“The premise of electronic patient records (EPR) is dead,” Liverpool Women’s NHS Foundation Trust’s CIO David Walliker claims.
“EPR is probably a 10-year-old idea. By the time we’ve caught up with the idea of doing it, technology has moved on,” he said to ComputerworldUK in an interview.
This is why instead, Walliker is focusing on introducing an electronic document management system (EDMS) from Alfresco to digitise the corporate side of the trust. On the clinical side, the trust is using EDMS technology from EMC. He will start phasing in the system department-by-department starting with oncology on the clinical side and governance on the corporate side. The aim is to present all the hospital's structured and unstructured data via a single portal (Fortrus Unity)
Other projects the trust is working on include a project with a local university to explore app-based communication with patients and trying to change staff culture around the use of expensive printers.
‘Technology has moved on’
Walliker believes that existing EPR systems are not sophisticated enough to handle the specialist requirements of his hospital.
He said: “As long as you’re seeing all the information pertaining to a patient, why should I put it in a single box and sacrifice the good things on the specialist systems so it’s all in one place? I think I could do a lot more good for patients with the money it would cost.”
Walliker said the trust abandoned a procurement exercise for an EPR in 2012 after it decided the offerings from Lorenzo, Cerner or Meditech were not “good enough yet”.
He explained that no major vendor has an EPR suitable for all the specialist areas the hospital needs, such as neonatology, gynaecology and genetics.
Walliker believes that these tools, combined with its new electronic document management system, could remove the need for him to buy an EPR.
Wider NHS demand
However Tola Sargeant, director at analyst house TechMarketView, told ComputerworldUK that she doesn't see signs that demand for EPR systems is decreasing in the wider NHS landscape.
She said: "As NHS Trusts strive to become 'paper lite' by 2018, some are opting for enterprise-wide electronic patient record systems whilst others prefer a 'best-of-breed' approach using some form of portal or middleware to share information between systems.
"The different approaches have pros and cons, but it looks as if EPRs are winning a larger share of NHS procurements in the acute sector at the moment and we expect that trend to continue."
‘Who teaches you to use Facebook?’
Liverpool Women's open source Alfresco system is due to be fully installed by July 2015 and will be used by 1,000 clinical and corporate staff on a daily basis, according to Walliker. The rolling annual contract will cost the trust £100,000 a year.
The initial build of the system is being done by Synapps. The trust was attracted by the fact that the system does not require too much training for users, Walliker said. He added that a basic training video or screen messages to show people what to do step by step should suffice.
Walliker said: “What we really liked about the product is that it’s just easy. ‘Who teaches you to use Facebook?’ is our mantra now. No one does. It just works. So we want the same ethos for our document library.”
To support the Alfresco implementation the hospital plans to replace its wireless network to ensure it has enough coverage for the new system, he said.
The trust is also planning to get rid of Microsoft collaboration software Sharepoint as part of its EDMS project.
Walliker explained: “We’re using five percent of the functionality and pay way too much in licensing costs. Now the enterprise agreements aren’t there anymore it’s not attractive. And it’s not just the licence, it’s also paying for the SQL server for it to sit on and other costs down the line.”
Communicating via apps
The trust is working with Liverpool John Moores University to introduce more app-based communication with patients to replace leaflets.
The first phase of the project is for signposting public health information such as smoking cessation and tackling obesity.
Providing evidence that patients have downloaded and displayed the information - and thus probably read it - puts the hospital in a stronger position with commissioners for funding, Walliker explained.
For phase two the hospital is exploring allowing patients to book appointments via the app and integrating it with the booking and scheduling system. The IT team is in talks with “a couple of technical providers” about the plan, Walliker said.
‘Ridiculous’ number of future projects
Over the next few months Walliker has a “ridiculous” amount of other projects to work on too.
Beyond the EDMS, he is working on systems for bed management and self-service check-in and plans to move to centralised management print services.
He said: “We’ve been sniffing around our printer infrastructure over the last six months. We’ve used 48.8 trees during that time, equivalent to an average of 110,000 sheets of paper a week.
“Multiply out what that costs – paper isn’t cheap, but then cartridges, that’s £40,000 a month, then the power on them, because no one turns them off. Most of them are underused too. They’re comfort blankets for a lot of people. So we need to change that culture.”