Liverpool Women’s NHS Foundation Trust presents...

“Meditech on the move… The Community Midwives

Story”

Catherine O’KeeffeBusiness IT specialist/Acting IT Services Manager

Liverpool Women’s NHS Foundation Trust (LWFT) IM&T Team - Who we are...

• Situated in Largest Women’s Hospital in Europe

• IT Teams include Information Services (Tech Support), InformationSystems, Clinical coding, IG & Data Quality, Information Team, Patient Services, Business IT Team

• IT team cover Crown Street site, Aintree Centre for Women’s Health,Clinical Genetics in Alder Hey, Remote Clinics in PCT, Children Centres,Local Council premises.

• Deliver 24/7 Helpdesk to all Trust staff

• Work to six sigma methodology – 70 Projects delivered in this years(2009/10) operational plan

• Team approach and ethos to all work we undertake.

• ISO 9001, 27001, 14001 certified.

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Community Midwives at LWFT

• 92 Community Midwives working for LiverpoolWomen’s

• Delivering ante-natal & postnatal care to pregnantwomen throughout Liverpool, Knowsley & Sefton area’s of Merseyside.

• Also responsible for delivery of parent education, aqua-natal and specialist advisory clinics in theseareas.

• Visits to patients homes as well as Primary Healthcare facilities

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Issues Regarding Community Midwives Processes• All appointments for the day given from Community

Midwives office via telephone each morning.

• Any clinical history of patient gained from patientshand held notes, or by telephoning Community Midwivesoffice

• Any advice required regarding policies and procedures gained via telephone to Trust or diverting to Trust site-view intranet or paper records.

• All Activity data captured on paper records, only presented when midwife on site and collated by admin staff

• No access to Trust Clinical systems – Clinical risk4

Health Care Business Drivers

• Historically – payments for Community Midwiferyservices have been received in a block payment by Primary Care Trusts (PCTs)

• In 2010 – payments for Community Midwifery services from all PCTs will be based on tariff (activity)

• This will require accurate patient level data recording - presently paper records – needing to be collated manually in order to be presented to PCTs

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Health Care Business Drivers cont...• Electronic Evidence required to support Community

Midwifery Activity out in the community in long term

• Capture of data regarding patients not previouslyobtained(patients receiving care by LWFT Midwivesbut delivering baby in another Trust)

• Streamlining of data collection

• Activity data could support the need for staff to be targeted in certain areas within Merseyside or forstaff to be employed in the future.

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Aim of project

• An innovative solution to provide Trustapplications to staff proving care in the communitysetting.

• Using the latest technology, built into a lap topPC

• Immediate connection between the Trust and theCommunity

• All Medical information regarding a patient available at the touch of a button.

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Expected Benefits

• Accurate Information captured in order to completethe Minimum Data Set required by PCT’s for PbR

• Accurate data collection to supply figures to theDepartment of Health

• Modernisation of Community Midwifery data collection practices

• Streamlining of business processes within theCommunity Midwifery team

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Technical Process “v” Business Re- design

• Set up of multidisciplinary team at start of project.included representation from...

Project ManagerIT Services Project SupportIT Systems TeamIT Specialist MidwifeInformation TeamFinance TeamCommunity Midwifery Manager/MatronCommunity Midwives (3 x Team Leaders)

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Tech “v” BPR cont...

• Initial project meetings to assess minimum requirements with regards to PCT, Information Team,Finance Team and Users.

• Scoping of potential vendors and providers byProject Manager and IT Technical Team

• Information Systems Team and IT Specialist Midwifeassess existing screens on Meditech to ascertainif they can be used for data capture

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Tech “v” BPR continued

• Process Mapping of present processes with regardsto paper data capture undertaken in order to baseline present practices.

• IT Services Project Support and Project Manager worked with vendors in order to “mix and match”products in order to find an effective solution.

• Final meetings and demo’s held for MDT Team in order to showcase the final solution.

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Tech “v” BPR cont...

• Pilot project undertaken with 7 Community Midwivesin which the following was assessed...- 3G connectivity- Ease of use- Access to Trust Applications- Convenience (weight, size, time taken to use)- Quality of data captured

• Follow up meetings held in which findingsdiscussed and documented

• Further pilots undertaken until correct solution found

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Final solution giving optimum value

• Dell D430 lap tops

• Vodafone 3G (sim card built into lap top)

• 6Mb SDSL Broadband Internet line

• Ericom Remote Connectivity Solution using Terminal Servers solution - 100 concurrent licences

• Meditech Ward Attenders Screen with CDS’s to capture additional data

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Other Trust applications available...

