ict16-109 nrh epr business case - ehealth ireland...safety, with relatively modest investment, and...
TRANSCRIPT
CONFIDENTIAL June 2016
EPR Business Case
Electronic Patient Record Business Case
Page: 2
Contents
Executive Summary ..................................................................................................................................... 3
High-level Financial Benefits ....................................................................................................................... 7
Document Purpose & Structure ................................................................................................................. 8
Introduction ................................................................................................................................................ 9
ICT Solution Overview ................................................................................................................................. 9
The Operational Case ................................................................................................................................ 11
The Strategic Case ..................................................................................................................................... 15
Solution Overview ..................................................................................................................................... 17
ProposedHigh-levelFunctionality....................................................................................................18
Benefits Overview ..................................................................................................................................... 18
AnticipatedFinancialBenefits..........................................................................................................18
BenefitsDetail..................................................................................................................................19
Programme Governance ........................................................................................................................... 23
Implementation Timeline ......................................................................................................................... 24
Risk Management ..................................................................................................................................... 24
Key Assumptions / Qualifications ............................................................................................................. 27
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Executive Summary
The migration to EPR is a pillar of HSE vision and strategy. It is also at the heart of delivering
functionality which could support the National Clinical Programme for Rehabilitation Medicine and
Neuro-Rehabilitation Strategy at local, regional and national levels. With a move to a new hospital
building in 2019 resulting in a much greater geographical
footprint the functionality provided by an EPR is seen as
essential. Furthermore, it is central to the NRH mission
and strategy to optimise use of its scarce resources to
enable provision of the best possible quality, safe and risk
adverse patient care.
This business case proposes the early deployment of both a Patient Administrat ion
System (PAS) and Electronic Patient Record (EPR) in the NRH. Ideal ly both sets of
functional ity wi l l be avai lable as one t ightly integrated appl icat ion suite.
Note: the terms PAS and EPR wil l be referred to as EPR within this business case.
The case illustrates why the NRH is uniquely placed to help the HSE to advance its EPR objectives in
common with those of the eHealth Ireland Electronic Health Record (HER) strategy; and
simultaneously help the NRH to protect and maintain its quality of patient care.
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Why the NRH is uniquely and best placed for an EPR?
National Showcase
The nature and scale of the NRH, make it an ideal flagship location in which
to prove and learn about the impacts of EPR on a medium sized hospital, the
challenges involved and best strategies for deployment.
Low Risk The NRH provides an environment in which this can be achieved in relative
safety, with relatively modest investment, and with a high degree of
confidence.
Informed Investment
Strategy
In view of the opening new hospital in Q1 2019, timing is of the essence for
the NRH. As a result, the HSE will benefit from an early result and feedback
which will help inform and protect future HSE supported EPR investments
Proven Change
Leadership
Delivery of the EPR is complex in its own right, but it is only half the story.
The ability to successfully manage the ‘people’ elements of the EPR change
programme is critical to enabling the widespread process and behavioural
changes required, and to generate the benefits. The NRH has proven ability
to successfully lead and deliver such major transformational change.
Management Commitment
This proposal has the full commitment of the Board, Executive, Clinical,
Programme, Nursing and Allied Health Professional teams to make it happen.
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EPR is key to achieving
HSE, national and NRH
strategies
The reliance on outdated paper based patient files is an impediment to the
successful achievement of the HSE, Rehabilitation Medicine Programme,
Neuro-Rehabilitation and NRH strategies – all of which seek to optimise use
of its scarce resources to enable provision of the best possible quality of
patient care, where it is need, when it is needed, and in a manner which is
truly patient centric.
EPR addresses
exist ing r isks and
ineff ic iencies
The following three NRH specific examples illustrate how an EPR will directly
address existing inefficiency and risk whilst simultaneously improving patient
care:
• Rehabilitation is unique within healthcare to the extent to which patients are
mobile with patients on average travel l ing upwards of 2km
between treatments within the NRH today. This requires the patient
record to follow the patient and be available at the ‘point of care’, and to be
secure at all times – this is labour intensive, inefficient, and in practice,
impossible to achieve with paper files, and whilst fully respecting protocols.
