ehospital - changing everything we do at cambridge university hospitals
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eHospital – changing everything we do
Susan GreenhillHead of Clinical Information Systems
(outpatients)
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Our largest ever investment in improving healthcare quality
Cambridge University Hospitals (CUH)
• 100,000+ ED attendances• 73,000+ in-patient
episodes• 115,000+ day-case
attendances• 570,000+ out-patient
episodes• 40,000+ surgical operations
Two hospitals:• Addenbrooke’s• The Rosie
5 clinical divisions – women’s healthcare fully integrated
• 5,700+ births• 12,000 staff • 1,150 beds• £704m turnover
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Our largest ever investment in improving healthcare quality
eHospital – the journeyDigital transformation programme at CUH to deliver high quality patient care
• 2010 – strategic outline case “Towards an EPR”
• 2011/12 – invitation to tender & competitive dialogue
• 2012 – preferred bidders selected (Epic & Hewlett-Packard)
• 2013 – 10-year contract signed with Epic & Hewlett-Packard
• 2013/2014 – Trust-wide network upgrade and IT infrastructure refresh
• October 2014 – Trust-wide go-live of Epic electronic patient record system
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Our largest ever investment in improving healthcare quality
Hardware
Background (I)
Before eHospital• No wireless network• Ageing PC / infrastructure• Low resilience• Limited remote access
With eHospital• ‘Infrastructure as a service’• Network refresh & wireless• Desktop refresh and new
devices (6750 PCs, 500 laptops, 395 WoWs*)
• Remote access & ‘bring your own device’
• Handheld devices (420 ‘Rovers’ iPod Touch with Honeywell barcode sled)
*WoW: Workstation on Wheels
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Our largest ever investment in improving healthcare quality
Software
Before eHospital• 1994 PAS* system, support
ending March 2015• No ED or critical care
systems• Pathology system upgrade
required
Background (II)
With eHospital• Tender process, weighted to
clinical quality• NHS Spine connected system• Extensible / supported LIMS*• Epic used Trust-wide
(3,200 concurrent users at peak times)
• Bedside device integration• 1000 staff using Haiku / Canto
mobile Epic apps*PAS: Patient Administration System*LIMS: Laboratory Information Management System
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Our largest ever investment in improving healthcare quality
• PAS, bed management• Case note tracking• Enterprise scheduling• Prescribing & formulary mgt
• All I/P & O/P care• Care plans & pathways• Clinical documentation• Standard clinical terms &
coding• Workflow management
• Reporting dashboards
• Cardiology• ED• Genetics• Intensive care• Maternity• Ophthalmology• Oncology• Pathology• Pharmacy• Radiology • Respiratory• Theatres & anaesthetics• Transplant• Orders & results
• Patient kiosk• Patient portal
• GP access
• Medical devices• Remote access• Mobile access
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Our largest ever investment in improving healthcare quality
2013 2014
Q2 Q3 Q4 Q1 Q2 Q3 Q4
Training Managed print / network “refresh”
Workflowvalidation Virtual desktops
Configure & build
Testing
Training
Go-live
Timetable
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Our largest ever investment in improving healthcare quality
Workflow validation• 1,000+ clinicians validated modules• 75% of analyst builders were clinicians seconded for 18 months
Training• > 95% of staff trained (12,000 people)• > 175,000 hours of training over 9 weeks
Operational • 120, 90, 60 & 30-day pre go-live eHospital assessments• Parallel divisional operational assessments• Specialty-level risk assessments• Dress-rehearsals including inter-departmental high-risk pathways• Increased focus on high-risk prescribing & WHO checklist at go-live• Go-live final decision made by full executive
Go-live preparation
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Our largest ever investment in improving healthcare quality
• Run akin to ‘Internal major incident’
• 150 people on-site command centre, 24/7 for 6 weeks• > 100 WTE CUH analysts, > 250 Epic staff, >50 HP staff• > 22,000 ‘tickets’ in 5 weeks
• 4 weeks of CUH / Epic ‘at-elbow’ floor-walkers
• Regular communication with CQC, CCG, GPs, Monitor, HM Coroner, governors and local MPs
• External assurance review in early December 2014
Go-live
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Our largest ever investment in improving healthcare quality
• Daily executive meetings to review safety and take action• Daily senior nursing ‘huddles’ to assess clinical safety
• Categorisation of ‘tickets’ to identify potential or actual safety issues for action
• Tip sheets and alerts developed
• Existing paper notes available until October 2015• Access to historic data (letters & results) through ‘LARDR’ web
based system
Clinical safety at Go-live
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Our largest ever investment in improving healthcare quality
• Specimen label printers
• Emergency Department workflow issues
• Communication with GPs
• Complex prescribing
• Training
Challenges at go-live
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Our largest ever investment in improving healthcare quality
HIMSS EMRAM & CUH
25 Oct 2014
15 Oct 2015
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Our largest ever investment in improving healthcare quality
Clinical staff experienceItem April 2015 March 2016
Staff are able to find relevant patient info easily in Epic 81.4% 86%
Staff are able to access the reports or metrics in the Epic system that are relevant to their role
79.7% 85.8%
Staff are satisfied with the support available/provided for Epic issues/Epic changes that arise
60% 68.2%
Staff who are able to find information about eHospital 84.9% 89.6%
Staff who are confident, at the present time, that the Epic system supports them in caring for their patients
77.2% 88.4%
Staff who are confident that, in 6 months time, the Epic system will support them in caring for their patients
85.3% 89.6%
% of staff reporting neutral, agree or strongly agree
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Our largest ever investment in improving healthcare quality
Pharmacy integration• Preparing discharge medication
reduced from 90 to 45 mins
Antibiotic prescribing• 100% recording of indication for
prescribing
Paediatrics• Zero PICU sedation related drug
errors since go-live• Barcode meds admin in general
paediatrics
Benefits (I)Transfusion• Full closed loop ordering,
preparation, supply & administration
Allergies• approx. 51,000 alerts, approx. 8,500
led to a change in prescription
Hip fracture pathway• Achievement of best practice care
rising from 66% to 82%
Increase in main theatre usage• 1,319 cases increased to 1,554 a year
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Our largest ever investment in improving healthcare quality
Virtual fracture clinic• 4,500 appointments freed up• £200k / year saving
Mobile devices• Real-time information recorded at
the bedside• £270,000 equiv. staff time saved / qtr
Integrated devices• All physiological monitors & ventilators
in 40 theatres & 148 high-dependency areas connected to Epic EPR
• £655,000 equiv. staff time saved / qtr
Benefits (II)Notes retrieval• 99% reduction for in-patients• 97% reduction for out-patients• £115k savings / qtr
Document handling• 153k / year - discharge summaries
sent electronically• 80% of clinical letters now sent to
GPs electronically• Reduction in specialist stationary• £157k savings / qtr• 0.9m documents sent to GPs by
Summer 2016
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Our largest ever investment in improving healthcare quality
Staff engagement• Support link users programme – network of clinical leads / liaison• Clinician ‘builders’ – devolved system configuration skills
External communication• MyChart patient portal – live April 2016• EpicCare Link for GPs, referring hospitals & others – Q3 2016
• Care Everywhere connection to:• West Suffolk Hospital (Cerner) – Q2/3 2016• CDA based discharge summaries to 1o care systems
Currently underway…
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Our largest ever investment in improving healthcare quality