ACE 2016 EPR Downtime Sarah Hulme, Head of EPR Development Andrea Popplewell, Head of Technical Development Salford Royal Foundation Trust, UK

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1 AUGUST 9 11, 2016 ACE 2016 EPR Downtime Sarah Hulme, Head of EPR Development Andrea Popplewell, Head of Technical Development Salford Royal Foundation Trust, UK

2 AUGUST 9, 2016 WELCOME!

Salford Royal NHS Foundation Trust Large teaching Trust in Greater Manchester Approximately 800 Beds

Manchester Supra District Renal Specialty Greater Manchester Trauma Centre Vanguard Site One of the

improving the patient experience, requiring respect, compassion and the right attitude to our patients

North West An industry leader in IM&T High Digital Maturity Index Provide safe, clean and personal

4 Salford Royal NHS Foundation Trust Large teaching Trust in Greater Manchester Approximately 800 Beds Serves population of 220, Staff Acute & Community Service Tertiary Services across Greater Manchester Supra District Renal Specialty Greater Manchester Trauma Centre Vanguard Site One of the safest hospitals in the UK as measured by mortality and harm rates CQC Outstanding Rating Focused on improving the patient experience, requiring respect, compassion and the right attitude to our patients Viewed as the leading hospital for Quality Improvement and the hospital of choice for patients in the North West An industry leader in IM&T High Digital Maturity Index Provide safe, clean and personal care to all patients every time Manchester Devolution Partner Copyright 2016 Allscripts Healthcare Solutions, Inc. 4

5 EPR Usage EPR (EMR/EHR) system since 2000 Upgraded to Sunrise Clinical Manager in June 2013 Currently on 14.3 CU 15 plan to upgrade to 16.3 in Spring EPR users, 3000 concurrent Areas of functionality within EPR used Order comms Documents E prescribing and administration Health Issues, Significant Events Clinical Summary Emergency module Tracking boards (facility boards) Copyright 2016 Allscripts Healthcare Solutions, Inc. 5

6 Downtime History No electronic downtime solution initially for x years EPMAR introduced to the trust in 2009 Downtime EPMAR Report initially just medications PC based and updated every 15 minutes As EPMAR expanded throughout the trust increasingly impracticable Decision needed on what downtime should include needed to think about other content not just medications Copyright 2016 Allscripts Healthcare Solutions, Inc. 6

7 Solution Design Complete website off replication server Uses patient list for each ward based upon workstation location as the default Further development outpatients solution and individual search facility Copyright 2016 Allscripts Healthcare Solutions, Inc. 7

8 Downtime Technical Details.net website written in C# Mostly Crystal reports slowly being transferred over to SSRS reports Stored procedures stored in a database alongside the EPR replication database on the same server Users Replication Server is replicated instantly - if EPR is down we can still use the Replication database For planned Downtime. A static copy of this database is taken 10 seconds before downtime occurs and the website points to this Copyright 2016 Allscripts Healthcare Solutions, Inc. 8

9 Downtime Security & Information Governance Users log on to the website using their AD usernames and passwords If machine is logged on as a generic user then the user is forced to enter their username and password otherwise credentials are passed right through Generic machines occur more on the wards Outpatients users will usually be logged on to the machines IG rules Need to put something about logging onto the outpatient individual patient log on Copyright 2016 Allscripts Healthcare Solutions, Inc. 9

30 minutes or more If out of normal hours, Trust Site Co-Ordinator switches on

10 Downtime Solution Folder within Start menu Readme guidance always available Downtime solution switched on by senior IT manager on call if system is down for 30 minutes or more If out of normal hours, Trust Site Co-Ordinator switches on Switch on is via Trust intranet Copyright 2016 Allscripts Healthcare Solutions, Inc. 10

Individual Patient Search Copyright 2016

16 Documents All documents entered within the last 24 hours are available An agreed list of other documents that have been entered is also available even if these have not been entered within the last 24 hours These include, amongst others: ED documentation Admission documentation Ceiling of Care / CPR Status End of life documentation Risk Assessments Discharge Summaries Copyright 2016 Allscripts Healthcare Solutions, Inc. 16

18 Downtime Audits Solution switched on on the first Tuesday of each month between 10am and 3pm Each ward is expected to test gives users confidence if downtime occurs Audit report shows which wards have utilised the downtime report Copyright 2016 Allscripts Healthcare Solutions, Inc. 18

19 Planned Downtime Documents & Orders Planned downtime agreed with Trust Board with notice, usually 6 weeks Communication sent at regular intervals and on Trust Intranet PC Screensavers updated to show downtime details Downtime documentation paper forms available on Trust Intranet Each ward has a downtime folder with relevant paper forms Copyright 2016 Allscripts Healthcare Solutions, Inc. 19

20 Planned Downtime Prescribing Prescribing and medication administration: Pre downtime: Ward will print out a Planned Downtime Drug Chart report for each patient from EPR/SCM Prescribing security rights removed from relevant security group at the start of printing to make sure nothing could be added, modified or cancelled during the printing period During downtime Paper report is used exclusively for all EPMAR records for the patient Copyright 2016 Allscripts Healthcare Solutions, Inc. 20

21 Post downtime team of pharmacists, medics and ANPs will be going from ward to ward to carry out a process of ensuring that each patient s electronic drug chart is updated in accordance with the paper chart (e.g. discontinued medication, newly prescribed medication, modified doses etc. They will change the status of the medication by giving a valid reason for the drug not being given Once this reconciliation has taken place the prescription transfer team will place a line through each sheet on the downtime drug chart At this point the paper drug chart becomes redundant and the electronic chart used exclusively The paper drug chart must be filed away immediately with the patient notes Copyright 2016 Allscripts Healthcare Solutions, Inc. 21

23 Lessons Learnt Users now prefer individual search more confident in viewing onscreen as opposed to printing out whole ward patient lists No ownership of downtime even though we have Monthly testing and it is part of the NAAS. They only care when it goes down. The EPR areas that is business critical ie the emergency villages they take ownership of the system and care. But other areas that are not as engaged Communication within the Trust Poor Workstation locations need to be correct on the ward PC s new PC need to ensure workstation location is set to correct ward Copyright 2016 Allscripts Healthcare Solutions, Inc. 23