Different medical specialists and therapists also require access to the
patients’ records simultaneously which is not possible. This creates the risk
of incorrect decisions being made on incomplete information. It may also
result in delayed discharge due to the patient records not being updated
appropriately.
• The NRH is fundamentally a ‘therapy’ hospital however, the schedul ing of
patient therapy and the production of patient t imetables is
manual and as a result complex, cumbersome and inefficient. The process,
by necessity conducted by clinicians, therapists and administration staff, falls
well short of being patient-centric.
• Patient files must currently be copied and the physical copies must travel off-
campus with authorised staff for liaison services and pre-admissions - with
inherent data protection and data pollution risks (confusion between master
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and copy records).
EPR is essentia l to
the New Hospital
The new Hospital will require medical, clinical, therapy and administrative
operations to be spread over yet further, more physically dispersed locations
throughout the hospital campus (with up to 410 metres between
buildings/locations). To compound this issue, the development of the new
hospital is being phased over two and possibly three phases, so staff will
have to operate from two separate accommodation blocks making the
management of charts that more difficult. One of the fundamental
responsibilities of the NRH as an internationally accredited rehabilitation
facility is to affect positive change in functional ability and independence and
self-reliance across environments, while protecting and promoting the rights
of patients. The new hospital design creates an environment specifically to
facilitate rehabilitation and its related service processes, delivered by an
integrated team which includes the patients. The intent behind designing the
integrated therapeutic and social areas in the new building is to create
flexible multifunctional space to support an interdisciplinary team approach
to programme delivery rather than a multidisciplinary team approach. The
adoption of an EPR will support and enhance this model of working, creating
opportunities for effective team working and communication which in turn
enhances the quality and efficiency of the service being provided by the NRH
to our patients and other stakeholders.
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High- level F inancial Benefits
The EPR will enable HSE, national and hospital strategies, all of which are singularly aimed at utilising
all available resources to provide best possible patient care.
The NRH Board and Executive commend this proposal.
Non-financial Benefits
Clinical and Patient Benefits
• more time for direct patient care
• access to clinical information at the point of care
• input to the patient record at the point of care and in real time
• improved patient safety and richer patient experiences
• significant clinical and patient benefits with better quality outcomes
• improved clinical governance through an integrated health record and more timely and
accurate decision making
• more complete and accurate generic patient data for medical research purposes.
Management & Staff Benefits
• accurate and timely management information (MIS) for NRH management
• better intrinsic rewards for staff through a richer, more interesting, workplace with less
routine tasks
• less duplication of data and improved management information across NRH.
HSE Benefits
• better quality MIS reporting from NRH to HSE
• the programme will support the HSE’s Better Safer Health Initiative
• EPR can benefit HSE National Rehabilitation Medicine Programme as it could be rolled out to
the regional and community based rehabilitation centres in due course. In effect we would
have a single integrated approach to rehabilitation services nationally.
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Document Purpose & Structure
This Business Case document sets out the scope of the NRH EPR Programme along with the expected
cost, outcomes, and how programme will be managed.
The document is structured as follows:
Introduction & Strategic
Case
Demonstrates how the NRH EPR Programme is wholly aligned to NRH and
HSE vision and strategy, and critically, why the introduction of an EPR is an
desirable prerequisite to the opening of the new Hospital in 2019.
ICT Solut ion Overview
Demonstrates why an EPR solution is required, the scope of the solution
and how it will be delivered.
Benefits Case Demonstrates the high-level benefits, and how these benefits will be
managed and realised.
F inancial Case Demonstrates the overall investment case.
Management Case
Demonstrates how the overall change programme will be governed and
managed throughout its lifecycle.
Key Assumptions
Highlights the assumptions on which the proposal is based.
R isk Management
Main risks and mitigants
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Introduction
The National Rehabilitation Hospital, NRH, is a CARF1 accredited voluntary teaching hospital in Dun
Laoghaire, Co. Dublin. The hospital currently has 110 in-patient beds and an active outpatients
department (OPD). Each year the hospital treats 620 in-patients and carries out over 13,000 out-
patients sessions with a complement of approximately 450 FTE staff. In line with international best
practice in-patient average lengths of stays (AVLOS) have reduced from 79 days (2008) to 71 days
(2013) as patients receive rehabilitation therapies to help their recovery from severe neurological
injuries, (brain or spinal cord) or limb absence injuries. The hospital has an excellent reputation and is
the national centre of excellence for rehabilitation services.
