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Implementing EPRs @ Salford Royal:
Motivation and outcomes
Salford Royal NHS Foundation Trust
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• Large 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
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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
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Patient Records in the NHS
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Salford Royal…….
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• 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
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• 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….
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• 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
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• 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………………
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• Went out to Procurement on12th 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 8th June 2013!
The Next Stage
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EPR Benefits – Legibility/Reduction in errors (Drug Charts)
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EPR Benefits – Legibility/Reduction in errors (Drug Charts)
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• 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
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EPR Benefits – Secondary Use of Information (Waterlow Scores)
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EPR Benefits – Secondary Use of Information (Waterlow Scores)
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EPR Benefits – Secondary Use of Information (Waterlow Scores)
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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
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• Informed/Personalised Consultations• Patients Spend Less time repeating information• Supports Patient Education• More time with Patients• Remote Consultation
Patient Interaction
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• 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
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• 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
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• 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
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• 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
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The Next Chapter…………
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RetrospectiveAutomated Reporting
ConcurrentSynchronous
Care
ProspectivePredictive
Care
RetrospectiveManual
Reporting
RetrospectiveManual
Reporting
Evolution of Electronic Patient Records
Paper Current EPR
New EPR
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Where HIT Lives
Beginning CDS
Advanced CDS:
Intelligent
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• Is the NHS Ready?
• Are Patients Ready?
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Ale
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or M
issi
ng A
sses
smen
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Month
Improved Phophylaxis
VTE Assessments
No Assessment
Missing Assessment Alert
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)
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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
Interval62.6% 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)