Implementing EPRs @ Salford Royal:

Motivation and outcomes

Salford Royal NHS Foundation Trust

• 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

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

Patient Records in the NHS

Salford Royal…….

• 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

• 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….

• 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

• 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………………

• 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

EPR Benefits – Legibility/Reduction in errors (Drug Charts)

EPR Benefits – Legibility/Reduction in errors (Drug Charts)

• 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

EPR Benefits – Secondary Use of Information (Waterlow Scores)

EPR Benefits – Secondary Use of Information (Waterlow Scores)

EPR Benefits – Secondary Use of Information (Waterlow Scores)

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

• Informed/Personalised Consultations• Patients Spend Less time repeating information• Supports Patient Education• More time with Patients• Remote Consultation

Patient Interaction

• 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

• 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

• 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

• 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

The Next Chapter…………

RetrospectiveAutomated Reporting

ConcurrentSynchronous

Care

ProspectivePredictive

Care

RetrospectiveManual

Reporting

RetrospectiveManual

Reporting

Evolution of Electronic Patient Records

Paper Current EPR

New EPR

Where HIT Lives

Beginning CDS

Advanced CDS:

Intelligent

• Is the NHS Ready?

• Are Patients Ready?

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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)

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)