In developing this business case we consulted widely with NRH clinicians, program managers and
patient administration system (PAS) users. We also linked in with the HSE National Clinical
Programme for Rehabilitation Medicine to ensure that the proposed NRH transformation programme
conformed with best practice and that the transformation programme would be relevant not only for
NRH itself but could also be rolled out to the proposed regional and community based rehabilitation
centres in due course. We also reviewed HSE’s strategy to ensure this business case was
appropriately aligned with HSE’s overall direction specifically the eHealth Ireland Strategic
Programme.
ICT Solut ion Overview
NRH is a major user of a legacy patient administration system (PAS) which is used extensively in HSE
hospitals across the country. The proposal envisages the deployment of a single instance, single
individual patient record EPR to support the delivery of Rehabilitation within the NRH within the
context of an increased more complex footprint, as a result of the New Hospital build, and a move
away from traditional nightingale ward to single patient rooms. Care within the inpatient
rehabilitation environment is delivered campus wide and not, in the main, delivered at the bed side as
would be the case in acute hospitals. Since the NRH is a tertiary care provider, first contact is made
with patients within the acute sector where NRH consultants and pre-admission coordinators provide
1CARFisanindependentnon-profitorganisationthatprovidesinternationalaccreditationtoprovidersthatdeliverrehabilitationservicestothecommunity.Detailsareatwww.carf.org
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clinical input while referring patients back to the NRH. The solution should provide functionality to
support the capture of pre-admission data by NRH staff. Pre-admission data is vital to ensure that
levels of complexity can be identified so that patients can be admitted to a set number of beds
available for each complexity level as well as managing equity of access.
Managing the inpatient phase of care is very different in the rehabilitation setting with patients
attending numerous therapy sessions on a daily basis. As a result, access to the patient record at the
point of care is not always possible. In addition significant clinical and therapy resources are used in
creating and managing patient diaries. Access to scheduling functionality would result in significant
time savings and a better use of scares clinical and therapeutic resources. Likewise access at the point
of care to an electronic form of the patient record would result in better safer and more efficient
care.
In addition to inpatient care, the NRH operates significant outpatient and community (liaison) based
services. The Neuro-Rehabilitation Plan would see services deployed country wide and it is our plan to
support this network via the use of a single electronic patient record. Post discharge and unlike the
acute sector, both Spinal and Brain Injury patients are monitored for life. EPR functionality supporting
care across this continuum is therefore vital if the NRH is to manage risk, deliver safe and effective
care and ultimately prevent readmission to the acute service or directly to the NRH.
Core Functionality Requirement
Patient Master Index (PAS) Bed Management
Clinical and Therapy Noting Clinical Coding
Therapies Referral Management
Nursing Obs and Documentation eDischarge
Inpatient Management Management Information
Outpatient Management User Defined Assessments
Integrated Clinical Pathways External Communications (correspondence)
Standardised messaging (HL7) Lab Integration via Healthlink
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Single Instance Adoption of National Strategies
Note: I t should be noted that the NRH is seeking to deploy a standalone s ingle
instance EPR.
The Operational Case
The operational case for EPR is also already well accepted.
However, the following examples help to illustrate why the
NRH is unique in comparison to other hospitals, and
consequently there is a significant win-win type opportunity
to directly address existing inefficiencies and risks whilst
simultaneously improving patient care:
• Patient files must currently be copied and the physical copies must travel off-campus with
authorised staff for liaison services and pre-admissions - with inherent data protection and data
pollution risks could occur (confusion between master and copy records).
• The NRH is unique to the extent to which patients are mobile
(travel up to 2km per day) as they move between therapy
sessions. This requires the patient record to follow the patient
and be available at the ‘point of care’, and to be secure at all
times – this is labour intensive, inefficient, and in practice,
impossible to achieve with paper files, and whilst fully respecting
protocols. Different medical specialists, therapists and
administrative functions also require access to the patients’
records simultaneously which is not possible. This creates the risk of incorrect decisions being
made on incomplete information. It may also result in delayed discharge due to the patient
records not being updated appropriately.
