IMPROVING CLINICAL ACCESS AND QUALITY

OF PATIENT CARE

A Case of Integration

Bob Telford

Commercial Director, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital

Rake Lane, North Shields NE29 8NH, U.K.

Keywords: Orion Health, Concerto, Clinical Workflow, Electronic Health Record.

Abstract: Health care systems face increasing challenges to meet the sophistications of 21

Century medicine, not

least the current fragmentation of patient information. Electronic Health Records (EHR) provide an

opportunity to optimise clinical workflow and improve patient outcome. Trusts across the UK face the need

to implement systems that will work smoothly with existing legacy systems, but will also bridge the gap to

future central IT implementation systems. Using a case study this paper presents the challenges faced by UK

Trusts to implement systems that work with existing legacy software to optimise information already

retained and future information input.

1 INTRODUCTION

Within Europe, health systems face an increasing

demand for services that are highly sophisticated to

cope with complex clinical issues, yet have limited

resources for implementation. Electronic Health

Records (EHR) have the potential to optimise

clinical workflow and to overcome the

fragmentation that is common within and between

healthcare institutions. The advantages of electronic

health records are many and include increasing

medications safety, improving clinical efficacy and

optimisation of support of a team-based approach to

health care (Chaudhry et al. 2006; Car et al. 2008).

Technological approaches taken in other sectors

are difficult to apply to the healthcare arena for a

range of reasons including:

• Complexity of healthcare organisations

(Braithwaite et al. 2009).

• A high degree of autonomy within healthcare

institutions which typically operate within a

hierarchical structure (Gillies et al. 2001;

Jadad et al. 2004; Braithwaite J et al. 2005)

• The fact that clinical tasks are highly

specialised and are typically non-linear in

flow (Westbrook et al. 2007; Braithwaite et al.

2005).

However, effective and safe patient care depends

upon horizontal work co-ordination, particularly

strong collaborations between professional groups.

Effective inter-professional and organisational

communication is therefore vital (Borrill et al.

2000).

However, it is clear that many healthcare trusts

already operate a range of clinical workflow legacy

systems. For optimum cost efficacy there is a need

for new operating systems to integrate existing

parameters and build upon them to provide Trusts

with the best IT infrastructure outcomes.

2 IMPLEMENTATION OF EHR

IN NORTHUMBRIA – A CASE

STUDY

Northumbria Healthcare NHS Foundation Trust

based in North West England is the largest

geographical healthcare trust in England and one of

the largest healthcare employers in the North East,

with over 6,000 staff working in 10 hospitals

throughout Northumberland and North Tyneside.

Northumbria serves a population of half a million

people. The Trust manages three general hospitals in

North Tyneside, Wansbeck and Hexham and seven

community hospitals situated in Berwick, Alnwick,

382

Telford B..

IMPROVING CLINICAL ACCESS AND QUALITY OF PATIENT CARE - A Case of Integration.

DOI: 10.5220/0003192703820385

In Proceedings of the International Conference on Health Informatics (HEALTHINF-2011), pages 382-385

ISBN: 978-989-8425-34-8

 2011 SCITEPRESS (Science and Technology Publications, Lda.)

Rothbury, Haltwhistle, Blyth, Morpeth and

Wallsend. Northumbria Healthcare NHS Foundation

Trust has had Foundation Trust status since August

2006 and this has enabled the Trust to have greater

control to respond to the needs of the local

community. This Trust remains fully integrated

within the NHS being inspected by the Healthcare

Commission and overseen by the independent

regulator, Monitor. Governors represent the eight

constituencies the Trust covers and the public are

invited to become members of the Trust.

Northumbria Healthcare NHS Foundation Trust

identified a need to rejuvenate their clinical

workflow systems, in order to mitigate duplication

of records and ensure patient demographic

information was complete, accurate and consistent in

the Trust’s major clinical systems, improving patient

care and operating efficiency. Having implemented a

series of ‘best of breed’ stand-alone applications it

was recognised that whilst these provide critical

clinical information they lacked a unique patient

identifier leading to duplication of records and

possible inaccuracies (Figure 1). As a result there

was a decline in clinical confidence in electronic

systems and an increasing reliance on paper records.

Any system implemented needed to build upon

existing applications already implemented and in use

at the Trust and create a foundation to enable new

and replacement systems to be

integrated/interoperable.

Figure 1: Schematic of clinical workflow systems within

Northumbria prior to implementation of Rhapsody

™

and

Concerto

™

An effective four phase strategy has been

undertaken in order to meet these needs. Phase 1,

consisting of two parts, explored the remit of

integration and data quality, to provide a fully

integrated IT landscape to support the Trust’s

information strategy and to identify and rectify

issues with data quality apparent within the Trust’s

current systems. Phase 2 was to implement a unified

single view of each patient’s record including all

data from relevant sources. And Phase 3 was to

develop and provide clinical enhancements to

future-proof the system and optimise clinical utility

and is ongoing.

