20131212 salford royal experience an epr 10 years on, implementing ep rs at salford royal motivation and outcomes

Madeleine Neve, IM & T lead at Salford Royal Hospital presents at Health 2.0 Manchester meeting. See http://www.htmc.co.uk/pages/pv.asp?p=htmc0519 to watch talk

1. Implementing EPRs @ Salford Royal: Motivation and outcomes Salford Royal NHS Foundation Trust

2. L arge teaching Trust in Greater Manchester Approx 800 Beds Serves population 220,000 Over 6000 Staff Provides: - General Acute Services - Community Services - Tertiary Services across GM Salford Royal NHS Foundation Trust

3. The Trust prides itself on delivering care for patients by aspiring to be: The safest hospital in the country as measured by mortality and harm rates. Viewed as the leading hospital for Quality Improvement and the hospital of choice for patients in the North West. Focused on improving the patient experience, requiring respect, compassion and the right attitude to patients as our customers. Ensuring the highest standards of environmental cleanliness. Salford Royal NHS Foundation Trust

4. Patient Records in the NHS

5. Salford Royal…….

6. Results Viewing Electronic ordering Recording of allergies and significant events Clinic letters Clinical Documentation Electronic Prescribing Medication Administration Recording of Diagnosis & Procedures Immediate Discharge Summary Functionality Currently Available

7. Started in 1998 Quality Improvement (QI) was a hospital priority, Clinical quality performance monitoring data to support QI was becoming unsupportable despite investment in 80 independent, specialty specific, stand-alone clinical systems GPs were dissatisfied with the content, legibility and timeliness of discharge summaries Management of patients admitted as emergencies was compromised by delays in access to their records Reinforced by two Institute of Medicine publications ‘To Err is Human’ and ‘Crossing the Quality Chasm’ and by visits to successful EPR implementations in the USA The Salford EPR Journey….

8. 7000 current active users 200 users concurrently logged in 160 GPs at 55 surgeries have access across Salford 28,000 records accessed daily One complete record 1 Million Patient Records 100 Million Diagnostic Results 2.3 Million Pharmacy Orders Salford Royal EPR

9. Current system 10 years old and used to optimum benefit No further developments being made on the system Senior Leaders could see more potential Demand for new Capability Demand for improved usability Needed a new system to serve us well into future and has potential for future innovation, eg patient portals Above all – better and safer for patients, who can be confident their records are being held in one central, secure location The Next Stage of the Journey………………

10. Went out to Procurement on12 th August 2011 Preferred Bidder Selected December 2011 12 Months of preparation and migration of over 1 million patient records! Trained 7000 users! Phase 1 Big Bang Go-Live 8 th June 2013! The Next Stage

11. EPR Benefits – Legibility/Reduction in errors (Drug Charts)

12. EPR Benefits – Legibility/Reduction in errors (Drug Charts)

13. Increased Legibility Reduced Dose Errors due to predetermined dosages Control of certain drugs Rapid Identification of new patients and new drugs items by Pharmacists Timely Medication Administration Corrections to drug charts can be made remotely Loss of Drug charts has been abolished Reduced transcription errors when re-writing drug charts Prescribing & Medication Errors: Benefits

14. EPR Benefits – Secondary Use of Information (Waterlow Scores)

15. EPR Benefits – Secondary Use of Information (Waterlow Scores)

16. EPR Benefits – Secondary Use of Information (Waterlow Scores)

17. Anytime! Anywhere! Concurrently! This has allowed us to: Offer remote Site Clinics for Tertiary Services Multidisciplinary Record Removed issues with lost notes and embarrassing consultations Enhanced GP Communication Email patients Complete Clinical Coding directly from the electronic record EPR Benefits – Availability of Information

18. Informed/Personalised Consultations Patients Spend Less time repeating information Supports Patient Education More time with Patients Remote Consultation Patient Interaction

19. More effective, multidisciplinary ward rounds Virtual Ward (ward rounds) Opportunity for senior oversight remotely Guided practise – Pre–Set dosages, clinical guidelines Education tool with patients EPR Benefits – Changes in Clinical Practice

20. Base Infrastructure platform – PCs, Network etc Integration – The EPR never stands alone Performance & Reliability Support Conflicting priorities for development IT Resource to Support Lessons - IT

21. Senior Organisation support is essential Quick wins/benefits breed adoption – Results reporting as first function User Driven Gradualism Keep it simple One size does not always fit all Training & IT Skills of staff are essential Lessons – Adoption & Implementation

22. Take the enthusiasts with you but don’t forget about the rest. Electrifying paper is not enough Customisation has is benefits and also its challenges Departmental systems v.s. greater good. Expectation increase. Continuous development is required Lessons – Adoption & Implementation

23. The Next Chapter…………

24. Retrospective Automated Reporting Concurrent Synchronous Care Prospective Predictive Care Retrospective Manual Reporting Evolution of Electronic Patient Records Paper Current EPR New EPR

25. Where HIT Lives Beginning CDS Advanced CDS: Intelligent

26. Is the NHS Ready? Are Patients Ready?

27. With CPOE and traditional CDS With Outcomes Toolkit incl. Advanced CDS Order Sets Improved Prophylaxis 97.4% Reduced Alerts (p<.001) 145.3% Increased Assessments (p<.001) 139.6% Improved Assessment Rate (p<.001)

28. DVT/VTE Rate per Bed Day Intelligent Order Set 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 Week 95% Confidence Interval 62.6% decrease in mean DVT/VTE rate (p<.001). From mean rate of .431 to .161. 59.4% decrease in variation (p<.001) That’s approximately 302 fewer patients suffering from VTEs each year * 95% Confidence Interval Mean Rate £ 725,400 *reduced variable costs (p<.001) 0.8 Days reduced mean LOS (p<.001)