• The NRH is an internationally accredited rehabilitation hospital and is critically aware of the need
for efficient management of resources and continuous improvement. A key requirement for the
EPR is inpatient therapy scheduling functionality. The provision of this functionality is a key
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enabler in supporting the NRH to free up both clinicians and therapists time from administrative
work to direct patient contact.
• A further differentiating feature is that the NRH manages the patient’s journey through the
services from the time they are referred and placed on our waiting list. This supports an
integrated care model, which is also a national clinical programme offering patient centred, co-
ordinated care. With appropriate access to an EPR, availability of the requisite patient
information would promote admission to the various points of the rehab continuum. As tertiary
provider/ specialist the NRH has the potential to integrate neuro-rehabilitation through this
continuum, in turn supporting the achievement of HSE and NRH goals and helping NRH offer the
highest quality of care.
• As a result of our central waiting list management system as an elective service, the NRH
manages all patients on that list from a central location with the centrally held paper record. In
order for multiple users i.e. consultants, liaison nurses, pre-admission coordinators to provide
clinical input, get updates, respond or advise local teams e.g. Kerry/ Waterford/ Cork/
Roscommon/ Letterkenny, they require access to the file at the point of contact. Routinely when
replying to requests NRH consultant cannot access the file and therefore ensure they are
working off the most up to date patient information. This is replicated across all the above
personnel and introduces unnecessary delays. The movement of charts can also result in charts
becoming mislaid or in some cases lost.
• In Q1 2019, the first phase of the new hospital development will
open. The New Hospital is being redeveloped in Phases due to
funding constraints. The brief for the first phase of the hospital is
to provide ward accommodation with integrated therapy spaces.
The new building will comprised of fit for purpose 120 single
rooms with ensuite facilities, programme specific integrated
therapy spaces on each ward, living and social spaces and ward
clinical and ancillary facilities. The brief for the second phase of
the hospital redevelopment will include all elements of the
hospital not included in the scope of phase 1. This environmental
separation of facilities poses significant logistical and communication challenges for the
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organisation. The delivery of an EPR will mitigate against many of the associated risks to patient
safety that are caused by delivery of care across different geographical locations. The NRH
evolution to a new modern healthcare facility will be a showcase for healthcare buildings in
Ireland and the wider International Healthcare Community. Consequently, increasing use of
technology for patient care and improving patient outcomes is central for successful project
delivery.
• This phase incorporates 120 private rooms in a new accommodation block adjacent to the old
main hospital. The temporary, but long-term, new layout (with up to 410 metres between
buildings/locations) will operate indefinitely, and until such times as the requisite funding and
permissions are secured and remaining works completed, which will consolidate hospital
operations bringing the medical, clinical, therapy and related administrative functions together.
In the absence of EPR, the hospital will struggle to maintain the quality of patient care, and it will
exacerbate the pressure on resourcing - which will already be stretched as hospital operations
transition to the new environment and at the same time are reshaped to deliver
programmatically rather than departmentally.
• The ability of a fully deployed EPR at the NRH will enable the hospital to manage waiting lists
better while transitioning patients through the care pathway more efficiently. These efficiencies
should see an increase in inpatient throughput and as a result will have a direct impact on acute
feeder hospitals.
• The ability of an EPR to fully and electronically document patient outcomes will enable the NRH
meets national guidelines for the production of discharge summaries. The NRH is keep to ensure
that relevant patient data and patient discharge summaries are available on discharge and can
quickly be made available to the patients GP and or Patient Support Services such as Acquired
Brain Injury Ireland, BRÍ, Headway, Ability Matters, Spinal Injuries Ireland, and the Irish
Wheelchair Association. It is essential that GP’s and agencies have relevant patient data to
support patients in their home and to prevent readmissions to either the acute sector or the
NRH.
