Ayrshire goes slowly with TrakCare

NHS Ayrshire and Arran has slowed down its roll-out of TrakCare following feedback from clinicians on phase one of the go-live.

The Scottish health board went live with InterSystems’ patient administration system in May 2011.

Feedback on the implementation has resulted in the roll-out of phase two – order communications – being staggered to allow for greater engagement with clinicians.

NHS Ayrshire and Arran assistant director of eHealth and infrastructure services Denise Brown said a staff engagement exercise was prompted by feedback that clinicians felt they had not had enough involvement with the PAS implementation. 

The original plan was to go live with order communications across the board or site-by-site.

Instead, the board decided to roll-out order communications by specialty, resulting in a much longer implementation. Phase two began in November and is one third of the way through.

“For phase two we wanted to take things a bit slower. It’s a big change and we agreed with them [clinicians] that we would take a much slower approach and work on a much more individual basis with them,” said Brown

“We set an end date and have a plan, but we are very much guided by clinicians and how they are getting on.”

She said some issues rasied during the engagement exercise were easily resolved by changes to the system while others were passed on to InterSystems to address.

“The feedback was generally like; ‘can you make that screen a little bit tidier or reduce the number of clicks to outcome a clinic,” she said.

“They can be quite minor things, but they impact on clinicians in a busy clinic environment so they can really make a difference.”

Dr Ken Ferguson, assistant medical director and SRO for the programme, said the board was “on a journey” to convincing clinicians about the benefits of electronic patient records.

“We have invested a lot of time and effort with them as a group and with individuals so they recognise we have a responsive approach and that we are working together to make it better and make it work for them and to deliver better care for patients,” he said.

The engagement exercise involved talking to clinicians and other staff on a one-to-one basis, asking how the system did and did not work for them and listening to ideas on how to take things forward.

“That’s why phase two has been as successful as it has, which is great,” Dr Ferguson explained.

He acknowledged that the issue of the time it took to enter information electronically had come up.

“If you look at something in isolation you can advance the argument which says it takes more time to do this, but this is a whole different way of delivering healthcare and e-health has to be an enabler to improving the way we deliver healthcare,” said Dr Ferguson.

“We might ask a clinician to do something they didn’t do before, but they get a lot of benefits in terms of access to information.”

InterSystems signed a contract to deliver its TrackCare patient management system to five Scottish health boards in January 2010.

The core functions being delivered include general hospital patient administration, complex scheduling and order communications. Optional modules include A&E, community, pharmacy management, maternity, radiology and theatres.

Brown said implementation of the PAS at Ayrshire and Arran included all appointment bookings in outpatients and electronic vetting of referrals from primary care.

Appointments functionality is also being extended to child and adolescent mental health services and musculoskeletal services.

Completion of order communications for radiology is planned for the end of March. The lab build is expected to take six months and will roll-out after that.

Ayrshire and Arran is deploying digital dictation and is trialling the use of tablet devices to access the EMR.

It is also considering implementation of the Orion portal, which it has purchased along with three other Scottish boards, and the roll-out of JAC e-prescribing.

Brown added that the health board was also implementing single sign-on from Imprivata under a framework contract in Scotland.