Using technology to re-design services. John Thornbury - Director of ICT Worcestershire Acute Hospitals NHS Trust

Transcription

1 Using technology to re-design services John Thornbury - Director of ICT Worcestershire Acute Hospitals NHS Trust 1

2 2 Worcestershire Acute Hospitals

3 Worcestershire Acute Hospitals Trust Facts One of the larger non-teaching trusts in England serving a population of more than 550,000 Turnover 264m in 2006 / 2007, 5500 WTE staff PFI on one site Key issue 100,000 I/Ps, 400,000 O/Ps, 100,000 A&E attendances beds on 3 main sites Historical deficit - 30m Medical Records Key Issues 3 trusts merged into one Little attention paid to records management Just put together New PAS no de-duplication Culture keep hold of record or never see again Paper cashing notes ie never complete 3

4 Medical Records Problems with Paper Clinicial Misfiling of documents Documents never filed Records lost Multiple records Speciality notes Time taken to find relevant information Security No audit process Records left in insecure areas Difficult to control access Records physically lost Paper Management Filing & retrieving Policies for retention and disposal Health & Safety Space Transport Cost A requirement to re-engineer the process and wrap a technology solution around it 4

5 Moving away from 11 miles of files! 5 Page 5

6 Escaping from Crate Mountain! Data Security issues associated with transportation of hard copy records Significant storage space requirement Carbon footprint impact of transporting records across the trust A record can only be in one place at any one time 6 Page 6

7 Project Vision Within the next two years, to enhance and simplify delivery of safer patient care within Worcestershire, we will access patient medical records electronically at the point of care delivery 7

8 The Journey 2010 Into the Digital World Page 8

9 Project objectives Re-design processes first Dramatically reduce costs Reduce the risk associated with the availability and accuracy of records Comply with UK Government targets and incentives for cost down and productivity Enable the trust to focus on its core business Integrate paper and electronic records to overcome culture challenges Deliver an environment that provides continuity from the past but marries together technology 9 Page 9

10 Redesign processes and then apply technology.. The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency The second is that automation applied to an inefficient operation will magnify the inefficiency. Bill Gates 10

11 What are we trying to do - Health records transformation from paper to digital Clinical Care Health Record Process + + Patient Journey + Outsource As Is paper process People, facilities & processes Design new electronic process Use~ability Forms rationalisation Update procedures Heath Records digitisation Conversion Indexing Archiving & destruction Implement electronic health records management system Full transformation over 2-3 years Financing cost of change to achieve YOY cost reduction targets Central File Store Supporting 3 Acute & 4 Community Hospitals 11

12 The Process Started as financial imperative( 30m deficit in trust) Health and Safety issues Business case to board OJU process (but different used negotiated process rather than traditional specification based approach) 12

13 Criteria for selection Reduce the financial costs associated with storage of records and the clinical administration service (short term and long term) Develop a health records service that is able to flex to meet current and future changes, both local and national Improve existing timeliness and responsiveness of case note availability to support the treatment of the patient. Develop the ability to access clinical information from multiple sources at the same time, therefore reducing clinical risk to the patients and clinical staff Maintain accurate and timely clinical record keeping Reduce administration duties required by clinical staff. Provide a safer working environment Support the process of continual improvement, but ensure that implementation of any transformation is quick. Enable effective advance planning of department(s) workload. Compatible with the National electronic patient records strategy. Maximise existing and future technology leading to a paperless service with no paper-based systems Improve efficiency of workflow in all associated administration areas, therefore eliminating duplication and delay Provide KPI information as a by-product of the solution, to use as a management tool for performance managing teams and monitoring SLAs Integrate with other solutions that the hospital may have / may want to have in the future. 13

14 Building a partnership Xerox Global Services selected as partner Xerox lead a consortium including a technology provider and a change management consultancy The trust identified a strong need to leverage private sector expertise, process management and experience to drive change Formed a partnership to capitalise on NHS strengths and private sector strengths sector strengths Pro-actively worked project pre-contract to identify critical path activity as well as quick wins to secure immediate service improvement whilst service transformation activity was launched Senior engagement and strong governance process Stakeholder engagement from all aspects of trust to drive awareness and input to future shape of service 14