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Some general examples:
Significant efficiencies and better decision making can be achieved with the implementation of an EPR
at the NRH as management, administrative and indeed clinical time spent reconciling data from
multiple, and in some cases paper based sources can be prevented. The NRH invests significant
overheads in the production and validation of business information for both internal and external
reporting agencies (e.g. HSE, ESRI, NTMA, etc.). An EPR would also support the production of ad-hoc
reports which in many cases currently require staff to pull charts and extract data manually.
PAS cannot deal with suspended beds (e.g. where inpatients are returned to an acute hospital for
treatment), inpatients temporarily returning home as part of their treatment or with inpatients who
attend NRH on a split week basis (e.g. Mondays, Wednesdays and Fridays).
Legislation requires that patient medical records be kept for many years and there are costs in storing
archived medical records on-site in secure locations. For example NRH delivers complex rehabilitation
services to people who have sustained catastrophic injuries due to road traffic accidents and medical
records are required for medical/legal purposes. Similarly there are administrative costs and
overheads incurred in managing these records and there is a risk of highly confidential documentation
being mislaid or misfiled in the process. We want to inhibit growth in archiving of paper records and
reduce costs managing same.
Insummary,theNRHhasanimmediateneedforanEPRtosupportachievementofHSE,National
andNRHstrategies.Itisalsokeytoaddressingexistingefficiencyandriskissues,andtofurtherits
objectiveofachievetruepatientcentriccare.Furthermore,intheabsenceofanEPRtheexisting
inefficienciesandriskswillbeexacerbated,making it increasinglydifficultmaintainstandardsof
patient care, and placing increased pressure on already stretched resources coping with the
transitiontothenewhospitalandaprogrammaticapproachtoservicedelivery.
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The Strategic Case
The compelling case for EPR is already well accepted both nationally and internationally, and
migration to an EPR is already a key element the HSE vision and strategy.
Access to an EPR is also at the heart of enabling and delivering on Neuro-Rehabilitation strategy at
local, regional and national levels by delivering an integrated care model which is supported by the
national clinical programme, as well as being central to the NRH mission and strategy to optimise use
of its scarce resources to provide the best possible quality of patient centred care.
The national strategy for the future provision of Neuro-Rehabilitation is based on a hub and spoke
model. The patient moves through the rehabilitation continuum from acute to tertiary and then
returning to secondary/ regional services. Secure, comprehensive, effective and timely information is
essential to support this patient journey through these complex services. The NRH provides these
outreach services nationally across each of its brain, Stroke, spinal, POLAR and paediatric
programmes. A single instance Rehabilitation EPR can support and enable this strategy by providing a
single rehabilitation electronic medical record.
The reliance on paper based patient files is an impediment to successful achievement of each of the
Neuro-Rehabilitation Strategy and NRH strategies – all of which seek to optimise use of its scarce
resources to enable provision of the best possible quality of patient care, where it is need, when it is
needed, and in a manner which is truly patient centric.
• The nature and scale of the NRH, make it an ideal flagship location in which to prove and
learn about the impacts of EPR on a medium sized hospital, the challenges involved and best
strategies for deployment.
• The NRH provides an environment in which this can be achieved in relative safety, with
relatively modest investment, and with a high degree of confidence.
• In view of the opening new hospital in Q1 2019 timing is of the essence for the NRH as the
change management effort required needs to be implemented in advance of this move. The
provision of an EPR is essential to ensure effective, safe and risk adverse patient care.
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• This proposal has the full commitment of the Board, Medical Director, Executive, Clinical,
Programme, Nursing and Allied Health Professional teams to make it happen.
The NRH manages the patient’s journey through the services from the time they are referred and
placed on our waiting list, which is a unique feature. This supports an integrated care model, which is
also a national clinical programme offering patient centred, co-ordinated care. With appropriate
access to an EPR, availability of the requisite patient information will promote admission to the
various points of the rehab continuum. As tertiary provider/ specialists the NRH has the potential to
integrate Neuro-Rehabilitation through this continuum, in turn supporting the achievement of HSE
and NRH goals while helping NRH offer the highest quality of care.
Provision of the best possible patient care has always been, and will always be, at the centre of the
NRH mission and goals. The development of the new hospital is key component in the future delivery
on these objectives. To achieve this, we must make the very best use of our scarce resources and our
amenities. In the absence of an EPR we struggle to maintain the current level of patient care whilst
we transition to the new hospital environment, and with absolute certainty, we will fail to make best
use of scarce resources.
