14.09.16
Taunton’s open source success: a new era for electronic patient records
Recognised as a digital health pioneer in the NHS through its use of open source technology, Taunton and Somerset NHS FT has recently been named as a global exemplar for digital excellence by NHS England.The trust’s chief information officer, Malcolm Senior, explains why open source technology has supported this initiative and how it can save the NHS significant sums, spread innovation, improve care and allow the health service to take greater control over IT investment.
Almost one year ago our organisation, Taunton and Somerset NHS FT, achieved an important milestone in delivering transformational change in our digital programme: we became the first NHS trust to go live with an open source electronic patient record (EPR).
Some may have perceived this as a risky choice. An open source EPR was untested within the NHS, and NHS organisations can tend to do what everyone else has already tried. Yet we saw that, by having a flexible system that had no licence fees, we would be able to tailor the system as we went along, to suit the needs of our clinicians, patients and our healthcare partners in Somerset.
Our experience to date has shown the benefits of taking an open source approach, an achievement recognised recently when we were named as one of 12 NHS organisations chosen to become a global exemplar for digital excellence. The government is making up to £10m available to us, in exchange for rapid innovation and progress over the next two years.
There is much to be done, and the driver is always improving the quality, safety and experience of our care for patients. Our EPR, openMAXIMS, is helping us achieve a lot in a short space of time, and will enable us to do much more in the future. Our supplier, IMS MAXIMS, is with us on this journey as we work at pace to complete our digital roadmap.
Achievements to date
How have we advanced our digital maturity? The EPR project saw eight million records migrated into the new system with only seven individual records needing to be manually loaded, resulting in minimal disruption to service delivery. This now means that processes for admission, transfer and discharge of patients are more efficient and coordinated, with the help of real-time bed management and discharge planning.
We have redesigned outpatient workflows, so that clinicians triage referrals, record outcomes and add patients to waiting lists in real time. This information then is fed into documents, such as clinic outcome letters and discharge summaries, that are sent electronically to GPs and other care providers, enabling paper-light working.
All therapist teams have decided to use the software too, so physiotherapists and occupational therapists are working paper-light, and cardiology and diabetes specialties have also followed suit.
We have implemented county-wide order communications and picture archiving and communication system solutions, enabling all care providers in Somerset to access diagnostic information. And significant numbers of patients are starting to access their records through the GP Connect programme, with some practices having up to 60% take-up.
A bright future ahead
Our progress continues. We are now moving to completely paperless nursing and outpatients, with all assessments, outcoming and noting being performed on the new EPR via app-based technology. Alongside IMS MAXIMS, we are developing smartphone apps to record vital signs which will enable our clinical teams to identify and treat deteriorating patients faster and more effectively. We also have plans to implement a medicines management solution, and our app-based solutions will link with openMAXIMS via open APIs to ensure interoperability is achieved.
Further down the line, e-prescribing will be introduced, allowing us to link the trust with external GP systems. All three phases are due for completion by 2018 and will enable the trust to be paperless by 2019.
Much of our work will support the county-wide sustainability and transformation plan (STP), connecting providers and facilitating new models of care in Somerset. Finally, and most importantly, we will enable patients to have full access to their records and to interact with the service in a way that meets their needs.
The real benefits of open source technology
Financially, the cost of moving to openMAXIMS will pay for itself within three years, and is set to save the trust £600,000 a year by 2018 by eliminating the need to move the 140,000 paper notes around the county every month.
But the wider benefits of choosing open source are clear, for the trust and its clinicians, and national ambitions of sharing good practice.
Clinical engagement and leadership is key to achieving ownership and adoption of any new system, as Dr Robert Wachter recognised in his recent review, and the open source approach has helped drive that engagement. Our clinical teams worked closely with IMS MAXIMS, and explained what was needed – right down to how drop-down menus could best meet the workflow needs of each team. This has led to usability benefits, such as fewer clicks being required to perform certain tasks.
How can other providers follows suit?
We now have software which we, and other trusts, can develop at scale and pace, achieving the same result as proprietary options but at a fraction of the cost. We can now collaborate on functionality developments with other trusts for the benefit of the wider NHS. We can share ideas and experiences, and provide the same governance guarantees as other options.
It’s really satisfying to know that we are not only delivering positive results for our trust, but inspiring others too. We have hosted several visits from other healthcare providers across UK and Ireland who are keen to learn about our experiences of implementing an open source EPR.
The open source approach is providing viable technology options for the NHS at a time when financial constraints continue to make the headlines. In my view, there is certainly room in the marketplace for suppliers that are innovative and flexible in how they deliver their software to match the needs of NHS providers.
What is most gratifying about this project is that we believe we have helped to develop a robust EPR system that can be replicated and benefit other hospitals in meeting today’s healthcare challenges – not just in the UK or Europe, but globally.