The Clatterbridge Cancer Centre NHS Foundation Trust is striving to become one of the world’s leading cancer treatment centres, Thomas Poulter, head of IM&T says this ambition can only be achieved with the right technology in place.
Many patients would be surprised to know the lengths that our staff go to in order to look after and provide their medical records at the point of care. If we showed them the image below and told them that this is where their case notes are securely stored before the lengthy process of allocating them and transporting them to the correct healthcare professional begins, they simply wouldn’t believe it.
In many ways, ensuring our clinicians have the correct information on each patient readily available is even more important for our patients; we deal with hundreds of people everyday whose lives have been turned upside down by cancer.
For many of those people, it would be distressing to have to repeat information about diagnosis or treatment. In addition, they are often extremely nervous about what to expect, so every second they are kept waiting can seem like hours. This is why our journey to becoming paperless is mission critical.
From suitcases to ‘single front door’
Our aim is to embed fully electronic systems and processes into clinical practice before the doors of our new world-class cancer treatment centre in Liverpool City Centre open in 2018. This seems a long way off but there is a lot to do and the strategy is made up of several different projects, with the vision remaining the same for each; enhance clinical safety, efficiency and improve access to information.
The system from IMS MAXIMS that we have in place has set us some way on our journey by providing the single front door to all electronic patient information, including the flexibility to act as a type of portal to provide access to third party applications.
For example, staff can access various systems such as the patient administration system and the ePrescribing system, which is specifically designed for complex chemotherapy treatment regimes, through the EPR solution. This single entry approach simplifies the process for the end user and makes the system more intuitive to our clinicians and nurses who simply don’t have the time to log into numerous different systems and hunt for information.
Digitising our existing records
Alongside the development of our EPR we have a programme of work to digitise the existing 20,000 active paper-based patient records. As a cancer centre we do not tend to discharge patients, instead they have varying review cycles. This means that the number of records that we hold is constantly growing, probably more so than in most other NHS organisations. We are using a scan on demand process where we digitise clinics in phases based on consultants, who are then provided with an iPad and a series of applications to simplify access.
New patients are automatically generated an electronic case file within the case system and all clinical correspondence which is generated using MAXIMS Web system is automatically filed. With almost 8,000 new registrations per annum, it is not an easy task but eventually it will mean that we will be able to deal with more patients using the same resource.
Another big project for us is digital dictation; within the next 12 months we expect to use a system in conjunction with MAXIMS that enables all content to be dictated in the future using BlackBerry devices. This is part of our vision to provide appropriate access at the point of need – no matter where that is.
Mobile technology and forward thinking
We’re also using mobile technology in what we believe is a first of a kind initiative to pilot a mobile chemotherapy service. We have a chemotherapy treatment van, which is parked in a supermarket car park and uses satellite equipment on the roof to connect to the EPR system wirelessly. This means that patients can have their chemotherapy nearer to home, reducing travel times and visits to hospital. Friends and family can even pop in and get their shopping while they wait!
We’re also using 3G through ‘vanilla sim cards,’ which enable staff to safely and securely roam the available network providers in the area so that they can access the information securely at anytime even including in a community setting.
Another strand of our strategy is to put infrastructure and partnership relationships in place to facilitate electronic data transfer with other NHS organisations so that we can receive electronic referrals and e-discharge info, e-clinical correspondence to patients and GPs that allow us to make oncology summary records available to clinicians working outside of oncology. This includes providing this information to A&E departments across the cancer network, so that if patients become unwell during or following their cancer treatment or if they are admitted to hospital, their oncologist is notified of that at the earliest opportunity so that they can intervene as appropriate.
Paperless by 2018?
In some ways it felt like Jeremy Hunt had listened to our own vision and timelines when he announced his ambition for a paperless NHS by 2018.
However, one of our biggest issues in becoming paperless is our dependency on the other partner organisations that we work with, as all of our patients are referred through to us from district general hospitals and acute teaching hospitals. Unless those hospitals are also becoming paperless, we will continue to have to scan lots of paperwork from other trusts into our system or perhaps get to a point where we use devices that scan ad-hoc pieces of paper.
In order to get to where we are and for healthcare professionals to understand our future direction, we have placed a really heavy emphasis on clinical engagement, which has been crucial to ensuring the success and usability of our systems. We have learned that you have to find clinicians that recognise the systems not only have the potential to improve their working lives but can be more efficient and improve outcomes for our patients. We have a growing group of consultants within our medical staff that recognise this and several who are willing to contribute their time and clinical expertise to help with IT system development projects.
One of the things we look for when choosing a supplier is someone who can work with us as a partner and help demonstrate the benefits that IT will achieve. Finding the right one is never an easy task but as a small NHS specialist hospital we need suppliers who have a compatible culture that can customise their solutions to the specialist work that we do and also demonstrate a roadmap for the future. The way we work is really a hybrid where we are able to develop some of the system in-house while at the same time working with a supplier that removes some of the risk associated with doing that.
The NHS has traditionally been ineffective at measuring IT benefits for staff, patients and the organisation as a whole. Whilst our business cases show that our systems should pay for themselves in the long term, putting real metrics in place is something that the NHS generally needs to get better at in order to demonstrate the true value of technology.
What we can say is that the electronic systems we have in place are enabling us to deal with the large increase in activity levels we are seeing across the organisation more effectively with the same, if not less resource, which in itself is a huge achievement.