using technology to re-design services john thornbury director of ict worcestershire health...
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Using technology to re-design services
John ThornburyDirector of ICT Worcestershire Health Informatics Service
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Worcestershire Acute Hospitals
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Worcestershire Acute Hospitals
Medical Records Key Issues
3 trusts merged into one
Little attention paid to records management
Just put together
New PAS no de-duplication
Culture “keep hold of record or never see again”
Paper cashing notes ie never complete
Trust Facts
One of the larger non-teaching trusts in England serving a population of more than 550,000
Turnover £264m in 2006 / 2007, 5500 WTE staff
PFI on one site – Key issue
100,000 I/Ps, 400,000 O/Ps, 100,000 A&E attendances
800 + beds on 3 main sites
Historical deficit - £30m
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Medical Records – Problems with Paper
A requirement to re-engineer the process and wrap a technology solution around it
Clinicial
Misfiling of documents
Documents never filed
Records lost
Multiple records
Speciality notes
Time taken to find relevant information
Security
No audit process
Records left in insecure areas
Difficult to control access
Records physically lost
Paper Management
Filing & retrieving
Policies for retention and disposal
Health & Safety
Space
Transport
Cost
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Moving away from …………11 miles of files!
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Escaping from Crate Mountain!
• Data Security issues associated with transportation of hard copy records
• Significant storage space requirement
• Carbon footprint impact of transporting records across the trust
• A record can only be in one place at any one time
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Project Vision
“Within the next two years, to enhance and simplify delivery of safer patient care
within Worcestershire, we will access patient medical records electronically at
the point of care delivery”
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The Journey
2010 Into the Digital World
2012
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Project objectives
•Re-design processes first
•Dramatically reduce costs
•Reduce the risk associated with the availability and accuracy of records
•Comply with UK Government targets and incentives for cost down and productivity
•Enable the trust to focus on its core business
•Integrate paper and electronic records to overcome culture challenges
•Deliver an environment that provides continuity from the past but marries together technology
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Redesign processes and then apply technology…..
• “The first rule of any technology used in a business is that automation applied to an efficient operation will magnify the efficiency
• The second is that automation applied to an inefficient operation will magnify the inefficiency.”
Bill Gates
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What are we trying to do - Health records transformation from paper to digital
Outsource ‘As Is’ paper processPeople, facilities & processes
Design new electronic process• Use~ability• Forms rationalisation• Update procedures
Heath Records digitisation• Conversion• Indexing• Archiving & destruction
Implement electronic health records management system
Full transformation over 2-3 years
Financing ‘cost of change’ to achieve YOY cost reduction targets
Patient Journey+ +
ClinicalCare
HealthRecordProcess
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Supporting 3 Acute & 4 Community Hospitals
Central File Store
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The Process
• Started as financial imperative(£30m deficit in trust)
• Health and Safety issues
• Business case to board
• OJU process (but different used negotiated process rather than traditional specification based approach)
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Criteria for selection
• Reduce the financial costs associated with storage of records and the clinical administration service (short term and long term)
• Develop a health records service that is able to flex to meet current and future changes, both local and national
• Improve existing timeliness and responsiveness of case note availability to support the treatment of the patient.
• Develop the ability to access clinical information from multiple sources at the same time, therefore reducing clinical risk to the patients and clinical staff
• Maintain accurate and timely clinical record keeping • Reduce administration duties required by clinical staff.• Provide a safer working environment • Support the process of continual improvement, but ensure that implementation of any
transformation is quick. • Enable effective advance planning of department(s) workload. • Compatible with the National electronic patient records strategy. • Maximise existing and future technology leading to a paperless service with no paper-based
systems• Improve efficiency of workflow in all associated administration areas, therefore eliminating
duplication and delay• Provide KPI information as a by-product of the solution, to use as a management tool for
performance managing teams and monitoring SLAs• Integrate with other solutions that the hospital may have / may want to have in the future.
