Joined-up healthcare for patients through digital technology

This is Cambridge University Hospital NHS Foundation Trust’s electronic patient record (EPR) system that enables the hospital to share patient records and data across the hospital, between hospitals and with primary care to promote joined-up healthcare. Patients also have access to their own records.

Dr Afzal Chaudhry, Chief Medical Information Officer of the Cambridge University Hospitals NHS Foundation Trust, says the EPR means there is “one view of the truth across all disciplines” and that it has brought confidence to patients who go back and forth between clinicians as every health care professional involved in their care can see what treatment or tests they have had.

The EPR allows clinical teams to see a single unified view of a patient’s health record in its entirety. Implemented trust-wide (Addenbrooke’s and The Rosie Hospitals) in October 2014, it has enabled the hospital to transform clinical processes from paper-based to fully digital ways of recording care and accessing information; supported by medical device integration in 40 theatres and 148 critical care beds, handheld and mobile device integration to enable care to be recorded in real-time at the bedside and connection with national systems, including the NHS Spine (national Personal Demographics Service) and e-Referral Service (electronic referral service by primary care to secondary care).

More than 8,000 patients use the patient portal, which is populated automatically with information from their record within the EPR, including everything from appointment details and clinical correspondence to vital signs and automatic release of test results. Patients can access their information from a computer, laptop, smartphone or tablet.

How was it developed?

The EPR was an off-the-shelf commercial product configured in-house by the trust’s eHospital digital division, comprising clinical, administrative, operational, analytical and technical expertise.

A team of over 100 clinicians and hospital staff were trained in how to configure the system to tailor it to the needs of the trust and to that of secondary care in the NHS. Over 18 months, they worked with clinical and administrative colleagues and services to create the custom ‘built by staff for staff’ trust-wide EPR, validating and configuring over 500 major clinical pathways and ensuring each pathway incorporated local, professional and national guidelines. In the nine weeks leading up the implementation, the team delivered over 175,000 hours of training to over 12,000 hospital staff. On 26 October 2014, the EPR was implemented trust-wide, across both of its hospitals – a first-of-its-kind implementation in the NHS.

There were early problems with the system and shortcomings contributed to the trust being rated inadequate by CQC in 2015. These problems were overcome and the most recent CQC reports note that the electronic records system has allowed staff to ensure records were completed fully and consistently, with information being shared across services within the trust to coordinate patient care.

With 95 per cent of requested changes to the EPR made by the eHospital division, the trust has been able to continuously develop the system.

In April 2018 the trust linked its EPR with a neighbouring hospital’s EPR – two different software suppliers (Epic and Cerner) - to enable real-time digital record sharing to advance patient care. It now shares approximately 400 patient records a month with West Suffolk Hospital, enabling clinicians from both trusts to securely access the clinical information they need about their shared patients. In addition, the trust has integrated the EPR to Royal Papworth Hospital’s Lorenzo system to enable real-time sharing of test results as soon as they have been resulted in their laboratories.

In May 2018 the system was further developed to enable GPs and community nurses of Cambridgeshire’s largest primary care service to securely access their patients’ hospital records through a digital portal into the EPR. They can securely view information in the hospital records to advance shared patient care in a more timely and effective way. And they are able to view the latest information about their patients – from conditions, tests and procedures to results to treatments clinical letters and recommended follow-up care.

Plans now being developed include extending the portal’s capabilities to allow Bluetooth-enabled devices to be connected from either a wearable or home device via Apple’s HealthKit on iPhones, or via Google Fit on Android phones. Data from these devices can then flow straight into the patient’s record in the EPR, enabling a remote review by clinical teams, or providing data in advance of a future clinic appointment. This data can drive clinical decisions’ support processes, engaging patients with their care and enabling more timely reviews and interventions leading to better quality care.

Outcomes

The trust claims that these initiatives combined mean that its patients, clinical teams and local GPs all have a more comprehensive view of their health and care status, enabling more informed decision-making and further involving patients in their care.

The ability to share records with primary care, it says, is helping to speed up the discharge of patients from hospital. Instead of having to wait for a summary, GPs can look at the patient’s record directly and save time.

Electronic prescribing is included in the EPR and has led to a range of claimed benefits including a 100 per cent reduction in sedation-related prescribing errors in paediatric intensive care.

The trust reports the system also enabled staff in orthopaedics to introduce a multi-disciplinary ‘virtual’ fracture clinic which resulted in 4,500 fewer clinic appointments, as clinicians now view the case notes and images together in a structured way before deciding if face-to-face review is needed, so reducing unnecessary hospital visits.

Use of the EPR is said to have contributed to the trust improving its performance in relation to sepsis. Seeing an increase in mortality rates in 2015, it carried out work to describe the ideal clinical pathway and then how technology could support the pathway by identifying points at which various actions, such as ordering a test, should take place. As a result, the trust says there has been 42 per cent reduction in mortality since 2015, saving at least 64 lives in 2018/19.

During the Healthcare Information and Management Systems Society (HIMSS) Europe Conference in June 2019, CUH was announced as the winner of a European award - HIMSS-Elsevier Outstanding ICT Innovation - for these initiatives in joining up healthcare for patients.