“For as long as I have been in the IT service, people have wanted to go to one place and log-on and see all the relevant information about a patient,” says Des O’Loan, the electronic care record project lead for Health and Social Care Northern Ireland.
O’Loan’s words could have been uttered by more or less any IT lead or clinician in any health organisation across the UK; and the majority are still searching for a solution.
However, IT directors and senior clinicians in Northern Ireland really seem to believe that they are getting close with an Orion Health web-based portal that gives them access to an electronic care record built out of feeds from existing systems.
Background to the pilot
In 2008, O’Loan and his team undertook a study tour that took in countries such as the US and Canada to find out what IT options were available to the board.
The group visited a number of hospitals and encountered a number of systems, including Microsoft’s Amalga, Orion’s offering, and a dbMotion portal.
“As soon as people saw the systems, they went ‘wow’ and the lightbulbs went on, so we put a business case together to get the money together to do a pilot,” says O’Loan.
“We thought we were a bit naive, and that if we went to procurement for a system we would end up getting fleeced as we didn’t know what we were talking about,” he adds, disarmingly.
After securing central funding of around £130,000, an ECR ‘proof of concept’ team invited trusts to submit ‘expressions of interest’ to take part in the new project.
As a result, the pilot area was defined as Ulster and Belfast City Hospitals, Priory Surgery and Carryduff Surgery. All of these are in close proximity to each other, and patients tend to “alternate” between the two acute organisations.
The pilot
In October 2009, a contract was awarded to Orion Health for its web-based Concerto portal. Within three months the system was up and running, with views personalised for GPs and acute clinicians.
“We had a few teething problems as we hit things that people had never hit before, but once these were sorted, the system stabilised,” O’Loan says.
The portal gives clinicians a single browser view of key patient information, interfacing with 16 IT systems. These include the hospitals’ iSoft Clinicom patient administration systems, lab and radiology systems, and the emergency care summary, which holds patient medication and allergy details held on GP clinical information systems.
A letter was sent to each of the 25,000 patients registered with GPs who were likely to be impacted, asking them to provide their consent.
This caused no problems for the project. In fact, O’Loan says many people expected such a process to be in place already. Only 120 patients decided to opt out of sharing their ECS with the acute sector.
Otherwise, the emphasis from the outset was on making sure that there was no disruption to the day-to-day service; which is one reason why no big systems were replaced. O’Loan says it was “fundamental” that the project had “zero footprint on the desktop” and “was clinically driven.”
Dr Roy Harper, a consultant endocrinologist at Ulster Hospital, and one of the many clinicians involved on the ECR project board, says the use and popularity of the portal soon “took off.”
“During the first pilot we had 100 users on each [acute] site. And while I had seen it elsewhere, and thought it was going to be good, boy I didn’t imagine how good it was going to be.
“A lot of clinicians were involved and that was important as we got a real good feel for all of the issues. But once the pilot got up and running it transformed the way we work.
“All the patient information we need to make clinical decisions is there, and although we have only put in our core systems it is enough 80 or 90% of the time to make the decisions you need to make.
“Patients also think you are amazing, as you didn’t have to ask questions as it is all there in one nice view.”
Benefits
The development of an ECR for Northern Ireland has been a key goal for its ICT strategy since 2005. However, it has had to take place against a backdrop of increasing pressures; rising demand, falling budgets and the expectation for the health sector to be “doing much more for much less”.
According to Dr Ken Fullerton, clinical director for older person services for the Belfast Health and Social Care Trust and another clinician involved in the project team, the portal has delivered several benefits, including making better use of ECR information.
“It’s the first thing I turn on when I come in in the morning, as it provides me with an up-to-date list of all the patients I have in the hospital.
“Before I go to the ward I can check up the results, such as MRI and CT scans, meaning I know who I need to see first and what needs to be done, which is a big advantage,” he says.
As a stroke specialist, Dr Fullerton encounters many patients entering hospital who might require thrombolysis. However, if a patient is also taking the drug warfarin, then that treatment could potentially kill them.
“Sometimes the stroke affects the ability of a patient to communicate so if someone comes in on a 999 call then you need to make a quick decision.
“The ECR has helped in at least one case with providing that information and when that is rolled out to involve all patients all GP practices it will become even more valuable,” he says.
The Health Board is wary about putting a specific figure on the potential savings it will see from the system and is keen to make sure it is not viewed as “cash releasing.”
However, with 500 clinicians now using the system, one area in which savings are consistently being made at Ulster and Belfast Hospital is in clinical interactions such as blood testing.
Dr Harper says: “The first thing we noticed when we started with the ECR is that duplication is extreme in terms of blood testing.
“Even in clinical interactions, there is a lot of duplication and we were able to see that and reduce our requesting for lab tests and imaging.
“It improves the efficiency and effectiveness of our work and we are even much more relaxed, as we are not always struggling to find the information as it’s presented.
“We have prevented a few catastrophes, a few ICU admissions and unnecessary investigations. It’s always difficult to quantify but across the world, similar system’s savings are considerable as it reduces all the duplications.”
The future
Following the success of the initial pilot, the portal has received central backing from Northern Ireland’s health minister, Edwin Poots.
Driven by this government support, the Health Board went out to procure a nationwide portal system, and in May this year it signed a £9m contract with Orion.
At the time of the announcement, Poots said that the ECR would contribute to the delivery of the key proposals in ‘Transforming Your Care’, Northern Ireland’s strategy for developing a new model for health and social care.
The roll-out of the system will begin in April 2013 and the target is for the system to eventually have 20,000 users, with all 350 GP practices in the country also involved.
While preparations are being put in place, the clinicians currently using the system are busy extracting more functionality from the portal.
Ulster Hospital is set to start a trial of iPads for clinicians, which will provide them with access to the system at the bedside. According to O’Loan, the latest version of the Orion portal will run natively on the tablet device.
The ehealth and social care team is also investigating the potential for incorporating ‘alerts’ into the system, while cardiology, diabetes, renal, and social and mental health systems will also linked in gradually.
O’Loan believes the system compares favourably with other solutions implemented in England: “When we go to England and go to conferences we look at the systems and say ‘well that’s good but we have something like that’.
“Actually, we probably even better but we are not very good at blowing our own trumpets. We haven’t changed any operational systems and there was no impact on a service in which there were lots of changes going on.
“There’s just no capacity to change our lab system, for example. That’s what they were doing in England; they were just changing systems all over the place and that’s why it cost them 12 billion quid.”