The initial business case suggested a number of benefits which could be derived from the pilot which have been evaluated below:

Transcription

1 PROCUREMENT of ARDENS TEMPLATE SYSTEM 1. Executive Summary A business case was submitted to Norwich CCG in January 2017 requesting approval to run a pilot of the Ardens Clinical Templates which sit within SystmOne across the 23 member practices. The pilot was given the go ahead and has been running across the Norwich CCG area for a period of approximately 4 months. This document evaluates the success, or otherwise, of this pilot and proposes the next steps. 2. Introduction and Overview Ardens is a suite of sophisticated templates, protocols and reports, created by a practising GP in Wiltshire, to enable the regular GP to optimise their use of the clinical system. It is well known that SystmOne (S1) is a comprehensive clinical system that allows data to be stored and cut in a variety of ways. However, it is not particularly user friendly and the collation of data is not standardised, meaning that the ability to draw conclusions as to the needs of the patient population is limited. It was hoped that during the pilot, GPs and Practice Managers would be able to test the system and be in a position to answer the following questions at the end of the pilot: Do the Ardens templates enable more consistent entering of data into the clinical system? Will they encourage the completion of the money data fields? Will the Ardens templates allow sharing of staff across sites due to more consistent working practices? Will the templates allow a more streamlined offering of information within S1 that negates the need to access Knowledge Management Norfolk for clinical referral criteria? Will the reporting elements of Ardens allow for greater interrogation of all contracts on a month by month / quarterly basis LCS / DES / QOF? Do the reporting elements allow you to identify otherwise untapped opportunity for maximising income without the need for further investment in external services? Will the Ardens quick access formularies increase your likelihood of achieving savings / maintaining your prescribing budgets? 3. Assessment of Benefits The initial business case suggested a number of benefits which could be derived from the pilot which have been evaluated below: Time saved in dealing with routine clinical and administrative tasks Anecdotal indication from clinicians suggest they are able to undertake more comprehensive, patient focussed consultations using the templates as they encourage increased structure and less timely completion than the historic free-text fields. Reduction in the potential for variation in recording information The system captures information in a standard format across all its templates and pre-

2 populates the same fields in concurrent templates reducing variation and duplication. Standardised data results in robust data for subsequent commissioning decisions. Consistency of information presentation Historically, clinicians work in a variety of ways and capture data in many different formats. It is often difficult to follow the flow of consultations and identify key information. Through the templates and use of S1 filters, data entered into Ardens is standardised and although comprehensive at times, easier to navigate with the correct use of filters. The standardisation offered as a result also ensures that it is significantly easier for staff to transfer across sites and organisations, increasing the resilience of the CCG practice area in both clinical and administrative capacities. Improved consistency of CCG agreed formulary To date, ScriptSwitch has provided a facility to encourage GPs to prescribe more cost effective versions of individual drugs, mainly generic to branded switch options. Ardens takes this process one step further and incorporates the CCG formulary enabling clinicians to prescribe first line drugs at a single click of a button. Over time, this should both increase compliance and negate the need for investment in ScriptSwitch. Highlighting of potential patient safety issues Templates are built into the system to ensure those patients on DMARDs are highlighted to the clinician and regular prompts for monitoring tests appear. Patient specific warnings are pulled through when new medications are prescribed and all medication screens clearly list any allergies or reactions to medication at the top of summary screens. To date we do not have the evidence that this has impacted patient care during the pilot, but it will only present itself when a never or near miss situation occurs and therefore lack of evidence should not be gauged negatively. Identification of patients at risk of avoidable admission to hospital Inbuilt reports within the system encourage pro-active patient care, highlighting patients on combinations of risks and medication who should be reviewed. As a risk stratification tool, these reports are not comprehensive enough to replace systems such as NELIE or Eclipse, but will assist clinicians in their management of preventative situations. Improved protection against Medico-Legal claims The ability to undertake a greater detailed consultation, with the prompts of safety netting advice, satisfies the demands of medical defence unions. The templates provide reminders for the capture of monitoring data aiding safe practice. Completing Enhanced Service claims more efficiently All clinical templates identify those fields which activate financial payments. The reports suggest patients where income claims may not have been made and whose correct coding could increase income. The monthly and quarterly reports enable practices to crossreference, easily, the CQRS reports which actually trigger the financial payments from NHSE and this releases capacity within practices to manage the day job.

