BY A N D R E W S TA P L E S

ADDENBROOKES & ROSIE EHOSPITAL GO-LIVE & BENEFITS REALISATION

INTRODUCTION

• Background• Go-live • Workflow consideration• The future• Summary

What is eHospital?10yr+, £200m, programme to deliver high quality care underpinned by modern informatics tools

CUH - 2010• Multitude of clinical IT systems• Limited functionality, accessibility• Inflexible & poor integration – technical limitations• Decades old – impending permanent loss of support• No results reporting audit trail• No decision support

Background (I)

Background (II)

• Full tender process, weighted to clinical quality• Extensive clinician involvement and feedback• Epic selected

> 150 million US patients 40% of US academic centres

• External board assurance

Workflow validation• 1,000+ clinicians validated modules• 100+ clinician builders (doctors, nurses & pharmacists) seconded for

18 months

Training• > 95% of staff trained (10,000 + people)• > 175,000 hours of training over 9 weeks

Preparation (I)

Preparation (II)

• 120, 90, 60 & 30-day pre go-live eHospital assessments• Parallel divisional operational assessments

• Specialty-level risk assessments• Dress-rehearsals including inter-departmental high-risk pathways• Increased focus on high-risk prescribing and WHO checklist at go-live

• Go-live final decision made by full executive

• Run akin to ‘Internal major incident’

• 150 people on-site command centre, 24/7 for 6 weeks• > 100 WTE CUH analysts, > 250 Epic staff, >50 HP staff• > 22,000 ‘tickets’ in 5 weeks

• 4 weeks of CUH / Epic ‘at-elbow’ floor-walkers

• Regular communication with CQC, CCG, GPs, Monitor, HM Coroner, governors and local MPs

• External assurance review in early December 2014

Go-live (I)

• Daily executive meetings to review safety and take action• Daily senior nursing ‘huddles’ to assess clinical safety

• Categorisation of ‘tickets’ to identify potential or actual safety issues for action

• Tip sheets and alerts developed

• Existing paper notes available until October 2015• Access to historic data (letters & results) through ‘LARDR’

Clinical safety at Go-live (II)

EPIC HAPPINESS CURVE

Stabilisation & Optimisation work streams• Inpatients & discharges• Emergency department• Medication• Outpatient administration & clinical• Hardware

Ongoing Governance• Executive-led weekly assurance board, including CCG, Union

representation• External review by Stanford Hospital, CA, USA, HIMSS

Post Go-live

• Pathology & transfusion• Pathways• Training & education

People• 50 additional substantive posts – analysts, trainers• CMIO appointed and developing further divisional / specialty

engagement• CIO being recruited

Processes• eHospital Operational Board meeting monthly• Complete integration with Transformation programme• Increased training resource, supported in division

Supporting the organisation

BUILDING AND IMPROVING

• Optimisation working groups• Focus on key trust priorities / patient safety initiatives

• Help desk & system support• Staff raising issues that are critical problems to resolve

• Planned system updates• Planned SU programme to receive developments from EPIC to improve

workflows / functionality

• Maintenance programme• Preforming maintenance tasks e.g. FDB Multilex data load

INTEGRATION OF PRESCRIBING AND PHARMACY (1)

• Unique feature of the CUHFT install compared to the rest of the UK • The dispensary systems are fully integrated with ePrescribing• Benefits

• Workflow efficacy• No transcription phases, no unnecessary manipulation

• Accuracy • Audit trail • Research

INTEGRATION OF PRESCRIBING AND PHARMACY (2)

• Challenges of integration• Configuration • Dispensary inventory Vs. what is ordered• Workflow sequencing

• Challenges• What if the item is not a stocked item / what if the item is not the exact

product you want to dispense• What if you want to manipulate your label

EXAMPLES (2)

• Aseptic workflow (cytotoxics)• Regimen eprescribed within EPIC• Chemotherapy including intelligent selection of preparation based on

order can occur, generate an appropriate worksheet.

• Challenge• “release” of orders

• Beacon will not allow the order to release ahead of time

THE FUTURE

• Improve our response time and capacity for adapting the system to different clinical needs• Bring online workflows that sit outside of EPIC and introduce

new functions• MyChart, External PO

• Work with EPIC to implement large system updates to improve functionality for CUHFT staff

SUMMARY

• In 18 months CUHFT implemented two trust wide streams• A hardware stream updating the trust physical structure• A software stream implementing a single solution across all areas of the

trust• We successfully utilised a rapid roll out implementation• All areas within CUHFT are live in EPIC

• The only hospital in the UK to achieve a HIMSS level 6 within 12 months of go-live date.

• Maintaining and improving the system based on clinical feedback and targeted improvements.