What is Smartcare?
Smartcare is a change programme that will utilise technology to enable significant changes and improvements to the way we work, making our services fit for the future. ///
Initiated in 2012 as a collaboration between three NHS Trusts (Northern Devon Healthcare NHS Trust, Gloucestershire Hospitals NHS Foundation Trust and Yeovil District Hospital NHS Trust) the programme has progressed through a number of key milestones. After a rigorous procurement process the organisations selected InterSystems TrakCare as the EHR system to be implemented across all three Trusts. We are planning to implements phase 1 of TrakCare in 2017.
The Smartcare programme oversees the implementation of a number of projects that are all working towards the improvements in clinical care as expressed by the EHR Vision. This includes digital dictation and voice recognition, digital observations management, upgrading our IT infrastructure (e.g. Wi-Fi, devices, computers etc), improving IT service management and aligning the recruitment process to the needs of the EHR. A key focus of the programme is working with staff to change the way we work to make the transition as smooth as possible and once new systems are in place ensuring that we reap the benefits of the EHR.
What is an electronic health record?
In general terms, an electronic health record is an electronic version of a patient’s care and medical record. However, an integrated EHR provides us with additional functionality that can radically change and improve the way we work to benefit patient care. The EHR is a real-time system that constantly updates, allowing instant access to patient records and history from all departments and areas such as radiology and pharmacy, as well as some access to records held by other care providers such as GPs, community teams and social care.
The electronic health record for our hospital inpatient and outpatient services is a web-based platform called TrakCare. This means that it can be used across multiple locations, on multiple devices, by multiple users at the same time, including several health care professionals accessing the same record simultaneously. The system allows you to see information from a number of different views including viewing information from a ward or as a specific role such as a healthcare assistant, nurse or consultant and filters the information required for different tasks to make it as simple as possible to fulfil tasks and view the required information. The system uses colour coding to quickly be able to see categories, auto-population of codes from pre-selected clinical coding tables (including national and local codes) and ‘click and drag’ usability for instance to be able to the quickly transfer a patient from one clinical area to another.
Our community services have selected RiO as the EHR which will support their services. RiO will at some stage be fully integrated with TrakCare, and although the systems will look different to use, healthcare professionals will be able to share information between the two. Similarly both systems will be able to interface with existing systems used by other care providers including provider trusts, primary care, GPs and social care.
Why is Smartcare a priority for the Trust?
We all know that the NHS cannot continue to operate in its current form, against a backdrop of increased demand through an ageing population and increasingly complex health needs. While there are significant issues to be worked through at a national level in terms of our health policy, political ideologies, challenges and priorities for our health services over the coming years, we must act now in order to provide a sustainable service of the highest quality that we all, as patients, expect from our national health service.
The Government recognises the challenges faced by local NHS providers as well as the benefits that using technology can bring. Introducing electronic health records across all Trusts in England means that we have to change the way we work for the better. We have to review and streamline processes, be more efficient in the way we work and reduce risk in our services. The benefits we will see for our patients, within our teams and within our future services mean that this is an absolute ‘must-do’ for the Trust.
The national vision for the NHS is to be paperless by 2018. We are already working towards this and the EHR will ensure we get there. Although centred around the implementation of an EHR, the Smartcare programme is rigorously driving a number of changes across the organisation, including our recruitment process, IT infrastructure and training. All these changes will make sure that we work in the most efficient environment possible for the best outcomes for patients.
How will this improve patient care?
There will be a number of significant benefits to patient care. Some of these are set out in our vision and some won’t be realised until the system has been implemented and is in use. Broadly we envisage care being more consistent through having readily accessible, up to date information enabling us to make more informed, holistic decisions about a person’s care. We will operate a safer, risk-reduced service to patients. For example allergy information will be regularly available so we won’t prescribe something which we know a person will have a reaction to, for example penicillin. We will be using and analysing the data captured through the EHR to assure ourselves and our patients that the care they are receiving is of the high quality we expect, and highlight where improvements could be made. In the future we would like to develop patient portals where patients can view their health records and be more involved in decisions about their care.
How will this benefit staff?
Similarly there will be significant benefits to staff as individuals and to teams and departments, not all of which we will know until further down the line. We will record clinical and care information efficiently and consistently meaning that other clinicians always know where to find information and we are assured it is up-to-date and accurate. Multiple users will be able to simultaneously access the same record. We will build and maintain an IT infrastructure that allows easy, consistent access to all clinical application systems. We will invest in IT devices that are appropriate for your role and environment, supporting you more effectively in your work, to give you the time to focus on patient care.
Will this change how we work with partner organisations?
This will open up a lot of opportunities for how we work with partner organisations including other delivery partners, providers trusts, primary care, social care and GPs. The communication between organisations should become seamless and the EHR systems will have the ability to share information between them meaning we can access vital information about patient input by another health professional involved in their care. We would also like to work towards a patient portal when patients can view their health records and become more involved in decisions about their care.
When will the changes start happening?
Work has been ongoing over the last two years to secure funding, select a supplier and plan for the implementation phase. InterSystems, the supplier of the TrakCare system are now onsite and working with the programme team to start designing and configuring the system for our needs. In 2017 the system will switch over from the current patient administration system (PAS) to TrakCare and utilise A&E and maternity functions. Following this in phase to we will be working towards using the additional functionalities across all our hospital inpatient and outpatient services including order communications, e-prescribing, theatres and oncology and the development of the electronic health record. Although the first phase is due to go live in 2017, it is important to remember this is only the start of the journey, and we will see the changes and the benefits for years to come.
Where will we be in 5 years?
In five years’ time we will look back and wonder how we ever managed with paper files and their inability to provide us either with the useful information that we need to manage an individual patient or to provide us with meaningful real-time data about our patients, our management of specific conditions and the performance of our Trust.