02.08.15
Taking electronic patient record maturity to the next level at St George’s
Source: NHE Jul/Aug 15
Dr Martin Gray, chief clinical information officer at St George’s University Hospital NHS Foundation Trust, discusses the importance of clinician involvement in developing a closed loop medication administration capability.
St George’s University Hospital NHS Foundation Trust has become the first major teaching hospital in the UK to be validated at stage 6 of the international acute Electronic Medical Record Adoption Model (EMRAM).
Developed to measure the progress and the cumulative capabilities of electronic patient record (EPR) systems within hospitals, EMRAM is an eight-stage model that classifies hospital IT from stage 0 to stage 7.
Croydon Health Services NHS Trust last year became the first to be validated at stage 6 in the UK, but St George’s is the first site to be accredited following a site visit by Healthcare Information and Management Systems Society (HIMSS) inspectors.
During the inspection, the trust demonstrated examples of best practice by highlighting the speed and uptake of its Cerner Millennium product since it went live in 2012. The centralised EPR system now has more than 5,500 users including nurses, consultants, doctors in training and administrative staff.
Speaking about the progress and validation, Dr Martin Gray, chief clinical information officer at St George’s, said: “I am extremely proud of our achievements as a trust at being recognised as being in an elite group of digitally mature healthcare systems in the UK.”
Hospitals that reach stage 6 have established clear goals for improving safety, minimising errors, and recognising the importance of healthcare IT. Dr Gray said that in the last five years the trust has come a long way from rolling out patient administration modules on FirstNet A&E tracking, has fully implemented Order Comms for pathology and radiology tests, and has rolled out clinical documentation and electronic prescribing across 44% of its acute inpatient beds since 2014.
HIMSS says St George’s is also the first trust in the country to “demonstrate a closed loop medication administration capability”, including electronic prescribing with technology-assisted identification of both patient and medication.
With its electronic documentation management system to digitise all the remaining paper, the trust is now paper-light and on its way to becoming paperless by 2018.
Doing all this has meant getting clinicians on board. Dr Gray told us: “The first challenge is to get [clinicians] involved, so the system serves their needs and also to look at their internal processes before transferring them to electronic systems.
“We were very successful in the design process, in terms of the amount of clinicians. But, at the same time, there is always this perception inside the organisation that we still haven’t done enough to engage our clinicians.”
St George’s has used every communication channel it can think of to keep everyone up-to-date, including face-to-face meetings, newsletters, blanket emails and corporate events.
Dr Gray said the trust has to roll-out clinical documentation and then “tackle outpatients and automate the outpatient process for the patient and the clinician”.
Speaking about the stage 6 validation, John Raynor, director of professional development at HIMSS UK, told us: “There are only two hospitals in the UK that have successfully validated against the stage 6 standards, which are international standards, they are not standards that relate to the NHS or UK.
“There are many things that other trusts could learn from St George’s. For example, the inspection team was impressed by the way the trust was using barcode technology to identify the patient and medicine, which takes us a stage closer to the closed loop medicines administration process.
“We were particularly impressed with the role of the pharmacist and the fact the pharmacist was verifying medication before that medicine was being administered.”
The inspectors were “surprised” by the trust’s scanning capability, which “demonstrated to us that this trust is serious about reducing the amount of paper”, he added.
Validation lasts for two years and Raynor told us that he hopes by then that St George’s could be seeking stage 7 rather than stage 6 status.
“My intention will be to work with the trust to have a plan in place to get them there,” he said. “We would expect to see more of what the trust has already done, covering more wards and departments, including A&E and outpatients. To some extent, stage 6 is looking for capability, stage 7 is looking for the deployment of that capability over a wide area.”
Dr Gray said achieving stage 6 was a great “morale boost” and gives the trust something to work towards the next level. He added that if any trusts would like to learn more about St George’s progress, the door is always open.