Without access to an EPR the NRH will continue to struggle to gain access to appropriate patient data
and, management information and analytics. An EPR is therefore vital to ensure, not only high quality
care but also to provide management with information about financial and operations aspects of
hospital management.
Access to an EPR will help fulfil national Neuro-Rehabilitation and NRH strategic objectives. The NRH
is ideally placed for success. As the national centre leading rehabilitative medicine, it is also ideally
placed as a flagship and model for EPR. It needs EPR and has the change leadership capability to
deliver it. It has the drive, commitment and support throughout the organisation.
In summary, an EPR is a key enabler for each of these strategies. Access to patient
information, where it is needed, when it is needed, and in a control led and secure
manner, is a cornerstone to the del ivery of true patient-centred, interdisc ipl inary
rehabi l i tat ion.
The NRH team is both willing and able and, it will ensure EPR is an unqualified success.
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Solut ion Overview
The NRH is seeking an EPR which will allow the hospital to effectively manage the entire Patient
Journey, capture all relevant data for rehabilitation, review, clinical reporting and governance
requirements.
The proposed solution will deliver the necessary platform to create a paper-light hospital which
eliminates the need for expensive paper record storage and management and importantly provides
access to data at the right time and within the right place. This is crucial in a distributed hospital
environment, such as the NRH.
By storing and sharing health information electronically in a single record and in real time, the EPR will
speed up clinical communications, reduces the number of errors and assists healthcare professionals
with the diagnosis and treatment of patients by allowing them to follow predefined integrated Clinical
Care Pathways.
The EPR will have user configurable functionality which will allow assessment tools (Bartel Index, Fim ,
Fim+Fam ect) and forms used within Therapy, and by other health care professionals to be easily
developed by internal hospital IT staff. Access to these tools is vital to ensure that all relevant data is
held centrally at a patient level within the EPR.
I t is essentia l that any solut ion wi l l include a ful ly functioning Patient Administrat ion
System designed for or configurable to meet the needs of the Ir ish Health Service.
The Vendor wi l l be required to del iver a l l current and future Ir ish specif ic legis lat ive
requirements, such as the Indiv idual Health Identif ier ( IHI) during the l i fe t ime of
the contract. I t is envisaged that no local isat ion wil l be required ful ly implement
both the EPR and PAS functional ity .
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Proposed High-level Functional ity
• Patient Administration System - PAS
• Bed Management
• Clinical Coding
• Clinical and Therapy Noting
• Therapies
• Referral Management
• eDischarge
• Management Information
• Nursing Obs and Documentation
• User Defined Assessments
• Inpatient Management
• Outpatient Management
• External Communications
• Integrated Clinical Pathways
• Standardised 3rd Party Interfaces
• Individual Health Identifier (IHI)
Benefits Overview
An EPR is central to providing the best quality, safe and risk adverse patient care and clinical
outcomes. Furthermore, the data gathered will inform how best to deliver the care programmes so
as not only to achieve best clinical outcomes, but also to accelerate discharges, and to reduce and
minimise the demands on resources post discharge.
Antic ipated Financial Benefits
€0.5m pa recurr ing
Est imated
• Anticipated savings based on research of 8 person days per month
(@ €200 per day) on internal and external MIS reporting assuming
reports will be generated automatically and data MI will be
accessible to management.
• Administration synergies can be achieved through efficient
workflow that will enable up to four staff in the NRH to be
redeployed in the hospital over a two year time frame.
• It is anticipated that clinical synergies, proactive patient
management and better access to patient flow would result in a
reduction in an average length of stay per inpatient at a saving of
€500 per patient day. A reduction in AVLOS is backed up by
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l i terature.
• Efficiencies in preparing interdisciplinary discharge reports,
equivalent to one day for 620 inpatients per annum at a cost of
€300 per day.
• On this basis we estimate that an EPR meeting the specific needs of
rehabilitation will yield savings of €5.9 million over 10 years,
equivalent to a Net Present Value (NPV) of €0.5 million using a 6%
annual discount rate. Alternatively the EPR transformation
programme generates an internal rate of return (IRR) of 12.1%. For
a programme of such strategic importance to NRH, these are
attractive financial returns.