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Building a partnership
• Xerox Global Services selected as partner
• Xerox lead a consortium including a technology provider and a change management consultancy
• The trust identified a strong need to leverage private sector expertise, process management and experience to drive change
• Formed a partnership to capitalise on NHS strengths and private sector strengths
• Pro-actively worked project pre-contract to identify critical path activity as well as quick wins to secure immediate service improvement whilst service transformation activity was launched
• Senior engagement and strong governance process
• Stakeholder engagement from all aspects of trust to drive awareness and input to future shape of service
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Expected Project BenefitsObjective Associated Key Benefit
Delivery Improvement
To support provision of best possible care and treatment of the patient
To reduce the financial costs associated with the storage of records
To support in enabling the most efficient and effective use of clinical time and associated resources
To minimise the time spent by medical, nursing and other clinical staff on clerical duties
Clinical Governance
To reduce clinical risk associated with health records, therefore, securing NHSLA & Information Governance standards
To maintain a complete and accurate record of the activity carried out within the Trust for clinical, legal, research and business purposes
Strategic & Management
To provide information both within the departments, across trust, and external stakeholders, quickly with the minimum use of resources
To enable effective advance planning of department (s) workload
To move to a ‘paperlight’ environment and support the National strategy electronic patient records
Foundation Trust application
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Six Sigma Lean
Driving Improvement with Xerox - Six Sigma and Lean
Mean Shift
BeforeAfterReduce Variation
After
Before
Lean focuses on • process efficiency • identifying non value added steps and reducing waste• reducing bottlenecks• Increase speed and cycle time
QuantityTimeliness/SpeedZero Bottlenecks Reduced Non-Value Added Steps
Six Sigma focuses primarily on • process effectiveness • understanding and reducing variation • reducing and eliminating defects.• improving performance on Customer CTQs
QualityAccuracyZero DefectsReduced Variation
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Community Care
GP’s
Social Services
Laboratories
ResultsResults/orders/orders
Work DoneAcuteAcute
Hospital
Education
SpecialistDepartmentalsystems
EPS
EDS
Path li
nks
C&B
Paper chase
Electronic flows
80-90% paper
Overview of Existing Process
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The existing process
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Future Management of Health Records
Community Care
GP’s
Social Services
Laboratories
ResultsResults/orders/orders
Forms design Group
Tasks
Tasks
Tasks
Tasks
Work Done
Results
Work Done
Work Done
Rules
Work Done
AcuteAcute
Hospital
Education
Tasks
Work Done
Records viewable at multiple locations at same time
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The Future Management of Health Records
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The journey so far…..
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Initial Focus areas
Forms rationalisation -1500 in total and growing -same forms with several variants
Process efficiencies within current operation – Missing notes focus
Service Improvement approach throughout entire process
Stakeholder engagement and strong CEO support to drive change
Change management organisation as part of outsourced consortium
Strong partnership developed to bring innovation and finance the change
Bar-coding of records to move away from NHS terminal digit filing process to industry benchmark process. Remove risk and mitigate medical / legal issues
On track to roll out new world in 2011
• Project management expertise from Xerox to help drive improvement• Lean Six sigma core to approach• Numerous processes reviewed, refined and improved • Significant productivities realised
Initial Press Coverage Q4 2009
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Critical Success Factors
Key to Success is an overarching Key to Success is an overarching Strategy incorporating EDM, Strategy incorporating EDM,
not left as islandnot left as island
TechnologyProcessPeopleKnowledge
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SummaryKnowledge
• Knowledge within the people involved needs to be retained• Communication and stakeholder engagement is vital to secure success • Allow the NHS to focus on what it does best• Financing the cost of change is a critical value add from the outsourced vendorPeople
• Strong senior management support crucial to success• A partnership must be formed and well managed throughout the contract• Meets clinical needs and saves time• Patient Safety and Care improved• involve and engage users from outset
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SummaryProcess
• Approach to procurement critical • Re-design the process and wrap the technology around the process• Think “outside the box” to drive change• Forms are criticalTechnology
• Bring in best of breed partners to bring external knowledge and best practice to the NHS• Ensure infrastructure is right to enable right information at right time and place e.g. Wifi, connectivity at right locations etc.
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Awareness of unexpected
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Contacts
John ThornburyDirector of ICTWorcestershire NHS
Jonathan ElliottRegion ManagerXerox Global Services
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