Setting a path for digital transformation
Kathy Adams, Senior Sister in the Emergency Department at Homerton University Hospital Foundation Trust, writes for Hospital Times, outlining how the Trust is implementing its’ ambitious digital agenda.
At Homerton, we have incredibly ambitious digital transformation goals. In the coming year, we hope to go fully digital, or “paperless”, to improve the quality of care we deliver to our patients and to meet imperatives for finding additional funds under our Local Digital Roadmap (LDR) and the Sustainability and Transformation Partnership (STP), which covers north east London.
It is now a given that the NHS must find significant efficiencies if we are to continue to deliver care to meet the demand. At Homerton, we need to save £1.5m from the Outpatient Department alone. When we talk about transformation, it’s not for transformation’s sake.
Working with partners that support our vision
We’ve been on a four-year journey towards achieving our digital transformation goals. Developing the right partnerships have proven crucial in turning vision to reality.
BridgeHead’s Independent Clinical Archive (ICA), HealthStore®, was introduced in 2014. One of the features of the ICA is its ability to manage all healthcare data regardless of vendor or format. Initially, the Vendor Neutral Archive (VNA) component of HealthStore was implemented, which is an essential part of our enterprise imaging strategy and something we wanted in place prior to selecting a replacement Picture Archiving and Communication System (PACS) for the Radiology Department. We needed a data repository independent of, but interoperable with, the PACS to give us greater flexibility around how our data is used and stored.
In July 2016, we began to surface data from within the ICA via our Cerner Millennium. Clinicians could easily launch the ICA from the EPR to view all radiology images alongside patient notes.
Whilse the VNA component of HealthStore has been used as a central repository for storing, protecting and sharing radiology images, we always recognised the potential for the broader ICA solution to be utilised across the hospital for other purposes.
We’re now in a position where we constantly ask ourselves “what else we can do with it?” One thing that became apparent was that other departments, primarily those using paper-based processes, could also benefit from using an ICA. The radiology project had already served as our proof of concept, so we were confident that we could replicate the work across the Trust on a much wider scale.
Today, we are in the process of moving other departmental data to the ICA, including other types of medical images, such as from Cardiology, Medical Photography and Endoscopy.
We want to integrate more data into the EPR to fuel the transformation of our outpatient department. Our goal is to have all outpatient data outside of our EPR, living and breathing within the ICA. All of this data would be accessible directly through Cerner, simplifying workflow by offering clinicians one system by which to access a complete patient record.
The value of data at the clinicians’ fingertips
Clinicians shouldn’t need to be IT experts to get a 360-degree patient overview; they don’t want to remember multiple passwords to log-in to different systems to view patient records, blood results and X-rays. Access to the data they require needs to be made simple and feel part of the working environment. The integration between the ICA and Cerner Millennium enables users to browse and locate the complete patient record, thus improving clinical efficiency.
It is incredibly powerful for clinicians to have all of the information they need at their fingertips when assessing or treating a patient. Even in an A&E setting, there is often a need to access the full patient record. The more information clinicians have to hand, the easier it is to diagnose, treat and refer patients appropriately.
For example, when a patient comes into A&E, it helps to know if we are dealing with a dementia sufferer or someone with low blood pressure and/or on medication. When assessing a patient in a psychotic state, we need to know whether they are being treated for mental health problems and we want to know whether they are suffering from something new or whether we are dealing with a historical case.
Having previous patient history to hand is invaluable. Without it we might admit patients and keep them in overnight while we call mental health services or try to match and check paper records. We might repeat a blood test or scan if the information isn’t readily available, all of which can result in delays and drain already stretched resources, with patients occupying beds that could potentially be freed up sooner.
The future of digital and data
While much of the data we currently have in the ICA is in the form of images, we are already starting to ingest other data formats. We want to see richer data such as echocardiograms or short surgical films included as part of the patient record. The ICA is the perfect place to store this type of data so that it can be used by the EPR.
Although a much longer-term vision for Homerton, we can see a future where patients have access to their own records – for example a patient portal that integrates with the EPR and ICA systems, collecting data from patient apps for monitoring blood pressure, blood sugar or collecting food diary information. We envisage a scenario where a patient gives lifestyle information prior to attending an appointment in order to save time spent with a clinician.
In terms of where we are today, our priority is to move as much patient data as possible into the ICA and ensure it is fully integrated with the EPR to deliver a complete view of the patient. This means migrating data from our legacy applications and making it available in one place, directly linked to the EPR. In doing so, we are seeing improvements in data quality and adherence to data standards.
Once we have all the data in the ICA, we can focus on the next part of our digital roadmap, which is about getting proper patient involvement. With huge savings to be found in the NHS, we all have a role to play in ensuring resources are used to best effect.