Benefits Detai l
C l in ical and Patient
Benefits
• Care Pathways providing Improved quality patient care, greater
patient centricity of care, safety and richer patient experiences
• Integrated multidisciplinary integrated care pathways
• Improved overall patient outcomes
• Up-to-date information on patient flow
• Supporting discharge planning from the point of admission,
identifying potential complex discharges.
• Supporting patient pathways
• Reductions in Length of Stay
• Improved clinical governance through an integrated health record
and more timely and accurate decision making
• Clinical decision support
• Access to patient notes at the right time in the right place
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• More time for direct patient care
• More complete and accurate generic patient data for medical
research purposes
Management & Staff
Benefits
• Accurate and timely management information (MIS) resulting in
better and more rapid decision making
• Less duplication
• Better working environment for staff through a richer, more
interesting, workplace with less routine tasks
NRH Benefits • Improved efficiency and safer delivery of care
• Reductions in Risk
• Key enabler for the new hospital
• Key enabler to achieving NRH strategic goals
• Access to accurate quality data for planning and research
HSE Benefits
• Key enabler for National Neuro-Rehabilitation strategies
• Support eHealth Ireland Strategic Programme
• Supports the Better Safer Health Initiative.
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Examples of other Benefits
• On referral, inpatient information will be recorded once in EPR but used many times, the clinical
pathways module would define the treatment route for inpatients and patient records will be
updated by clinicians, nurses, therapists immediately post treatment. The production of
inpatient interdisciplinary discharge reports that comply with HSE policy is a lengthy manual and
complex process in the NRH today but with accurate and complete patient records EPR can
generate patient discharge reports quickly. This enhanced workflow would improve patient
satisfaction, shorten patient treatment programmes, reduce average length of stays and shorten
inpatient waiting lists.
• Similarly attendance at outpatients department (OPD) will improve through a reduction in Did
Not Attend (DNA) and Unable to Attend (UAT) statistics as the EPR should can generate text
messages automatically to remind patients of their date and time of appointment. Increased
patient throughput would reduce OPD waiting lists and increase patient satisfaction. DNA and
UAT rates can be measured before EPR deployment and then post implementation to calculate
the improvement. We estimate that we could run up to 500 additional out-patient sessions per
annum.
• In the NRH’s spinal program, international best practice mandates that patients are tracked for
life (this is also a CARF requirement). Increasingly, this applies to people who are in need of
complex specialised rehabilitation. With quality long term data, patient outcomes can be
reviewed easily and inpatient re-admission rates to local acute hospitals can be reduced through
better patient education and treatment in OPD as necessary. A similar situation arises in
Paediatrics where children have to tracked and moved to adult programmes as appropriate.
• Once the EPR has gone live in the NRH it will deliver clinical, medical and administration benefits,
and it will produce KPIs that are required by National Rehabilitation Medicine Programme
(NRMP) on a regular basis. The solution should then be rolled out to the proposed regional
rehabilitation centres and in time to the community based centres. This means there could be
one standard EPR system delivering the reporting requirements of NRMP which is important at a
national level.
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• Data from the EPR, can be married with data from other NRH systems such as CoreHR, to assist
and underpin CARF accreditation, inform how resources are best deployed and services offered,
and aid the migration from Departmental to the programmatic approach to patient care.
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Programme Governance
NRH will establish a Programme Board which will be responsible for implementation and ensuring
that the programme delivers to specification, on schedule and within budget.
The CEO is the Senior Executive Sponsor, on behalf of the Board. The Clinical Director will be the
Senior Executive Owner with overall responsibility for delivery of the programme, recognising the very
significant impacts on, and behavioural changes required on the part of, the medical, nursing and
health professional teams across the entire Hospital.
The Programme Board will be chaired by the Senior Executive Owner, and will comprise senior
representatives from across the organisation including the CEO, HR, ICT, Risk, Clinical, Nursing, and
Allied Health Professional teams. Responsible line managers and the Programme Board will formally
sign off on business requirements, timelines, budgets, risks and benefits, and will oversee the delivery
and achievement of all deadlines and outcomes. Sub-groups will be used and tasked as required.
