Why caring is desperate for records sharing: the case studies

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Airdale Foundation Trust

Airedale Hospital has been using TPP’s SystmOne to share primary and secondary care information for over six months and it has transformed care, allowing nurses and doctors in the emergency department to see patients’ GP records.

Now the trust is going a step further to create a single record for patients accessible wherever they are, by whoever needs to see it - although always with patient consent.

The trust has now embarked on an ambitious project that involves four SystmOne acute modules: PAS, bed management, e-discharge summaries and e-prescribing.

‘We tend to trust the patients more than the IT at the moment,’ he says. ‘It is a work in progress’

Tim Rycroft, head of IT for the trust, says: “We are pretty much SystmOne territory up here in West Yorkshire so we are keen to explore how to exploit this.”

The acute trust, community providers and most GP practices now use SystmOne. The PAS went live last November and bed management and e-discharge summaries are now being rolled out gradually, starting with the emergency department and medical admissions unit.

Later this year will see the implementation of e-prescribing before other systems, such as the PACS and RIS, are interfaced with the PAS. Eventually this will create a single electronic patient record within SystmOne.

“Our job over the next year is to take the hospital product from an administrative system into a clinical system and to consider what a hospital electronic patient record will look like,” he says.

It already exists in a nascent form. “We have the demographic details and now, with a bed management system in the ED and medical assessment unit, GPs can see where their patients are in the system and in terms of their treatment. Now we need to start to refine it,” says Mr Rycroft.

Offering reassurance

At the moment, the shared system is probably more use to the acute clinicians than it is to the GPs. “Hospital clinicians are able to view GP records from the hospital, with the caveat of permissions and consent,” says Mr Rycroft. “They can see really useful information about medications, allergies, when the patient had the last consultation with the GP and so on.”

The acute clinicians are not using the system as a CPOE (computerised physician order entry) because other systems, such as the PACS and RIS are not yet interfaced so no pathology or radiology results can yet appear.

“We have started to do some electronic discharge summaries from the ED and MAU that go straight into the GP record but that is about the extent of it at the moment,” says Mr Rycroft.

Clinicians locally are on board, he says. “The GPs have been very helpful and very supportive but they have needed some reassurance and I hope we have been able to give that. We are using a cloud-based system so it will put them in a good position for giving patients access to their records.”

Paul Jennings, consultant in emergency medicine, says the system in place so far is easy to use. “We can get access to the GP record very easily and now we are able to pull allergies and drug histories and past medical history from the GP record into the A&E card so we can fill in our record here. It is not 100 per cent perfect yet but it is very useful.”

Clinicians not only ask for permission but also check with patients that they have the right information. “We tend to trust the patients more than the IT at the moment,” he says. “It is a work in progress. Some people like it; some people prefer to have a box they can fill in line by line.

“But everyone agrees that for patients who are not able to answer for themselves, whether it is because they are inebriated or have an injury or dementia, it is very useful.”

He is looking forward to seeing how the full EPR will develop and what other clinical uses the system can support.

“One of the things I think is very exciting is the idea of GPs sending an email via SystmOne asking a hospital specialist for advice,” he says. The combination of secure email coupled with access to the patient’s notes could be very powerful in transforming how GPs and specialists work together to support patient care.

St Barnabas Lincolnshire Hospice

When St Barnabas Hospice in Lincolnshire first deployed TPP’s SystmOne in 2006, it set the organisation on an information sharing journey.

“When I first started using it in 2007 it was really where we entered information about the patient,” says Hospice at Home manager for North East Lincolnshire Jill Edwards. “Now it is much more about what we do every day. How we integrate the team around the patient, how we plan and prioritise our work and even how we communicate.

“If SystmOne goes down - which it very rarely does - we do have backup systems but we struggle. I cannot imagine life without it.”

It is a system that has kept up with changes in end-of-life care as St Barnabas has moved from providing care in a hospice to care out in the community in this largely rural area.

The Hospice at Home team cares for patients who are in the last 16 weeks of their life with a team that brings in GPs, district nurses, out of hours doctors and Marie Curie nurses, community hospitals and acute trusts.

Of these, the St Barnabas team, the community nurses and hospitals and most of the GPs use SystmOne. This means that, with the patient’s consent, each can see information from the others not just about the care delivered but also about the patients’ wishes. It is all contained in a single electronic patient record.

“We do a lot of advanced care planning,” says Ms Edwards. “It is recorded on SystmOne so the GP can see it, we can see it and the community nurses can see it.”

Change in attitudes

It also helps the hospice at home nurses plan their care. “We come in at 8am and the first thing we do is look at activity overnight on our patients’ SystmOne records,” she explains.

“If there has been an out of hours visit by the Marie Curie nurses or the out of hours GP, it shows on the system. We can then call those patients and find out if there is anything they need and plan our visits accordingly.”

Over at Northern Lincolnshire Goole and District Hospitals, the emergency department and medical admissions unit has deployed the TPP SystmOne clinical record viewer and so is able to access - but not write to - the patients’ electronic record.

The system overall helps not just with information sharing but also with communication, adds Ms Edwards. “Sometimes, when we have not been able to reach a GP or district nurse by phone, we use ‘tasking’ in SystmOne,” she says.

This means sending a secure message via SystmOne that pops up on the clinicians’ screens when they log in. “It does not replace the phone call or the meeting but it is very useful.”

SystmOne also figures in future plans. St Barnabas Hospice recently bid for - and won - some funds from the Department of Health’s capital grants scheme to refurbish part of United Lincolnshire Hospitals as a “hospice in the hospital” - thought to be the first of its kind.

Sarah Furley, head of strategic development for St Barnabas, explains: “We have a partnership between ourselves, the acute trust and commissioners to redesign end of life care in Lincolnshire and the hospice in a hospital is part of that. We hope to open it in January 2014.”

The plan is for the hospice to use the acute TPP SystmOne module. This would link its patient record not just with GPs and the community but also with the hospital PAS.

This would create a record of care in the hospital that can move with the patient should they be discharged from the hospice. It would also allow the hospice to inform GPs very quickly should a patient die in the hospice.

“We would be able to alert the GP the same day. That is incredibly important from a carer point of view,” says Mr Furley.

Like Ms Edwards, she says there has been an information sharing journey over the last seven years where the technology to support effective sharing has fostered a change in attitude.

“I do think the battle is being won,” she says. “Our experience overall here in end of life care in Lincolnshire is that people are prepared to share.”

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