambitions
There is no doubt that better use of data and technology can be an overwhelmingly positive move for the NHS, and is therefore unsurprising that the Department of Health and NHS England have been so keen to limit the amount of paperwork and increase the dependency on technology within UK hospitals.
Technology not only reduces the administrative burden for care professionals, but will also give patients more control over their health and well-being. Launched in February 2016, NHS England set out a wide‑ranging strategy to transform the records of its trusts, naming 16 Global Digital Exemplars that would lead the way in reducing the paper burden on the NHS and promote digital records and patient information.
Digital Health Intelligence’s CDMI+36 NHS technology adoption report, published earlier this year, argued that Jeremy Hunt’s NHS ‘Paperless 2020’ target would not be met by trusts, and warned that all NHS hospitals would not be paperless until 2027 by the earliest. This furthered the view of Dr Robert Wachter, who’s NHS commissioned review recommended that the ‘unrealistic’ 2020 target be relaxed, and instead suggested that a target should be set for all trusts to be ‘largely digitised’ by 2023.
However, while the 2020 target remains understandably contentious, the progress that some trusts have made digitising their records and implementing new technologies should not go unnoticed.
1 South Tees Hospital NHS Foundation Trust
South Tees Hospital NHS Foundation Trust is gradually introducing a new electronic document management system across all of its wards at The James Cook University Hospital and the Friarage Hospital. First to benefit will be children’s services which will start piloting the new digital e-forms soon.
The Evolve Clinical Noting system will eventually replace all healthcare records at the trust. Clinicians will still have access to past paper records, but any new information will go onto the electronic system so they can securely access it from any NHS site. Benefits of going paperless include that it is more secure, it’s live, it’s efficient and it improves reporting.
As part of the project, 1.5 million case notes have been digitally created and 18 months of historic letters are being migrated into the system. Any paper documentation that is received in future will be scanned onto the system.
Ian Whitehead, consultant in anaesthesia and critical care and clinical project lead, said: “Patient records are currently paper based and can be located across numerous places in our hospitals or community health services. This can often mean that the complete picture of a patient’s health and care is not immediately available to a clinician at the point of care.
“Evolve will enable colleagues to have access to all the information they need at all times and in all locations, with the digital record available 24 hours a day, seven days a week. It’s a stepping stone toward a complete electronic record.”
Lisa Lizzio, clinical noting project manager, said: “It has taken a lot of hard work to ensure we are delivering a system that is safe and fit for purpose but it’s very exciting to be able to roll this out across our hospitals starting with our children’s services. Over time patients will see a more streamlined service with clinicians having improved access to clinical records.”
2 County Durham & Darlington NHS Foundation Trust
In September this year, County Durham & Darlington NHS Foundation Trust and Sherwood Forest Hospitals NHS Foundation Trust announced that they were now processing all of their hospital referral appointments electronically via the NHS e-Referral Service.
Electronic referral appointments reduce a hospital’s paperwork, saving millions of pounds for the NHS in the process, while also allowing patients to decide on an appointment at a date and time that suits them and at the hospital of their choice, limiting the likelihood of cancelled appointments or patients not turning up.
Old paper methods are being phased out across all trusts and, from 1 October 2018, providers will no longer be paid for activity which results from referrals made other than through the NHS e-Referral Service. There are approximately 60,000 referrals made across the NHS every day.
Sarah Perkins, director of performance at County Durham and Darlington NHS Foundation Trust, said: “We’re delighted to be pioneers in the introduction of e-referrals which have many benefits for our patients. Following their appointment with a GP at which the need for a referral to see a consultant is agreed, patients can choose to take a unique booking reference number home and make the appointment themselves. This enables them to see the availability and make an appointment for the date and time of their choosing, receiving instant confirmation. When patients prefer not to do this themselves, GP practices can make the booking for them.”
3 Taunton and Somerset NHS Foundation Trust
Partnering with IMS MAXIMS, Taunton and Somerset NHS Foundation Trust became the first NHS trust in the country to go live with an open source electronic paper record (EPR) in 2015, before its newly announced ‘Fast Followers’ Wye Valley NHS Trust and Blackpool NHS Foundation Trust adopted the system this Autumn. The trusts were named at the recent NHS Expo.