15 Expected Project Benefits Objective Delivery Improvement Associated Key Benefit To support provision of best possible care and treatment of the patient To reduce the financial costs associated with the storage of records To support in enabling the most efficient and effective use of clinical time and associated resources Clinical Governance Strategic & Management To minimise the time spent by medical, nursing and other clinical staff on clerical duties To reduce clinical risk associated with health records, therefore, securing NHSLA & Information Governance standards To maintain a complete and accurate record of the activity carried out within the Trust for clinical, legal, research and business purposes To provide information both within the departments, across trust, and external stakeholders, quickly with the minimum use of resources To enable effective advance planning of department (s) workload To move to a paperlight environment and support the National strategy electronic patient records Foundation Trust application 15

16 Driving Improvement with Xerox - Six Sigma and Lean Six Sigma Lean After Reduce Variation After Before Mean Shift Before Six Sigma focuses primarily on process effectiveness understanding and reducing variation reducing and eliminating defects. improving performance on Customer CTQs Quality Accuracy Zero Defects Reduced Variation Lean focuses on process efficiency identifying non value added steps and reducing waste reducing bottlenecks Increase speed and cycle time Quantity Timeliness/Speed Zero Bottlenecks Reduced Non-Value Added Steps 16

17 Overview of Existing Process 80-90% paper Central file community Community Care C&B EDS Acute Hospital acute Work Done GP s GP s Specialist Departmental systems Education Social care Social Services 17 Paper chase Electronic flows Laboratories Results /orders

18 18 The existing process

19 Future Management of Health Records Forms design Group Rule s Work Done Tasks Community Care Tasks Work Done Acute Hospital Work Done Tasks GP s Tasks Work Done Records viewable at multiple locations at same time Results Social Services Education Laboratories Results /orders 19

20 20 The Future Management of Health Records

21 The journey so far.. Project management expertise from Xerox to help drive improvement Lean Six sigma core to approach Numerous processes reviewed, refined and improved Significant productivities realised Initial Focus areas Forms rationalisation in total and growing -same forms with several variants Process efficiencies within current operation Missing notes focus Service Improvement approach throughout entire process Stakeholder engagement and strong CEO support to drive change Change management organisation as part of outsourced consortium Strong partnership developed to bring innovation and finance the change Bar-coding of records to move away from NHS terminal digit filing process to industry benchmark process. Remove risk and mitigate medical / legal issues On track to roll out new world in

22 Legal Admissibility A Trust which goes to court with a scanned version of a Medical Record is likely to be vulnerable if it cannot demonstrate adherence to BIP :2008 This Code provides a framework and guidelines that identify key areas of good practice for the implementation and operation of document capture and electronic information storage. Complying with the code is structured into : Information Management Policy Duty of care Policies and Procedures Enabling Technologies Audit Trails 22

23 Beyond the Record The majority of the content of a medical record comprises forms Forms drive every clinical process An Acute Trust can have several thousand different forms with many obsolete and many duplicated Good clinical governance depends on the use of the right form in the right place, every time The rationalisation and re-engineering of the forms is a prerequisite of moving to an EPR Forms with embedded intelligence can be used to drive workflows and care pathways 23

24 Lessons learnt to date At due diligence be prepared to find a disconnect between actual records and the entries on PAS Prepare for and recognise that data quality may be poor Define and map all processes rigorously Be realistic about expectations for the transition of the service Select the appropriate contracting model which meets the needs of all parties Engage all staff about the potential impact of the business transformation Be realistic about the transfer of risk 24

25 25 Initial Press Coverage Q4 2009

26 So What has been delivered 26

27 Critical Success Factors Key to Success is an overarching Strategy incorporating EDM, not left as island Knowledge People Process Technology 27

28 Summary Knowledge Knowledge within the people involved needs to be retained Communication and stakeholder engagement is vital to secure success Allow the NHS to focus on what it does best Financing the cost of change is a critical value add from the outsourced vendor People Strong senior management support crucial to success A partnership must be formed and well managed throughout the contract Meets clinical needs and saves time Patient Safety and Care improved involve and engage users(all clinicians) from outset 28

29 Summary Process Approach to procurement critical Re-design the process and wrap the technology around the process Think outside the box to drive change Forms are critical Technology Bring in best of breed partners to bring external knowledge and best practice to the NHS Ensure infrastructure is right to enable right information at right time and place e.g. Wifi, connectivity at right locations etc. 29

30 Supporting QIPP Quality patient safety improved as information is available to clinicians Misfiled notes % reduced Missing note % Reduced Innovation combining paper and electronic records Notes will be available electronically for remote clinics Productivity Increased efficiency when filing and retrieving 1km of space gained Promotion Reduced carbon footprint - less travel Page 30

31 Contacts John Thornbury Director of ICT Worcestershire NHS 31