The Key to Breakthroughs in Patient Care

The SmartCare

Procurement and its

Vision for Evaluation

SmartCare

Gareth Evans – SmartCare Programme Manager - GHT

What is SmartCare?

SmartCare is the collaborative procurement and implementation of

a Managed Service for an Integrated Clinical Information System

Gloucestershire Hospitals NHSFT

Northern Devon Healthcare NHST

Yeovil District Hospital NHSFT

Background

All three Trusts are operating on legacy systems of 20+ years (HP

Swift/Swift+).

All lack functionality to capture true clinical information.

Limits the Trusts ability to progress with Clinical Pathways in an

integrated manner and satisfy NHS vision.

All have a history of aborted attempts to provide a full clinical

solution.

Vision

• Provision of current and sustainable systems and technical

infrastructure to support the Trusts to provide high quality patient

care.

• The collaborative will enjoy strategic benefits of better quality,

improved patient safety and efficiency.

• One patient, One record’ accessible wherever it is needed.

The Requirement

• Clinical Administration

• Pathology

• Pharmacy & Pharmacy Stock Control

• Emergency Department

• Theatres

• Women’s & Children’s (Maternity + Neonatal + Paediatric + Gynaecology)

• Oncology e-prescribing & Oncology management

• Order Communications

• Electronic Prescribing and Medicines Administration

• Clinical Documentation, Decision Support and Reporting

Collaboration – Why?

££££’s – 4-Years of Central Funding offered for a collaborative

procurement.

Shared Vision

Shared Risk

Same starting point

Collaborative Procurement – How?

Joint Executive Sponsorship – CEO level

Joint Governance

Joint Requirements Development

Joint Clinical Leadership

Excellent Working Relationships

Excellent levels of understanding – Clinical & Business

Joint desire to succeed!

Procurement - The Restricted Procedure

Traditional route of Competitive Dialogue no longer approved for

Central Government backed procurement.

Specific & detailed requirements agreed by all – even clinicians!

OGC IT Services Contract to be applied – puts the restrictive into

Restricted!

Single Lot procurement with three Trust contracts

Clear procurement process, well managed.

Legal Involvement

Probably the Most Important investment!

DAC Beachcroft (other legal advisers are available)

• Excellent advice

• True collaborative working saves cost

• Experienced (on both sides of the fence)

• Investment saves time and money!

Evaluation – How we did it…..

Innovative Approach

Strong Clinical Engagement

Usability is key

Over 200 evaluators

• ITT response – 6-weeks

• Virtual Hospital – 5x Clinical Teams for a week

• Demonstrations – Multiple teams per day

• Finance – Lower weighting than usual!

Evaluation – What was different?

Virtual Hospital

Designed to enable evaluators to assess usability of a clinical system by means

of training and use.

Enabled subjective evaluation to be carried out in a structured manner

Full clinical involvement

Excellent vendor platform for demonstrating real usability

Virtual Hospital

A common problem with systems selected by OBS response and demonstration

is that staff will not have a clear view on how usable the solution is. This will

effectively alienate key staff groups, especially clinicians and result in a poorly

used and potentially unsafe solution.

Dr Michael Richards’ vision for resolving this issue was to create the Virtual

Hospital as a key part of the systems evaluation.

Virtual Hospital takes advantage of many system suppliers claim to provide

initial training in just a few hours for clinical and non-clinical staff.

Virtual Hospital

The objective of the Virtual Hospital process is to evaluate the usability of the

system in simulated real life.

In order to achieve this, a minimal hospital structure with clinical areas is

required to be pre-programmed into a training system.

Virtual Hospital - Structure

• ED: reception area, 12 bays and 2 resuscitation areas.

• Medical Ward: reception area, 20 beds in 5 bays

• Surgical Ward: reception area, 20 beds in 5 bays

• Maternity suite: 10 beds and 10 delivery rooms

• Theatres: Two main theatres and an emergency theatre – with the ability to

manage a real time waiting list for the emergency theatre list and schedule

cases to the elective theatres.