3 Ensuring future investment in projects dovetails with the current tools GP TESTIMONY Having used the Arden s templates for the last few months I can see the positive impact it has had on my consultations. Initially it was a little overwhelming with the sheer amount of information available on the templates but once I realised you didn t have to put a value in every box it became much easier. Having everything on one screen is invaluable and makes consultations much smoother and makes my notes more thorough especially with the more condition specific templates. Having the scoring systems eg CENTOR and Wells there is very helpful rather than searching around for them to add to the notes. The formularies are useful and only a few clicks to produce your prescription but the most positive aspect of this for me has been the end of life care templates. Being able to add the drugs and then print out the drug chart for the community teams has saved double handling work. Dr S Rushton, Partner, Bacon Road Medical Centre 4. Risk and Sensitivity Analysis The single biggest risk of implementing this project was felt to be the uptake levels across both individual clinicians and practices as a whole. Eight training days were delivered initially providing four role-tailored sessions to each of four localities across four differing dates of varying times. These times were rotated so each locality to optimise attendance and minimise impact on clinics. Initial sign in sheets showed 400 individuals being trained with attendees from all 23 practices,

4 excluding UEA who chose not to participate due to a differing clinical system. A proportion of those attending felt over-whelmed by the speed of the delivery of training and complexity of the Ardens system. To mitigate this risk the training was pared back almost immediately to the bare bones, working on the premise that confidence and understanding would lead to inquisitiveness and skill development. Clinicians, especially, were encouraged to attend more than one training session. A proportion of GPs, in particular, were clearly not confident with IT systems. One GP stated that they never read coded any elements of their consultations, simply free-texting the information into the patient record. The team tried extremely hard to engage him into the merits of the Ardens system but although showing promising signs, it will be a significant work process change for him to optimise his usage. This example could be a one-off but is more likely an extreme indication of a cohort of GPs who are unhappy with change and reluctant to embrace new technologies. Due to workforce pressures on practices, there is a risk that staff are paying lip service to their level of engagement and the reality could present another IT system that sits on the shelf. However, by embedding the Ardens system into a number of different projects and services, the clinicians will be presented with many occasions to utilise its merits. 5. Timescales Full rollout of training and implementation has now been completed. Two additional interactive sessions were held for another 60 staff and individual on-site training has also taken place. It has become apparent that as the practices use Ardens thoroughly, further refresh training is likely to be required. There is an opportunity to work with the Ardens development team to further expand the system to potentially incorporate a Directory of Service aiding the support of referrals and overall demand management. In addition, there is scope to tie in with the Knowledge Norfolk pathway reviews. 6. Conclusions and Recommendations A survey of Practices was undertaken to advise the project team on whether there was engagement and merit in continuing with the Ardens system. Twenty practices returned. Yes No Not Returned Of the two practices who said No, it was felt that workforce pressures in particular and lack of attendance at the training sessions fuelled this response. It is possible that with individual training sessions, it could be possible to engage with these practices. The decision as to whether to commission the system needs to reflect if it will release capacity in GP practices and thus increase their resilience. On this basis, it is recommended that Norwich CCG go ahead with the purchase of Ardens on a three year contractual term. In order to maximise return on investment, the Ardens engagement is to be further developed by the One Norwich Digital Project

5 Manager to ensure it is securely embedded in business as usual across all Practices. Further business cases may need to be raised to ensure that work is ongoing in the form of development of integration with Knowledge Norfolk, Prescribing Formularies and the Directory of Service. Refresher training will need to be delivered on a periodic basis to ensure that the updates and expansion of the system are further embedded. This is not a standalone, start, stop project. It must be understood that Ardens is a tool for ongoing development.