2_White Paper Electronic Meal Ordering

Based on economic assessment by

The Economic and Wider Benefits of Electronic Meal Ordering from Hospedia

This White Paper draws on the substantive analysis, performed by Deloitte, of the Hospedia Electronic Meal Ordering Service, alongside recent industry commentary, to assist hospitals in creating an evidence base and business case for using the service to improve patient care while supporting Cost Improvement Programmes (CIPs)

Contents

Executive Summary ............................................................................................................................................ 3

Introducing the Need for Electronic Meal Ordering ......................................................................... 3

The Quantitative Benefits of Electronic Meal Ordering ................................................................. 5

The Qualitative Benefits of Electronic Meal Ordering ..................................................................... 6

How Electronic Meal Ordering Works ....................................................................................................... 8

Implementation - Process and Support from Hospedia .............................................................. 9

How Hospedia are using Electronic Meal Ordering ........................................................................ 10

Conclusion ............................................................................................................................................................... 12

2

The Economic impact of Hospedia

Electronic Meal Ordering


©Hospedia Ltd 2014Page November 20143

1 Stephanie Proctor, Ethical and Sustainability Manager at NHS Supply Chain - Government and Public Sector Journal Spring 20132 http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digitalasset/dh_113807.pdf3 http://www.ehi.co.uk/news/ehi/8315/hunt-wants-paperless-nhs-in-five-years4 Source: Deloitte analysis based on a typical 500 bed hospital5 Source: Hospedia survey of 24,434 patients across 37 hospitals, March 2013

Executive Summary

The growing pressures on the NHS Acute sector to reduce costs while improving patient care indicate a serious

need for Trusts to identify efficiencies to current processes and utilise existing resources to deliver on their Cost

Improvement Programmes.

Investing in Electronic Meal Ordering from Hospedia has been validated by Deloitte to deliver financial benefits worth

at least £147k per annum for hospitals, and patient benefits worth £660k, supporting not only cost improvement

goals but also patient experience improvements, wastage reductions and improved patient nutrition.

This paper draws on substantive analysis performed by Deloitte, as well as recent industry commentary, to provide

an independent evidence base for the use of Electronic Meal Ordering from Hospedia in your hospital.

Introducing the Need for Electronic Meal Ordering

Patient nutrition is a significant contributor to patient wellbeing, speed of recovery and length of hospital stay. As

Trusts continue to find ways of improving patient care while delivering their annual Cost Improvement Programmes

(CIPs), the need to engage with IT solutions in order to deliver improved care, alongside cost savings and efficiencies,

is clear.

In addition to challenges of needing to find £15-£20 billion of savings,2 Tim Kelsey, National Director of Patients and

Information for the NHS Commissioning Board, has set out the goal that the NHS should be paperless by the end

of 20183. With approximately 365,000 menus printed, distributed and collected per annum in an average hospital4,

electronic processes can represent significant cost savings and efficiencies while contributing to the removal of vast

quantities of paper waste.

Reducing food waste and improving patient consumption, Hospedia’s Electronic Meal Ordering (EMO) service

enables patients to order their meals from their bedside terminal, transmitting the order directly to the catering

department for fulfilment.

A recent survey of over 24,000 patients5 who did not have the benefit of on screen ordering showed that; 85%

thought that food service was an important factor in determining their overall satisfaction during a hospital stay,

28% were not always offered a choice of food, 36% of patients did not always get the meal they ordered, 25% felt

that their dietary needs had not been catered for, 43% of the food was not fully consumed and 23% of food was

untouched.

“Hospital catering has come to the forefront of public attention over the past couple of years, and many NHS

trusts have already been working hard… to improve the patient experience”1



By reducing the time between order and delivery from 15 hours to under 2 hours, EMO helps hospitals make

sure that patients get the food they want, reducing untouched meals and plate waste while improving patient

nutrition.

Going digital can deliver significant benefits to patients and hospitals, from improvements in patient experience to

supporting clinical efficiencies and streamlined workflows. EMO releases staff time spent printing, distributing and

collecting paper menus, enabling staff to focus on patient care and delivering operational improvements.

Establishing the business case for automating existing processes, alongside credible ROI calculations, can represent

a major barrier to adoption for healthcare providers. We are therefore delighted to be able to provide independently

produced business case support for EMO, detailing not only the estimated financial savings but also the indirect

benefits to patients and staff, based on a number of case studies produced by Deloitte detailing the quantitative and

qualitative benefits arising from Hospedia’s products and services.

