Addenbrooke’s NHS Trust

Cambridge-based Addenbrooke’s NHS Trust has achieved what for most UK Trusts is considered the ‘holy grail’ of information management: critical information is available to clinicians at the point of care in real time, as it is created. The Electronic Medical Records solution developed with OITUK offers huge data quality benefits, significant savings in secretarial time and specialist stationery, as well as a Trust-wide standard for all documentation.

A common problem across the health sector has always been that one patient’s medical records might be required by a number of different people at any given time. In the case of a diabetic, for instance, records and notes might need to be available to the eye unit, the heart unit, and even a chiropodist. Managing such requirements from a paper-based system represents a logistical nightmare. Dianne Nixon, who was Project Manager for Electronic Medical Records (EMR) at the time of the project, recognised the need to identify first of all what types of information were being created both electronically and in print, and what was then happening to those documents. Essentially, she discovered, most letters were being generated electronically (in MS Word), printed out, and then moved around the various departments physically. Once a patient had had no further contact with the Trust for four years, each document would be scanned for archive purposes, and then shredded.

Dianne realised the potential benefits of a ‘fully electronic’ approach: create a document using a standard template and make it available via a web browser interface. “If we were scanning documents at the back-end, and creating paper documents to start with, I knew we could be doing things a lot smarter”, she comments.

When the project team looked around for possible solutions, they were surprised to find very little that really fitted their requirements. Lots of document management vendors offered systems to scan medical records, and specialist clinical IT systems were already in place in various departments, but nothing seemed to address the routine document production and management needs of the Trust: in the first instance, writing to patients, GPs and clinicians and keeping track of those communications.

What ultimately made the OITUK solution successful was the company’s willingness to involve the Trust itself in developing the system, as Dianne Nixon commented: “Vendors should never try to build something themselves and then impose it on the NHS – it won’t work!” There is a need, given the enormous complexity of the NHS, its Trusts, and the scope of work they do, for any supplier to work hard to ‘get inside’ how things are done, and be willing to let the Trust staff themselves specify much of the system.

The project team held an ‘open day’ for users of the planned system, to help them to decide the route they should take and to identify the crucial requirements. Very unusually, over 300 staff turned up to see what could be done – the need for an EMR solution was clearly something that they all felt strongly about. Once they saw the benefits offered by the OITUK solution, the users were hugely supportive of the development. The software was truly a co-operative production, with OITUK developers sitting alongside Trust staff during the requirements phase, ensuring that the system as delivered would address all of their most critical requirements. As Dianne Nixon enthuses: “Our users were literally saying ‘Wow!’ when they saw how the finished product corresponded with what we had said we needed the system to do. The Board and Medical Director too were impressed by OITUK’s understanding of the complex difficulties around medical records.”

Since the implementation of the OITUK EMR system there is considerable evidence of the success of this approach: nearly 2,500 registered users of the system now access over 1,000 templates specific to their departments via the Trust intranet. Around a million documents are now available within the system for review and reference. Many of the users are secretaries and clinicians rather than technical staff, and so it was essential that the system be intuitive and non-intrusive to their normal working practices. The OITUK solution requires no knowledge of indexing on the users’ part: all relevant index data is gleaned from within the system, transparently to the user - the system is integrated with a number of hospital systems, automating the patient data feeds into the system and into the letters generated, providing a single access point for the integrated patient records.

A unified logon means that users do not have to ‘enter’ the system; all documents are available from within their standard application interface, whether that be Word or a clinical application. The user enters a patient’s ‘hospital number’ used to uniquely identify each individual, and selects a letter type from the template, which will then automatically pre-populate many of the fields using data extracted in real time from a variety of different Trust systems. All letters are automatically saved to the system database, again with no special steps required by the user. The system includes such document management essentials as version control and a full audit trail.

But the OITUK system now streamlines much more than just letter writing: telephone conversations are easily summarized and saved in the system for easy retrieval and reference. Similarly, discharge summaries, complete with all take home drug information are completed at point of discharge and fully integrated with the EMR. This has huge benefits for patients and GPs alike, and the information is immediately available throughout the Trust should a re-admission occur.

Documents produced as output from other clinical systems also feed easily into the OITUK repository: the cardiology department, for instance, sends three different types of report (an ECG, diagrams, and a 24 hour exercise test record) which are automatically ‘pulled’ into the relevant medical record as they are produced. Other departments already feeding data in include the Renal, Endoscopy, Bronchoscopy and Cystoscopy teams.

The OITUK solution is already capable of exploiting other new technologies as their use expands within the Trust: previously if a call came in to say that a kidney had become available for transplant, the relevant team would have had to print out vast reports to see the entire patient data needed to make a decision. Now, staff use portable electronic communications devices to view all the appropriate data in a user-friendly format instantly, enabling them to make what could be a life-or-death decision more quickly, and with greater confidence. Future developments include use of more database technology within patient letters, use of web portals and electronic forms to support two-way interaction between systems and the professional staff, and document workflow to further automate back-end processes.

Dianne Nixon is effusive in her support of the new system and the impact it has had on the workings of the Addenbrooke’s Trust: “What we can do now - that simply wasn’t possible before - is to bring all the relevant data together, at the point of care. We can be assured that the data is accurate and up-to-date: new documents are available right across the system just a matter of minutes after being created.” Clinical engagement is vital to secure the success of NHS projects - a key success indicator in this project has been that clinicians are now coming forward with suggestions and real enthusiasm for future enhancements.

Dianne is carefully logging tangible benefits being realised through the use of the system, including:

• Robust records management
• Secure log on and access via user profile
• Improved data quality
• Immediate access via the Trust's Intranet
• Reduction in clinical time dictating discharge summaries, reduced secretarial time in typing discharge summaries, reduction in secretarial time due to automatic data population
• No clinic appointment cancellations due to 'misplaced medical records'
• Summary information taken from telephone calls held securely as part of the record rather than on scraps of paper
• Clinical staff can immediately respond to queries from GP's or other clinicians rather than ask for the medical record to be retrieved
• Reduction in storage space
• Reduction in time to re-digitize paper format back to electronic format
• Reduced administration time in filing paper
• Reduced number of requests for repeat information, i.e. from cardiology scans/investigations, full reports immediately available on EMR
• Etc…

OITUK Ltd.
September 2005

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