ehospital - changing everything we do at cambridge university hospitals

eHospital – changing everything we do

Susan GreenhillHead of Clinical Information Systems

(outpatients)

Our largest ever investment in improving healthcare quality

Cambridge University Hospitals (CUH)

• 100,000+ ED attendances• 73,000+ in-patient

episodes• 115,000+ day-case

attendances• 570,000+ out-patient

episodes• 40,000+ surgical operations

Two hospitals:• Addenbrooke’s• The Rosie

5 clinical divisions – women’s healthcare fully integrated

• 5,700+ births• 12,000 staff • 1,150 beds• £704m turnover


eHospital – the journeyDigital transformation programme at CUH to deliver high quality patient care

• 2010 – strategic outline case “Towards an EPR”

• 2011/12 – invitation to tender & competitive dialogue

• 2012 – preferred bidders selected (Epic & Hewlett-Packard)

• 2013 – 10-year contract signed with Epic & Hewlett-Packard

• 2013/2014 – Trust-wide network upgrade and IT infrastructure refresh

• October 2014 – Trust-wide go-live of Epic electronic patient record system


Hardware

Background (I)

Before eHospital• No wireless network• Ageing PC / infrastructure• Low resilience• Limited remote access

With eHospital• ‘Infrastructure as a service’• Network refresh & wireless• Desktop refresh and new

devices (6750 PCs, 500 laptops, 395 WoWs*)

• Remote access & ‘bring your own device’

• Handheld devices (420 ‘Rovers’ iPod Touch with Honeywell barcode sled)

*WoW: Workstation on Wheels


Software

Before eHospital• 1994 PAS* system, support

ending March 2015• No ED or critical care

systems• Pathology system upgrade

required

Background (II)

With eHospital• Tender process, weighted to

clinical quality• NHS Spine connected system• Extensible / supported LIMS*• Epic used Trust-wide

(3,200 concurrent users at peak times)

• Bedside device integration• 1000 staff using Haiku / Canto

mobile Epic apps*PAS: Patient Administration System*LIMS: Laboratory Information Management System


• PAS, bed management• Case note tracking• Enterprise scheduling• Prescribing & formulary mgt

• All I/P & O/P care• Care plans & pathways• Clinical documentation• Standard clinical terms &

coding• Workflow management

• Reporting dashboards

• Cardiology• ED• Genetics• Intensive care• Maternity• Ophthalmology• Oncology• Pathology• Pharmacy• Radiology • Respiratory• Theatres & anaesthetics• Transplant• Orders & results

• Patient kiosk• Patient portal

• GP access

• Medical devices• Remote access• Mobile access


2013 2014

Q2 Q3 Q4 Q1 Q2 Q3 Q4

Training Managed print / network “refresh”

Workflowvalidation Virtual desktops

Configure & build

Testing

Training

Go-live

Timetable


Workflow validation• 1,000+ clinicians validated modules• 75% of analyst builders were clinicians seconded for 18 months

Training• > 95% of staff trained (12,000 people)• > 175,000 hours of training over 9 weeks

Operational • 120, 90, 60 & 30-day pre go-live eHospital assessments• Parallel divisional operational assessments• Specialty-level risk assessments• Dress-rehearsals including inter-departmental high-risk pathways• Increased focus on high-risk prescribing & WHO checklist at go-live• Go-live final decision made by full executive

Go-live preparation


• Run akin to ‘Internal major incident’

• 150 people on-site command centre, 24/7 for 6 weeks• > 100 WTE CUH analysts, > 250 Epic staff, >50 HP staff• > 22,000 ‘tickets’ in 5 weeks

• 4 weeks of CUH / Epic ‘at-elbow’ floor-walkers

• Regular communication with CQC, CCG, GPs, Monitor, HM Coroner, governors and local MPs

• External assurance review in early December 2014

Go-live


• Daily executive meetings to review safety and take action• Daily senior nursing ‘huddles’ to assess clinical safety

• Categorisation of ‘tickets’ to identify potential or actual safety issues for action

• Tip sheets and alerts developed

• Existing paper notes available until October 2015• Access to historic data (letters & results) through ‘LARDR’ web

based system

Clinical safety at Go-live


• Specimen label printers

• Emergency Department workflow issues

• Communication with GPs

• Complex prescribing

• Training

Challenges at go-live


HIMSS EMRAM & CUH

25 Oct 2014

15 Oct 2015


Clinical staff experienceItem April 2015 March 2016

Staff are able to find relevant patient info easily in Epic 81.4% 86%

Staff are able to access the reports or metrics in the Epic system that are relevant to their role

79.7% 85.8%

Staff are satisfied with the support available/provided for Epic issues/Epic changes that arise

60% 68.2%

Staff who are able to find information about eHospital 84.9% 89.6%

Staff who are confident, at the present time, that the Epic system supports them in caring for their patients

77.2% 88.4%

Staff who are confident that, in 6 months time, the Epic system will support them in caring for their patients

85.3% 89.6%

% of staff reporting neutral, agree or strongly agree


Pharmacy integration• Preparing discharge medication

reduced from 90 to 45 mins

Antibiotic prescribing• 100% recording of indication for

prescribing

Paediatrics• Zero PICU sedation related drug

errors since go-live• Barcode meds admin in general

paediatrics

Benefits (I)Transfusion• Full closed loop ordering,

preparation, supply & administration

Allergies• approx. 51,000 alerts, approx. 8,500

led to a change in prescription

Hip fracture pathway• Achievement of best practice care

rising from 66% to 82%

Increase in main theatre usage• 1,319 cases increased to 1,554 a year


Virtual fracture clinic• 4,500 appointments freed up• £200k / year saving

Mobile devices• Real-time information recorded at

the bedside• £270,000 equiv. staff time saved / qtr

Integrated devices• All physiological monitors & ventilators

in 40 theatres & 148 high-dependency areas connected to Epic EPR

• £655,000 equiv. staff time saved / qtr

Benefits (II)Notes retrieval• 99% reduction for in-patients• 97% reduction for out-patients• £115k savings / qtr

Document handling• 153k / year - discharge summaries

sent electronically• 80% of clinical letters now sent to

GPs electronically• Reduction in specialist stationary• £157k savings / qtr• 0.9m documents sent to GPs by

Summer 2016


Staff engagement• Support link users programme – network of clinical leads / liaison• Clinician ‘builders’ – devolved system configuration skills

External communication• MyChart patient portal – live April 2016• EpicCare Link for GPs, referring hospitals & others – Q3 2016

• Care Everywhere connection to:• West Suffolk Hospital (Cerner) – Q2/3 2016• CDA based discharge summaries to 1o care systems

Currently underway…

ehospital - changing everything we do at cambridge university hospitals

Healthcare