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Present Use

• 67 Community Midwives presently live with thesolution.

• 25 to be trained

• Presently over 4000 activity episodes being capturedper month

• Other benefits other than capturing of activity databeing realised.

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Benefits realisation – Financial • Obtaining Activity Data not previously captured....

Time Consuming Activities –Child Case ConferencesParent Education ClassesTelephone Advice

Location Data –GP SurgeryChildren’s CentresPatient’s Home

Care Delivery –Patients delivering in other Trust’s.

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Benefits Realisation – Financial cont...

• Accurate and Real Time data capture – can be collated at any time for use (Data Warehouse)

• Streamlined Business Processes – Admin Assistantsfreed to carry out additional duties

• Improved Trust reputation – Modern working can lead to a increase of patients choice as LWFT for care

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Benefits Realisation – Clinical Excellence• Instant Access in Community to Trust intranet for

Polices, Procedures and Guidelines

• Advice can be delivered within the latest NICE Guidelines

• Access to all of patient’s Trust records at the touchof a button (prev and present pregnancies)

• Access to Home Birth Screens – real time data capture of home deliveries matching info of hospitalbirth delivery

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Benefits Realisation – Clinical Excellence cont...

• Access to Safeguarding Children/Social Service referralforms in Community Setting- Social Services made aware of potential situations

quicker- Action can be taken quickly by Trust to safeguardvulnerable women and children

- Assists the Trust in meeting Government targets in this area

• Potential decrease in litigation – increased staff and patient safety (NHSLA standards)

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Access to patient’s medical history

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Access to vital patient information

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Access to patient issues

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Benefits Realisation – Improved Patient Experience• Staff can deliver the optimum, informed care

• Increase in patient safety

• Care can be delivered at their choice of venue/convenience

• Reduced requirement for patients to repeat their history to staff delivering their care in Trust & Community setting

• Increased time staff can spend with patient

• Modern care delivery – increased trust in staff

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Benefits Realisation – Improved Staff Experience • Improved Care Delivery – all information required is

available quickly

• Improved Staff Safety – access in community to patient alerts and social history

• Access to Trust Internal Email System (GroupWise)- remote users have access to communication and

messages- option to use calendars for diary management

• Less travel time to hospital setting to enter data intoMeditech

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Lessons Learnt

• SIM Card Activation – ensure true activation beforerelease of lap top

• Connectivity 3G provider – check which 3G provider is best coverage for your area

• Terminal Services need little bandwidth to run smoothly (other solutions we piloted required more)

• Battery life of PC (will need extended battery life)

• Biometric log on (time consuming)

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Lessons Learnt cont...• Easy Operating System required (one button shut down)

& minimal user interaction for logging on to system

• Correct Image on PC – tested & tested before release

• Security/Loss – adequate cover for losses

• Ensure have rolling stock for replacement

• Choosing the right hardware – PC & bags

• Adequate training, guides and support

• Change Management planning26

Use in Private Healthcare and Primary Care

• Solution can be adapted for use in any business incPrivate healthcare

• Able to leverage latest 3G technology

• Clinics can be held in any location with3G access – no longer restricted to Trust Estates (potential to increase revenue)

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Use in Private Healthcare and Primary Care cont...

• Increase potential of Clinic/hospital reputation bytaking care to the patient

• Increase the use of “Virtual Teams” to deliver careover large geographical areas

• Can be applied to lap tops and static pc’s – can supportexpansion of companies to other geographical areas,and still retain centralised access to monitor and control the applications.

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Use of Remote Access by other LWFT Employees

We presently have a number of ways of gaining remote Access to the LWFT network......

• Ericom solution – by 3G and URL

• SSL VPN/Network Connect – used in ACWH toconnect to LWH network

• Log Me in – used by non-clinical staff

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Future Developments..• Move to smaller lap top PC’s to aid midwives moving

about within the community

• Use of URL in locations connected to N3 network– instant access to Trust applications

• Roll out of SSL VPN solution for connectivity in longer term

• Potential of development of Meditech Screens to capture further patient information– furtherstreamlining process

• Potential development of other screens to assist midwives in their remote working

• Further development of 3G technology in UK30

To conclude...• Innovative solution using latest technology &

Meditech functionality.

• Captures activity data and provides complete Trust functionality out in the community

• Assists Trust in meeting Corporate objectives of - improved patient experience- clinical excellence- financial strengthening

• Positive impact on Service Delivery

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Thank you for listening...........

Any Questions??

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