3 PHASE 1: INTEGRATION &

DATA QUALITY

Phase 1a: integration

The objective of Phase 1a was to provide a fully-

integrated IT landscape to support the Trust’s

information strategy as well as providing a basis for

improved data quality and integrity. The scope of

this phase was to convert all current integration to

the new platform – Orion Health’s Rhapsody

™

Integration Engine between McKesson PAS and

laboratories, radiology, maternity, theatres,

cardiology and order communications. The

McKesson PAS does not expose the requisite

messages as standard to provide available access to

Admission, Transfer and Discharge (ADT)

information in the form of HL7 or other formatted

messages, so it was agreed that McKesson’s

Interface Manager should be implemented in order

to provide the ADT feed from PAS to Rhapsody.

Such an approach was recommended and

implemented because of opportunities for a fast and

manageable transition with limited risk and good

cost efficacy. Existing interfaces were replaced with

G2 Digital dictation and Ascribe Pharmacy. Training

was provided to Trust stakeholders so further

interfaces could be developed as needed within the

Trust itself.

Phase 1b: data quality

Using the interfaces developed in Phase 1a it was

possible to interrogate the system and identify and

resolve data quality issues as Rhapsody assures data

quality once an interface goes live. To explore data

quality, interfaces from Phase 1a were used to

populate Orion Heatlh’s Concerto

™

Enterprise

Master Patient Index (cEMPI). EMPI stores a range

of patient demographic information and allows an

unlimited number of each item type to be associated

against each patient, for example names, sex, date of

birth, identifiers etc. Running the cEMPI provided a

IMPROVING CLINICAL ACCESS AND QUALITY OF PATIENT CARE - A Case of Integration

383

report of actual or potential duplicates that were then

resolved in McKesson PAS. Whilst this resolution

was achieved manually in PAS, all further updates

were subsequently automated to all other systems

using the interfaces developed in Phase 1a providing

those systems accepted Patient Demographic Update

and Merge messages.

The EMPI was vital for data cleansing but was

also used with a view to enforcing new business

processes, to ensure that data quality was not

degraded by lack of adherence to correct processes.

cEMPI use was extended to the live environment to

highlight the presence of duplicates and provide a

means to resolve those duplicates every time a

provider attempted to search for a patient when

using the portal.

4 PHASE 2: UNIFIED VIEW

The aim of Phase 2 was to implement a single,

composite view of a patient record consisting of data

from all relevant sources focusing initially on those

systems that delivered the most clinical benefit. The

scope of this phase was to present data from, and

provide single-click access to: patient administration

systems, pathology, radiology, PACS, digital

dictation and discharge summaries. Phase 2 was

implemented using Orion Health’s Concerto

™

Medical Application Portal using the Rapid

Deployment Edition so that a rapid implementation

focusing on the major systems of the Trust could be

achieved. Concerto was developed to work with

legacy systems within the Trust, and to integrate

with the Trusts current SSO solution, so that

dynamic patient summaries were obtainable using

information from a range of existing systems

including: McKession PAS, Anglia ICE Result

Viewing (current and past databases), HSS Cris

Radiology Information System, Agfa PACS,

G2/SIRIS documents and Immediate Discharge.

The observed benefits of Phase 2 were improved

user clinical engagement as well as improvements in

efficiency and clinic time. The value of existing

systems was enhanced and patient’s safety and

confidentiality improved.

5 PHASE 3: CLINICAL

ENHANCEMENTS

The objective of Phase 3 is to implement additional

clinical modules that will improve the use of data

within the hospital and drive process improvement.

These include Recurrent Admission Patient Alerts

(RAPA), Clinical Whiteboards for A&E and

outpatient departments and Infection Control and

Bed Management (ICBM).

RAPA is a unified alerting system that alerts care

workers when any patient from an identified cohort

presents in emergency care. In providing these alerts

the Trust can significantly improve the quality of

care provided and also reduce unnecessary

emergency admissions. It is being implemented

within Northumbria for cancer patients, those

terminal patients who have requested to die at home

and patients with identified chronic obstructive

pulmonary disease (COPD).

Orion Health’s Clinical Whiteboards

™

will

provide a user-friendly interactive solution for

providing real time visual information regarding a

patient’s status in relation to their progress along a

clinical pathway. Information can be both physical

in terms of location and also clinical in terms of

status of clinical processes, such as status of tests or

orders.

Concerto contains a solution for ICBM and

provides real time graphical representations of

patients, their locations and status updates on

expected discharge and infection status, enabling

hospital staff to recognise and respond appropriately

to specific patient situations.

Phase 3 is due to initiate in late 2010.

6 CONCLUSIONS

The NHS National Programme for IT is still ongoing

and is not due for completion for several years. As a

result there is a need for Trusts to implement

systems that will meet their needs for coherent

patient information both now and in the future;

services that provide good value for money and are

consistent with emerging central Government

strategy for the NHS. Although Northumbria is still

in the implementation phase of the project in many

facilities, the Concerto Portal and Rhapsody

Integration Engine solutions are already delivering

benefits in terms of accuracy, time and cost and as a

result will provide a good bridge to any services that

are delivered centrally in the future.

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