Imagine this scenario: a patient arrives at hospital for an appointment or an emergency, or is admitted for treatment and the clinical team can see their medical record in its entirety, wherever and whenever they need to.
At Cambridge University hospitals NHS foundation trust, that is what we set out to achieve when, seven years ago, we decided to invest in a sustainable digital future for our hospitals. Rather than relying on paper-based processes and simply replacing outdated technology as it became obsolete, we wanted to transform the way we care for our patients.
In 2013 we began a 10-year eHospital digital programme, to create a fully integrated electronic patient record (EPR) system, andset in motion a modernisation of our networking and computing infrastructure. More than 100 colleagues from various clinical areas were seconded to the eHospital team, so our EPR was built by our staff, for our staff.
In October 2014 our EPR went live across both hospitals in our trust: Addenbrooke’s and the Rosie. It spans all clinical areas – both inpatient and outpatient – including A&E, critical care, clinics, wards, surgery, pharmacy, laboratory and radiology services.
It was a big undertaking. More than 175,000 hours of training were delivered to about 12,000 staff in nine weeks as we prepared to make the system live. Around 5,500 old computers were replaced with 6,750 new ones, and we connected another 500 laptops, 395 workstations on wheels and 420 handheld devices, such as iPods with barcode wristband scanners. We also installed 1,350 wifi access points across all clinical areas.
For some of our staff the transition from paper to digital was not simple, even though they had access to the same information as before, just presented in a different way. Having “super users” – hospital staff who volunteered to have extra training so they could help others – proved invaluable.
The EPR has 3,200 concurrent users and every single one looks at the most up-to-date version of patient records
Today our EPR is vital to better patient care. It has helped us improve quality and safety, reduce duplication and eliminate unnecessary delays. Inpatients do not have to stay in hospital for longer than necessary as the time taken to prepare discharge medications has halved. Every inpatient has a barcoded wristband, which links directly to the EPR, and allergy-related prescribing alerts in the system have reduced adverse medication reactions, saving around 2,500 inpatient bed days per year.
Outpatients now only come in to hospital if it’s necessary as clinicians can review their patients’ notes and x-rays virtually. In orthopaedics this has freed up 4,500 appointments a year. Patients attending the surgical pre-assessment clinic complete their initial documentation on tablets, meaning this department now sees approximately 20% more patients than before.
Integrated handheld and mobile devices enable clinicians to document information in the EPR in real time at a patient’s bedside. This has released the equivalent of 120 nursing posts, allowing staff to spend more quality time with patients.
We typically have 3,200 concurrent users of the EPR at peak times and every single person is looking at the most up-to-date version of their patient’s record. Overall, we have reduced the use of paper records by 99%.
Moving forward, we are introducing a patient portal, MyChart, which will give patients secure access to parts of their medical record, so they can be more in control of their health information. The future of electronic healthcare is coming with the forthcoming launch of Care Everywhere and EpicCare Link, which will allow us to share key patient information electronically with other hospitals and primary care services.
As one of the UK’s highest rated trusts for the effective use of technology in providing high-quality patient care, not only will we continue to focus on using technology to deliver further improvements for our patients, but also as a global digital exemplar hospital we are committed to sharing our learning with others and helping the NHS embrace its digital future.
Dr Afzal Chaudhry, chief medical information officer at Cambridge University hospitals NHS foundation trust, will be speaking at eHealth Week on 3-4 May. The Guardian Healthcare Professionals Network is media partner for the event.
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How a digital NHS saves time and money – and transforms care | Afzal Chaudhry