• Simple future outpatient appointments diary for each doctor in the Virtual

Hospital.

Virtual Hospital - Evaluation

The evaluation consisted of 5-teams of 10 people being trained in each system

and undertaking the Virtual Hospital scenarios:

• Ward Clerk: 1 acting for all areas

• 3 Nurses: 1 for each area ED, Medicine, Surgery

• 1 Midwife

• 4 Doctors: 1 each for ED, Medicine, Surgery and Maternity (1 Obstetrician)

• 1 Pharmacist: 1 to cover prescribing activity in all areas

Virtual Hospital – System Requirements

The evaluation system is pre-populated with patient demographics and clinical

information provided by the Trusts.

Basic functionality includes a basic clinical record per patient (Demographics,

Diagnosis, Allergy recording, Scheduling of Intervention/theatres).

Alert management; basic order comms; the ability to enter clinical vital signs

and results manually in response to orders; and to record prescriptions and

drug administration (including fluids).

Prescribing clinical decision support (allergies, drug-drug interaction) should be

included.

Virtual Hospital – System Requirements

Certain clinical assessments must be available with appropriate alert generation

to clinicians when the clinical data entered creates an identified patient at risk.

E.g. VTE, DVT, Pain Score Assessment, GCS, EWS with alerts.

Clinical Decision Support for prescribing must include Drug – Allergy interaction

alerts; Drug – Drug interaction alerts; and, as possible, Drug – Results

alerts/CDS and Drug/Disease alerts.

Virtual Hospital - Results for Orders

It is required that results for any orders placed need to be captured by the

system in the patient’s record.

This will be entered by a member of the supplier’s team acting as an ‘Agent

Provocateur’ (AP).

At any time after an order is placed the AP will select a pre-define flash card

from a pack representing the order placed (ie U&E flash card from the U&E

pack if a U&E test is ordered).

The ‘results’ on the flash card will be entered into the system in the patient’s

record.

Virtual Hospital – Clinical Data

Most of the clinical data to be entered by clinicians is pre-generated and is

available on flash cards to ensure all systems are exposed to the same core set

of data values.

There are two sets of flash cards:

• Clinician

• Results

Virtual Hospital - Clinician Flash-Card

Will provide data values for data captured directly by the role players: HT & WT,

VTE assessment, Vital signs, pain scores and these will be available to all

clinical role players.

When instructed by the scenario script or when the role player thinks clinically

indicated, the clinician should enter data into the patient record for the variable

set required (eg vital signs, HT & WT etc).

Any clinician can choose to enter clinical data anytime but should do so using

data from the clinical flash card.

Virtual Hospital – Results Flash-Card

Test investigation results are entered by the supplier’s Agent Provocateur (AP).

These cards are not available to the clinical role players.

The AP will select the flash card for the results of the test ordered by the

clinician and enter these into the system for the appropriate patient sometime

after the order is placed.

The role player will not be able to predict when this will occur and will have to

consult the system regularly to pick up new and abnormal results or alerts.

This process simulates real life and the presentation of the data by the system

will be assessed for usability.

Virtual Hospital - Summary

• Clinical Training – half-day

• Simulated real-time use against pre-populated system and clinical

scenarios.

• Simulated result abnormalities/alerts

• Clinical Decision Support

• Clinicians making decisions and entering data

• Assessment of system usability

• Judged by Clinicians!

Virtual Hospital – Did it work?

Yes! Virtually all clinicians agreed this was a useful evaluation tool.

The process identified issues related to usability in all systems

evaluated. However, it is a subjective method and care must be

taken to ensure suppliers have the opportunity to ‘drive’ the solution

in an expert manner.

What was the result?

InterSystems TrakCare

The Future

Safe, Efficient and Patient Centric EHR

Three Trusts aiming for HIMMS Level 6 at full Go-Live in two-years

Vision and commitment to move to HIMMS Level 7