Imperial College Healthcare NHS Trust has installed sensors into a third of beds at its five London hospitals to monitor the condition of patients, cutting down on clerical errors and saving nurses precious minutes every day.
The project is part of a wider initiative to digitise health records, says John Kelly, group CIO at Imperial College Healthcare NHS Trust.
“What we are trying to do at the hospital is to digitise our operations, workflows, data collection and data management," Kelly told Computerworld UK at Oracle's Modern Business Experience event in London last week.
“We are keen to put the patient at the heart of what we do. So we want the patient to be able to interact with us digitally, to get their information, share it with carers and who they choose to involve in their care and give them control.”
Imperial College Healthcare NHS Trust was founded in 2007 and consists of five hospitals: Charing Cross Hospital; Hammersmith Hospital; Queen Charlotte's and Chelsea Hospital; St Mary's Hospital and Western Eye Hospital and employs nearly 10,000 people.
In 2013 Jeremy Hunt vowed to make the NHS paperless by 2018, and in 2014 NHS England committed to delivering a ‘paperless’ NHS by 2020. in other words: the digitisation of patient records in the NHS can feel a bit like waiting for Godot. Kelly, however, believes that the industry has “finally hit an inflection point.”
Currently most hospital wards still rely on paper records, with patient notes attached to clipboards pinned at the foot of beds. Imperial has now installed blood pressure, temperature and respiratory rate monitors into a third of its hospital beds which uploads to a software application from specialist vendor Cerner. This allows nurses to capture patient data directly into the system at the press of a button, rather than writing something down.
Having this sort of monitoring in a digital environment will help avoid what Kelly says is unfortunately termed “charting to death”, whereby a patient slowly deteriorates without anyone being alerted. Kelly explained: “We can see a white blood cell count to detect the onset of sepsis, or detect a patient deteriorating…and we can alert someone automatically.”
This also comes with time and cost savings for nurses. Not only does it cut down on transcription errors but also saves nurses having to physically plot points on a chart. "If each nurse is saving a couple of minutes per patient and multiply that by the thousand patients we have you save roughly 12,000 minutes per day," says Kelly. That time goes back into patient care.
The project has helped Imperial College Healthcare NHS Trust to move to mostly digital patient records over the past six months and has drastically cut down on the number of appointment letters being sent by post thanks to a partnership with Xerox. Imperial is looking to fit the remaining two thirds of beds across the trust with sensors by the end of the year.
From a technical perspective the trust is using Oracle SOA (service oriented architecture) suite of Fusion middleware to link up the various on-premise systems across its hospital footprint with the Cerner system to automate the flow of information between applications.
Kelly said that the trust had previously relied on Oracle's Java Composite Application Platform Suite, before transitioning to Fusion SOA.
“We use it to move data and monitor the messages,” Kelly said, before providing an example. “For example from local social services we get the local child protection registers and load those. So when we see a child registered in A&E we check the name and do soft checks against the list of patients and if we detect a patient on the child protection register we can message back to A&E and the district nurse to look at the notes and check.
“It allows us to link up a number of systems and detect events because the messaging has triggered a number of systems. So detecting events that the individual systems aren't designed to detect."
Care Information Exchange
Next on Kelly’s agenda is to scale what he calls the Care Information Exchange, a secure portal for patients and doctors to store, view and manage their health records.
Kelly wrote in a blog post last year: “We are starting to sign up patients in selected services to get access to appointments information, blood test results and x-ray reports on the Care Information Exchange. This will give patients their appointments and test results from our Trust in one place. Patients can share the record with other health and care professionals and, if they choose, with relatives or carers. It gives patients the assurance that everyone involved in their care can access their current health records at their discretion.”
Kelly says that it has 1,000 patients live on the system and that engagement has been high among early adopters.