Having been named as a Global Digital Exemplar by the government in 2016, the trust worked with IMS MAXIMS to implement an open source EPR and provide an effective digitisation model for the wider NHS.
Stuart Hill, deputy chief information officer at Taunton and Somerset NHS Foundation Trust, said: “We look forward to working with Blackpool and Wye Valley in making the most of digital technology to drive better and safer patient care. In using IMS MAXIMS open source technology, we are creating a more effective hospital environment, where informed clinicians have crucial information at their fingertips.
“We will be working with IMS MAXIMS, Blackpool and Wye Valley to continue the improvements to this system, so that they can be passed on at no cost to other parts of the NHS. This has always been part of the mission.”
4 Plymouth Hospitals NHS Trust
Plymouth Hospitals NHS Trust is the largest hospital in the south west peninsula, with a secondary care catchment population of 450,000 and a wider peninsula population of approximately 2,000,000 who use its specialist services.
In September 2017, the trust announced plans to implement the paperless prescribing and medications administration (ePMA) system, OPENeP, becoming the first trust in the country to do so. In the ‘first of type’ implementation in the UK, the system will replace time consuming manual administration processes, and instead will allow different technology systems to interoperate and for data to seamlessly flow.
The Code4Health clinical community, supported by NHS England and NHS Digital, has collaborated on the project to assure the safety standards are correct. The trust, which is a best of breed trust which implemented an EPR in 2005, plans to start wholly using the system from June 2018.
Andy Blofield, Director of IM&T (CIO) at the trust, said: “The trust has supported an open standards approach to solutions development and delivery for many years and the implementation of a class leading ePMA solution based on this, new to the NHS, openEHR platform represents a significant step towards true data and system independence.
“We see this as the core building block of our paperless Integrated Digital Care Record and, in collaboration with local and National partners, will encourage the development of a vibrant eco‑system which supports local development, promotes organic innovation and application development by SME’s and creates robust partnerships with major commercial partners to implement and support the solution.”
5 University Hospital Southampton NHS Foundation Trust
Back in 2015, clinicians and IT specialists in Southampton were awarded £1.35 million by NHS England to develop a revolutionary electronic health records system to enable immediate access to health records and allow the sharing of information with clinical colleagues from secure computers and tablets.
At the time, University Hospital Southampton NHS Foundation Trust planned to scan any remaining paper documents about a patient’s care before closure of the health records library in 2017. The system, it was hoped, would save the trust more than £1 million a year.
In 2016, the trust was named a digital centre of excellence by the Department of Health, following the success of a number of digital initiatives, including the development of My Medical Record – a personal online patient health record – electronic blood tracking via wristbands, a mobile vital signs early warning system and a full electronic record in all critical care units.
Adrian Byrne, director of informatics at UHS, said: “We are at a very exciting stage in digital technology development in the health service, empowering patients to take more control over their healthcare and working towards the development of personalised medicine, as well as safer practices.”
6 Imperial College Healthcare NHS Trust
Over 75,000 patients at Imperial College Healthcare NHS Trust are now able to receive their appointment notifications via email rather than traditional post, as part of a project to improve how the trust communicates with patients. This compares to the 1.5 million patient appointment letters sent via post the previous year.
By switching to emails, patients get their appointment details more quickly and conveniently, with the move expected to save £1 million over four years on postage costs – money that can be redirected to patient care.
The trust is also leading the development of a Care Information Exchange which will give patients access to key aspects of their records through a secure online portal, allowing them to take a greater role in managing their own health and care.
As John Kelly, head of systems solutions at the trust, acknowledges: “Once you have digital records, other improvements start to become possible. When you have your blood pressure, pulse and temperature taken on a hospital ward, the usual process has been for the results to be written down and then transferred into your records. Now, a combination of wireless technology and digital records allows those measurements to go straight from the monitor into your record. This increases accuracy and gives the healthcare professional precious extra time to devote to patient care.”