Using the Treasury Green Book Methodology, including in person interviews and deriving calculations from real

world examples, Deloitte evaluated the economic impact of using Hospedia’s EMO service to optimise meal ordering

processes and reduce wastage.

Deloitte calculated the quantitative, qualitative and indirect benefits of using EMO as part of their thorough analysis

of the service, identifying time savings and production savings, as well as patient experience and reputation

benefits.

6 Source: Deloitte Report “The Economic benefits of Hospedia. Supporting hospitals and patients”

Figure 1: Methodology Diagram6

Indentify Benefits

Conduct Interviews with

Hospitals

PrimaryAnalysis

Secondary Literature

Finalisation of Benefits



7 Source: Deloitte Report “The Economic impact of Hospedia. Electronic Meal Ordering”8 Source: Deloitte analysis9 Based on an expected reduction of 365,000 paper menus per annum for an average hospital10 Source: SSentif report January 201311 Agarwal, E. et al (2012) “Malnutrition and poor food intake are associated with prolonged hospital stay, frequent readmissions and greater in-hospital mortality. Results from the Nutrition Care Survey 2010”12 Source: Deloitte analysis

The Quantitative Benefits of Electronic Meal Ordering

Using a software-based system to

order patient meals, and therefore

modernise order processing,

generates cost savings of £40k

per annum. Replacing paper based

methods with an electronic system

removes the necessity of printing

menus; at a cost of 3p per menu this

saving equates to £11.5k per annum9.

The reduction in staff time spent on

processing, distributing and collecting

menus is worth an additional £28.5k

per annum.

EMO can support significant

reductions in the volume of food wasted in the hospital; NHS catering managers estimate that this reduction could

be as high as 60%. With over £27m worth of hospital food being wasted across the NHS10, reducing the number of

untouched meals represents a massive economical advantage by using electronic systems.

Patient length of stay reductions arise from improved nutrition, through EMO increasing patient food consumption

by 5%. Increasing meal consumption has been shown to reduce length of stay11; improving nutrition and speeding

recovery times. A 5% increase in consumption could reduce length of stay by 0.44%12, resulting in an overall

efficiency gain of £50k per annum.

Beyond reducing length of stay, improved nutrition from higher food consumption also improves patient wellbeing.

The financial value attributed to this function of EMO is estimated to reach £660k per annum, representing both a

significant benefit to patients and an alignment to the government policy regarding quality of secondary care.

Benefits Hospitals p.a.Patients p.a.

(QALY)

Order processing savings £40k -

Reduced food wastage £57k -

Reduced length of stay £50k -

Improved nutrition - £660k

Total benefits £147k £660k

Figure 2: Economic Benefits of IPFM8

“In a typical 500 bed hospital, Electronic Meal Ordering is estimated to deliver benefits of

£147k per annum to the hospital and £660k per annum to patients”7



13 Source: Deloitte Report “The Economic impact of Hospedia. Electronic Meal Ordering”14 Source: Hospedia survey of 24,434 hospital patients, 201315 http://www.commissioningboard.nhs.uk/files/2012/12/cquin-guidance.pdf16 http://www.rbch.nhs.uk/index.php?id=79917 Health Secretary Jeremy Hunt, https://www.gov.uk/government/news/new-principles-set-out-for-hospital-food

The Qualitative Benefits of Electronic Meal Ordering

Patient Experience

In a recent survey, 85% of patients identified that food and catering services were a significant contributor to their

overall satisfaction during a hospital stay.14 With EMO, patients are offered an improved choice of meals compared to

paper systems, and are able to receive personalised menus based on dietary requirements, contributing to improved

experiences with the catering services.

Improving patient experience is a key goal for the NHS, with financial incentives explicitly linked through the CQUIN

payment framework. In 2012/13 the CQUIN scheme allowed for commissioners to provide a 2.5% uplift on contracted

revenue, equal to around £5m15, for achieving CQUIN targets.

The EMO service also provides an opportunity for hospitals to educate patients on the nutritional composition of the

meals offered. With more space available than on a paper menu, on screen menus can provide images of the meals

as well as detailed information about their ingredients and nutrients. Studies show that information about the source

of ingredients or nutritional value is a motivating factor when choosing meals,16 and providing this information helps

to increase patient satisfaction.

Operational Improvements

Optimisation of the hospital’s catering service is supported by EMO, both through the collection of data at the point

of ordering as well as in conjunction with the Plate Waste Tracker also provided by Hospedia.

