Medical records

Innovation through partnerships: the Addenbrooke’s eMR story

ICT professionals working in the NHS in England constantly
face a wide range of challenges that can be summarised by the following:

1. how do we obtain as much functionality as we can from existing systems?;
2. how do we manage the expectations of clinical staff who know that the technology is out there — so why can’t they use it?; and
3. how do we continue to be innovative, alongside the timetable requirements of the National Programme for IT?

At Addenbrookes Hospital, our organisational approach to this has been to develop partnerships with small companies that are willing and flexible enough to listen and understand exactly what is required to deliver clinical information at the point of care. This inherent flexibility on the part of suppliers like OITUK, allows a development process in which clinicians, administrative and other hospital staff have an opportunity to contribute their views on what they require from an IT system.

Working with OITUK as our primary partner, which in turn worked with other organisations to produce multiple partnerships, has helped Addenbrookes to continue to be a leader in clinical and ICT initiatives. The partnership has won two international awards for its achievements.

eMR together with its inhouse-developed repository enabled patient care to continue uninterrupted during the seven days of server downtime resulting from the fire at Buncefield Oil Depot in December 2005.

OITUK and Addenbrookes developed a system that was constructed to answer all three questions posed at the beginning of this article. The system we developed, called eMR, was designed to correlate all critical patient-record information in a central repository which, far from being a legacy records management system, made the management of a patients record a live process.

Using electronic document management (EDM) as the underlying technology with a web interface, accessed from the Trusts intranet, users have access to a wealth of information, all of which is patient centred, creating a unique electronic medical record (eMR). The initial focus was to create a facility whereby users could generate patient-related correspondence from department-specific templates, eliminating the requirement for multiple duplication of data and at the same time ensuring quality of the core data being retrieved from a primary source. eMR has all the essentials for robust records management eg, full automatic indexing, version control and a full audit trail.

A screenshot from eMR

What makes the system different is the way it incorporates information and documents from other key data sources.

Users can:

• view crucial medical alerts on entry;
• view relevant patient information direct from the Hospitals patient administration system;
• view scanned images of archived medical records;
• create documents from over 3,000 templates;
• create a summary of information from a telephone call; and
• store documents by specialty, by document type or by date, which facilitates quick and easy searching for specific documents.

Documents can also be imported into eMR from legacy standalone systems and diagnostic systems, as well as from newer clinical information systems. This approach collates the document output from these other systems and, by bringing together key clinical information, allows the Trust to work more efficiently by avoiding the need for copious amounts of local system administration or training. An excellent example of combining technologies has been provided for the renal transplant team. Transplant co-ordinators using Blackberrys can access their own database of current patient demographic and clinical information with the latest diagnostic information held in eMR, which enables them to make important decisions about organ recipients based on up-to-date information.

Integrated within eMR is full electronic discharge summary letter production. This was developed in partnership with Beacon Computer Technology and has a wealth of functionality that allows information to be entered closely following a patients journey from admission through to discharge. The system, developed in close co-operation with clinicians and pharmacists, allows the smooth handover of information from secondary to primary care: the majority of the 800 summaries produced each week are sent electronically to the referring GP practices within minutes of discharge.

The latest addition to eMR has been notification of pathology and radiology results. Although the Trust had had full results reporting for 12 years, it was a passive system that relied on the requester to look up the results. With the assistance of a company called Medifusion, users now receive email alerts that results are available.

The facility is driven by business rules that monitor results as they become available, filtering on specific pieces of text, which generate emails and alerts for unexpected results. A result requires confirmation that it has been read. Specific alerts requiring an action to be recorded against them make use of traffic light indicators for high visibility, each alert being tracked and escalated as appropriate, with full audit trail information. Plans are being made to use this facility to generate email alerts when at risk patients are admitted eg, patients with MRSA or with a history of taking a particular drug, such as methotrexate.

Countless numbers of visitors from other organisations have come to see the system in use, and have expressed admiration for what we have achieved in a relatively short time. The system has many benefits but, for me, the most significant has to be the level of clinical engagement this initiative has encouraged. In the words of a senior clinician: At long last IT are delivering systems that give us the information and evidence on which to base clinical decisions.
Clinicians are actively encouraged to suggest ways in which the eMR could be further developed.

The majority of the 42 different types of documents are being imported into the record from departmental-specific clinical systems and databases that have a document output, following a request for inclusion. Making information available in this way means that users who need to know have access to information from electronic systems that previously would have required training and specific user rights to access. eMR is a secure, highly intuitive alternative to paper records.

The Trusts legacy hospital information system developed originally by McDonnell Douglas (MDIS) before being acquired by Northgate-IS and more recently by iSOFT was a victim of the Buncefield fire in December 2005, in which both the primary and secondary servers were destroyed. eMR has over 3,000 registered users from 74 departments creating documents from over 3,000 templates, making more than 2.5m documents available, as well as the huge archive of scanned medical records and diagnostic results, from any of the Trusts 4,500 PCs.

What makes Addenbrookes eMR unique is that it is not simply an EDM system that scans paper and makes images available: it captures documents at the point of creation making the information immediately available. This, together with bringing data together from numerous standalone IT systems, clinical engagement and an aspiration to use new and emerging information technologies to support efficient patient care, makes it unique.

It also demonstrates a successful partnership between the NHS and commercial-sector suppliers in delivering a viable and successful solution, which continues to act as a shining example of best practice in how both sectors can work together to make a real difference to patient care.

Dianne Nixon, IT Programme Manager, Addenbrookes Hospital, Cambridgeshire University Hospitals NHS Foundation Trust.

More information about these partnerships may be found at:

• www.oituk.com;
• www.beacon-ct.co.uk;
• www.medifusion.co.uk;and at
• www.imprivata.com