7 Kent & Medway NHS and Social Care Partnership Trust
Kent and Medway NHS and Social Care Partnership Trust (KMPT) has received national recognition at the Public Sector UK Paperless Awards, for the trust’s Electronic Discharge Notification Project (EDN). The project, which is having a positive impact on patients, was one of five finalists from across the UK in the ‘Paperless Project of the Year’ category and won the main sponsor prize from Wacom Clipboard.
The EDN Project gives information about a patient’s hospital care to the GP’s patient record system and has greatly improved both patient experience and care quality. The previous method was to physically send hard copies of records to services.
Dr David Chesover, clinical lead for mental health, West Kent CCG, said: “The work done for KMPT on the patient electronic discharge notification project was very well led with excellent attention to detail, collaborative with West Kent CCG Mental Health team and delivered an excellent product.
The project delivered on time using digital technology to significantly enhance patient care, note keeping and patient safety on discharge from hospital. It was a pleasure to undertake this important piece of work with KMPT.”
8 Oxford University Hospitals NHS Foundation Trust
As one of the largest NHS teaching trusts in the UK, Oxford University Hospitals NHS Foundation Trust is well placed to discover how new technology can improve efficiency and safety at its four hospital sites. Through the System for Electronic Notification and Documentation (SEND) project, staff have replaced bedside paper charts, which record adult patients’ vital signs, with tablet computers – meaning that information about patients can be shared more quickly around the trust, saving crucial time that was previously spent looking for and transporting paper charts.
Alongside the Real-Time Blood Transfusion Data and Decision Support project and the integrated electronic patient record system, the trust saves at least £500,000 a year.
Oxford University Hospitals NHS Foundation Trust was named as one of government’s 12 initial digital exemplars, having won funding from the Safer Hospitals, Safer Wards NHS Technology Fund in 2013 for an iPad-based early-warning system for patient monitoring and an ‘electronic prescription’ service that allows patients to leave hospital sooner.
9 City Hospitals Sunderland NHS Foundation Trust
In September 2017, South Tyneside and Sunderland Healthcare Group welcomed news that South Tyneside NHS Foundation Trust was to become a ‘fast follower’ in City Hospitals Sunderland NHS Foundation Trust’s digital footsteps.
Announced at the NHS Innovation Expo, South Tyneside NHS Foundation Trust will now partner with City Hospitals Sunderland NHS Foundation Trust, which was chosen by NHS England as one of 16 digital exemplars in September 2016 in recognition of being one of the most digitally advanced trusts in the country.
Through the alliance, both organisations are working towards the national ambition of patient records becoming paperless by 2020, with Sunderland being one of the first trusts to adopt electronic paper-free working within its new Emergency Department and maintaining electronic health records across its hospitals. Further plans have already been suggested for more online access to electronic records which will let the patient take more control of their health and well-being.
Ken Bremner, chief executive of South Tyneside and Sunderland Healthcare Group, said: “This is fantastic news for South Tyneside District Hospital and for our community teams and means we can accelerate learning from Sunderland to develop world class digital systems that will benefit patients in South Tyneside for many years to come.
“For over 25 years we’ve recognised the critical role that technology now plays in delivering world-class healthcare services and in Sunderland we have set the bar in terms of investing in our digital footprint to improve the quality of patient care. Our new Emergency Department is now completely paper-free at the point of care and uses technology that can move around with the patient.”
10 Wirral University Teaching Hospital NHS Foundation Trust
In 2014, prior to becoming one of the Department of Health’s digital exemplar hospitals, NHS England awarded Wirral University Teaching Hospital NHS Foundation Trust £3.5 million to help catapult it to become one of Europe’s leading users of healthcare IT. Part of the Safer Hospitals, Safer Wards Technology Fund, the investment encouraged the development and full roll-out of paperless integrated digital care records, something the trust uses through the Millennium software system, which allows patient information to be securely accessed from anywhere within the trust at any time. This then also reduces duplication of information and replaces paper-based working practices.
Mark Blakeman, director of Informatics for Wirral University Teaching Hospital, said: “Safe, digital record keeping is the way forward for the NHS. In order for the trust to continue to provide high quality and effective care for all, information must be able to flow securely in our hospitals allowing data to follow patients throughout their entire healthcare journey.”