Data collected during the ordering process allows catering departments to easily identify patient preferences,

optimising future menus based on accurate popularity information. With the addition of the Plate Waster Tracker,

caterers can identify improvements and reduce wastage. Hospitals should regularly evaluate their food service and

act on feedback from patients17; EMO provides the tools for hospital caterers to gather patient opinion using ordering

patterns that are captured electronically, as well as through supplementary information delivered by the plate waste

tracker.

In the survey conducted in March 2013, 28% of patients reported that they were not always offered a choice of

food, and 25% felt that their dietary needs had not been catered for. Information such as this is invaluable in helping

catering departments to act on patient concerns through evaluating and improving the food service.

“Electronic Meal Ordering can help to drive improved patient experience, aligning with NHS

initiatives, while the automated process also improves data quality”13



Efficiency

The use of an electronic system to submit meal orders significantly reduces the ordering lead-time. Where paper

based systems typically require the patient to submit their order up to 15 hours before the meal will be served, EMO

reduces this lead-time to less than 2 hours.

This gives patients an improved experience, reducing the likelihood of forgetting what they had ordered and

increasing the likelihood that they will still want to eat their meal, thereby increasing consumption and reducing

wastage. Further wastage, associated with untouched meals, is avoided through shorter lead-time, ensuring that

meals are not provided for patients who have been discharged.

Of the patients surveyed, 36% did not always get the meal they had ordered. Often this is a result of patients

moving beds and receiving the meal that the previous occupant had ordered. The reduced order lead times

leveraged by EMO significantly reduces the chances of this situation; bringing the point of ordering closer to the

point of consumption reduces the likelihood of a patient having moved beds in the time between order and delivery.



18 Datasym provide the market leading end-to-end catering solution to the majority of NHS Trusts, other systems can be supported19 Source: Hospedia

How Electronic Meal Ordering Works

The Hospedia EMO system has been designed to realise the benefits of electronic ordering by combining the best in

class food ordering system from Datasym18 with Hospedia’s unique patient bedside presence.

On screen menus at the bedside allow catering departments to provide a wide selection of menu items, alongside

nutritional and dietary information and images of each dish. The system alerts patients to the latest menu and the

deadline for orders, presenting them with an easy to use menu selection process.

The hospital catering management system provides hospitals with a comprehensive and intuitive solution for

menu collation, productions, planning, cook chill/freeze, nutritional analysis, stock control and reporting. This

system integrates directly with the Hospedia EMO system, submitting orders directly and instantly to the catering

department for fulfilment.

Patient-specific configurations enable the presentation of menus tailored to a patient’s individual needs, showing

only the menu items that are appropriate for that patient’s dietary requirements. This prevents ordering of unsuitable

options.

Whilst the vast majority of patients are able to order their own food through the bedside terminal, EMO recognises

there are those who sometimes can’t and therefore also contains an easy to use administrative tool for staff to order

on behalf of a patient if required.

CATERING SERVER

SECUREBROWSER

HOSPEDIA NETWORK

DIETICIAN(AWARENESS AND INFLUENCE)

MEAL DELIVERED TO PATIENT

MEALS PREPAREDIN THE KITCHENS

Patient At The Bedside

PATIENT PROMPTED TO ORDER MEALS AT THE BEDSIDE (MOST PATIENTS SELF SERVE)

PATIENT OFFERED CHOICES

PATIENT MAKES SELECTION

REPORT

Figure 4: Overview Diagram19



Project debrief. Ongoing support, including engagement in Hospedia User Groups to enable Trust contributions to the product roadmap

Hospedia implementation support throughout the initial stage of the rollout schedule.Rollout to wards with Hospedia and Trust support teams

Trial in single area to embed awareness and enable Train the Trainer approach.Based on rollout schedule - activate EMO icons on bedside terminals

Prepare system for live trial testing based on UAT signoff and Trust input.Datasym and EMO terminal training for Menumark and Menumate Back Office with Catering staff

Datasym software installation/setup and testing.Engage catering, IT and clinical teams in User Acceptance Testing (UAT)

Joint working between NHS and Hospedia teams to establish Connectivity (firewall, IP addresses and ports) and web server setup

Project Kick-off meeting to agree goal milestones, resources and Trust engagement.

20 Source: Hospedia

2

3

3

5

6

7

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Implementation - Process and Support from Hospedia

A dedicated Hospedia commissioning team is provided to oversee the initial implementation of the system, post

contract. No disruption to either normal ward routines or the patient media service is experienced during set up of

the EMO system.

