Health Service Focus

29.08.19

Binning paper for the new clinical wrap strategy

Source: NHE: Jul/Aug 19

Mark Hutchinson, chief digital and information officer at Gloucestershire Hospitals NHS Foundation Trust (GHFT), explains the benefits of its new ‘clinical wrap’ approach to electronic patient records.

GHFT is one of the most digitally immature organisations in the health service. We have some administrative systems, but the majority of the clinical care across all our sites is managed on the basis of paper records. 

With the board and workforce recognising the need for change, Allscripts Sunrise Clinical Manager was procured to be deployed as a ‘clinical wrap’ full electronic patient record. The term clinical wrap isn’t recognised by everybody, but it does what it says on the tin. It will enable us to retain our patient administration system (PAS), which is InterSystems TrakCare, and to wrap clinical functionality around it from Allscripts Sunrise Clinical Manager. 

The advantage of the clinical wrap approach is that if you buy a PAS and an EPR as one system, you have to deploy the PAS first. Deployment of PAS systems are rarely plain sailing and often bring with them a multitude of issues. The procurement and implementation of PAS can take several years and at the end of it, you will still only have a system that enables you to see where patients are in the hospital, to manage your waiting lists, and to submit your returns to central bodies. You will still be lacking the main benefits from an EPR, the clinical functionality. 

To deliver benefits at pace we are going to leave our PAS in place and use the Allscripts ‘Clinical Wrap’ solution to improve the way we deliver care, in the quickest possible timeframe; adopting proven technology and adapting to meet our local need. We started our deployment project in July 2019 and go live in July 2020. 

We are starting with clinical documentation and e-observations as well as providing our clinicians with access to digital images, letters, other documents, radiology and pathology results and discharge summaries from within the system on the go-live date. This approach will provide our clinicians with access to the key information that they need at the point of care. 

Subsequent phases will rollout paper-lite outpatients, order communications, and e-prescribing, taking out paper for the majority of our clinicians, wherever possible. Our intention is to achieve level six on the HIMSS EMRAM maturity model within two years of go-live and level seven within five years. 

Most importantly, our intention is to have made a significant improvement in terms of releasing time to care and in the reliability and safety of the care we provide. This is not an IT project; it is a project to improve the reliability of care, it is a patient safety project. In order to deliver these benefits, it was important for us to find the right IT partner. 

We drew up clear criteria for what we wanted from our clinical wrap supplier. The system had to be working as a clinical wrap with another PAS; it had to be delivering for another UK organisation, preferably a global digital exemplar; and it had to be configurable to our needs. 

Allscripts met all those criteria with Sunrise, which is rather like a Lego set. Or a Meccano kit. It provides the building blocks that will allow us to build a system around our pathways, for our patients. 

Gloucestershire faces the same challenges faced across the NHS; financial constraints, increasing levels of demand and staffing pressures. In those circumstances, I think organisations need to make wise investments in systems that can be deployed quickly for measurable clinical benefit, enabling digital leaders to build confidence in the IT being used. 

It is little surprise clinicians sometimes wonder what there is to show after significant time and resource investment into protracted PAS procurement and deployment projects, with no real clinical benefit delivered. The clinical wrap approach allows us to deliver, at pace, a solution that our clinicians can trust and enables us to realise the benefits that an EPR will deliver for patients.

For more information

W: www.gloshospitals.nhs.uk

Tw: @gloshospitals

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