Taunton and Somerset NHS Foundation Trust (TSFT) achieved a significant milestone when it deployed the UK’s first open source electronic patient record (EPR) from IMS MAXIMS.
This landmark move was part of the reason TSFT was named one of 12 NHS Global Digital Exemplars. They will receive up to £10 million to pioneer digital excellence, share best practice and fast track its plans to help staff achieve higher efficiencies, enable better organisational workflows and deliver better patient care.
As the largest acute hospital in Somerset, the trust’s 4,000 staff serves a population of over 340,000, managing around 700 beds, 30 wards and 15 operating theatres. TSFT wanted to replace its legacy patient administration system (PAS) that was implemented as part of the National Programme for IT. The trust used the opportunity to look at new ways of delivering an EPR and to procure a system that underpinned their ambitions for transformational change in delivering care, whilst reducing costs and having more control over the development of the software.
TSFT decided to use openMAXIMS, the open source version of the IMS MAXIMS EPR, a more flexible, cost effective option that provides the trust with more local control compared to a proprietary solution. The trust also recognised the future benefit to the NHS overall, from being able to develop, then share changes or improvements to the software with other NHS trusts, in turn taking advantage of economies of scale.
NHS trusts can access £45m worth of software development with no licence fees. The open source software has been developed in close collaboration with clinicians over the company’s 30-year history, resulting in a proven, safe and flexible clinical information sharing solution.
Eight million records were migrated into the new EPR and only seven needed to be manually loaded, with minimal disruption to service delivery.
Due to the innovative nature of the project, NHS England became interested in the work and was incredibly supportive endorsing the trust’s approach as a sensible and rationale one. NHS England’s involvement also gave non-IT personnel at the trust added confidence it was the correct strategy to deliver long-term benefits. Richard Jefferson, Head of Programme Commissioning at NHS England, said the project “represents a landmark moment in the use of open software in the NHS and validates the idea that open source can play a significant role alongside proprietary offerings.”
Greater clinical engagement
One of the main success factors in the project was the partnership forged between IMS MAXIMS and TSFT. Previously, the trust struggled with clinical buy-in to IT systems but the collaborative approach, coupled with positioning the changes as system transformation, rather than an IT project, ensured unprecedented levels of clinical ownership and adoption.
One of the largest events in the support and training process was an open day, which involved clinical staff demonstrating the new EPR to 500 other staff. The TSFT EPR team, building the system alongside IMS MAXIMS, also explained how they were going to create it, right down to the configuration of the drop down menus to meet the exact workflow needs of each clinical team. This has led to significant usability benefits such as fewer clicks being required to perform certain tasks, compared to the previous system.
Once the 2,500 staff had been trained, the trust was able to use a full replica of the software on the intranet and work through different scenarios. All of these factors meant that nearly every member of staff had seen the software before it went live, resulting in faster and better adoption.
Safer, more effective patient care
Improving the patient experience was also an important driver for the project. With the new EPR the trust has been able to make processes for admission, transfer and discharge of patients more efficient and coordinated with the
help of real-time bed management and discharge planning.
The first phase has also led to some new outpatients activity become electronic, such as real-time outcoming of patients instead of completing forms. Clinicians are triaging letters online rather than printing them out and also making decisions online for each referral.
Financial savings and paperless
Due to the nature of the software and approach to deployment, the cost of moving to openMAXIMS will pay for itself within three years. The EPR will also save the trust £600,000 a year by 2018 and has ensured TSFT is on course to achieve the paperless agenda set by government. The £10 million Global Digital Exemplar funding over the next two years will accelerate the delivery of its technology roadmap including paperless nursing, e-prescribing, clinical decision support, medicines management and integration with GP systems.