A network interconnect is installed between the Hospedia infrastructure and the hospital network. This will create a

firewalled connection between the two infrastructures, providing the necessary security and connectivity to support

electronic meal ordering.

Figure 5: Implementation Process20



How Hospitals are Using Electronic Meal Ordering

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

Bournemouth Hospital began implementing EMO in March 2012, replacing their paper menu system. The hospital

identified that an electronic system would provide significant benefits to their patients and their operational

processes compared to their existing method.

The hospital chose to undertake a gradual implementation programme of its 650 beds, phasing implementation

on a ward by ward basis. Throughout the process, Hospedia experts worked closely with the hospital team and

the catering software provider to ensure a smooth transition. Internal training further supported the hospital in the

adoption of the electronic system.

Bournemouth Hospital have experienced a range of benefits in the last 12 months; from improved efficiency through

reduced expenditure on producing and printing paper menus to improved patient satisfaction through increased

choice and the ability to order meals to be consumed on the same day. This has also led to reduced waste from the

catering operation.

Over and above the expected benefits, there were also a number of staff-based improvements that have arisen from

the hospital’s use of EMO. Relations between ward and catering staff have improved, through face-to-face contact

between departments. As a result of the time and resource savings delivered by EMO, catering staff are now able

to visit all wards each day. This further allows catering staff to proactively engage with patients on a regular basis,

helping to improve the catering service and contributing to improved patient experiences.

Southport and Ormskirk Hospital NHS Trust

Southport and Ormskirk NHS Trust have already experienced benefits including closer engagement between

caterers, nurses and patients to improve patient experience, and the provision of clear menu choices that present

informative detail around nutritional value.

The Trust was recently visited by its local MP who was extremely impressed with the service and commented that

the value of the patient-centric solution should be “sung from the rooftops”21.

21 Rosie Cooper, MP, West Lancashire

“The Electronic Meal Ordering system means patients get a wider choice of menu, and they order and

consume their meals on the same day. This greatly enhances patient experience within this hospital”

Denise Richardson, Hospital Catering Manager – Royal Bournemouth & Christchurch Hospitals NHS Foundation Trust



22 https://www.gov.uk/government/news/new-principles-set-out-for-hospital-food23 http://www.midstaffspublicinquiry.com/report24 BAPEN report “Hospital Food as Treatment” – Dec 201225 http://www.midstaffspublicinquiry.com/report

Conclusion

With the directive from Health Secretary Jeremy Hunt that “hospitals should take all reasonable steps to ensure that

patients have a healthy food experience22,” the method by which patients order their food should be considered an

important factor in delivering an effective and waste-efficient catering service.

Delivering cost benefits of £147k per annum, patient benefits of £660k per annum and significant wider benefits

including improved patient experience, improved nutrition and improved waste levels, Hospedia’s EMO service not

only enables patient care improvements but also supports NHS Cost Improvement Programmes (CIPs).

Allowing patients the opportunity to order their meals through the familiar bedside system supports patient

independence, tying in to the concept of patient-centred care, the importance of which has been heavily

emphasised following the Francis Enquiry.23

Improving patient nutrition is a key driver of patient care. Studies have found that patients are only getting between

30% and 75% of the recommended energy intake level24. Utilising an electronic system for menu ordering increases

food consumption, helping patients to get the nutrients they need to support their recovery.

Utilising a bedside device that also provides entertainment services to patients ties in to the concept of patient-

centred care, the importance of which has been heavily emphasised following the Francis Enquiry.25 Combining meal

ordering at the point of care with a familiar and ever-present device increases the interaction that can be achieved

and promotes patient involvement and engagement.

About Hospedia

Hospedia is the world’s leading provider of point of care systems in healthcare. Hospedia’s Patient Centred Care

Platform provides patient media, patient engagement and clinical workflow solutions that support hospitals, staff,

patients and visitors worldwide, through powerful software, hardware and integration capabilities. The Platform

delivers a range of services that make a real difference to patient care while providing clinical efficiencies and

substantial financial benefits.

If this white paper has been of interest, and you would like more information about how the solution can be

implemented to support your hospital priorities, please contact our team of experts. This paper summarises

the case studies produced by Deloitte; our team can provide the full cases and work with you to help build a

business case for individual circumstances, formulate an implementation plan that works around operational

requirements and assess how to tailor the service to your specific needs.

[email protected]

2_White Paper Electronic Meal Ordering

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