Benefits will be individually owned by the relevant line managers, who will be accountable to the
Programme Board for realisation of the assigned benefits.
The NRH has an excellent track record of managing within its budget and is experienced in managing
large change projects such as the recent HR Transformation Programme, and the on-going Health
Planning (New Hospital) project. Phase 1 of the New Hospital Development, has an approved project
budget of €55m with an assumed higher construction budget.
The programme will comprise several work streams including clinical, nursing, therapies,
administration, social work, information technology, data migration, user training and benefits
realisation. Proper project management principles will to adhered to which will include clinical
ownership of the project via the Medical Director, the establishment of a strong project board which
will include external members, a dedicated full time project team, and suitably qualified and
experienced project manager. Senior NRH staff will lead these work streams to ensure they are
successful.
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Implementation Timeline
Details of the programme high level timeline are set out below. The expectation is the programme
can be completed within 12 to 18 months but more detailed planning will be required to validate this
timeline at programme initiation stage. Full resource estimates will also be validated at programme
initiation stage. It is likely, based on experience that the project will require a fulltime team of five, led
by a project manager, and supplemented by relevant departmental staff, as needed, during the life of
the project.
R isk Management
Budgets & Timelines
• The programme budget and timelines may over-run.
Key Mitigants:
- The Programme Board will comprise suitable qualified senior
HRH personnel, who will review the scope, time, quality, cost
and benefits objectives in detail.
- A best practice ‘clarify the change’ method/tool will be used
to ensure full understanding of each component.
- Relevant executives, manager and the Programme Board will
sign of off the detailed programme deliverables.
- A senior member of hospital staff will own and be responsible
for each deliverable, and each benefit.
Lack of Buy-In
• The business process change is not communicated effectively and
there is little “buy in” from staff.
Key Mitigants:
- Best change management practice will be applied across the
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programme. By its nature this includes securing the right
involvement, ensuring effective and timely communication,
the right level of engagement, ensuring understanding and
support managers and staff throughout the change.
- Best change management practice also demands the highest
order of change leadership, publically and privately, from the
Board, CEO, Executive team, Change Owner and from line
managers. The NRH understands this, and will integrate all
the required actions and effort and required monitoring into
its programme plan, and its day to day management activities.
Data Migrat ion
• Data migration from the old PAS system is a complex and
resource intensive task.
Key Mitigants:
- A separate work stream will be established at an early stage
to manage this process, to validate that data can be migrated,
to determine the size and scope of the data to be migrated,
to cleanse the data as necessary and to ensure its accuracy.
Benefits - The programme benefits may not be realised or are only
partially realised. Proper project management principles
need to adhered to which will include clinical ownership of
the project via the Medical Director, the establishment of a
strong project board which will include external members, a
dedicated full time project team, and suitably qualified and
experienced project manager. Risks are further mitigated by
assigning owners to the benefits realisation work stream, by
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defining performance metrics to measure and record success
and ensuring that all staff using the EPR are fully trained.
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Key Assumptions / Qual i f icat ions
The main assumptions supporting the business case are set out below.
• NRH will work in close partnership with the EPR vendor throughout the project which is
expected to take 12 to 18 months to complete once the project is approved, contract signed
and respective teams are mobilised. Since the window of opportunity is approximately two
years, the NRH would hope to have a project start date of Q1 2017.
• NRH will support the project by committing six staff to the project for 12 to 18 months. It may
be necessary to backfill some of these staff resources as required.
• NRH will assign a project / change manager, on a full time bases, on a fixed fee basis following
competition.
• Hardware maintenance and support costs are estimated at €15,000 per annum (including
VAT) following expiry of one year warranty.
• All clinical, medical, nursing and administration staff in the NRH will receive and estimated
two days training on the new system.
• The Vendor will be required to deliver all current and future Irish specific legislative
requirements, such as the Individual Health Identifier (IHI) during the life time of the contract.
• NolocalisationwillberequiredfullyimplementboththeEPRandPASfunctionality.
• ThePASwillcomplywithorcanbeconfiguredtocomplywithallIrishPASrequirements.