Health Service Focus

Better letters

Alder Hey Children’s Foundation Trust was among the winners of money as part of the Information Sharing Challenge Fund, a Connecting for Health / Department of Health initiative to improve interoperability. NHE speaks to EPS project manager at the trust, Heather Swanston.

Improving the speed and accuracy of clinical correspondence has benefits for patients, for costs and for hitting CQUIN targets.

Alder Hey Children’s Foundation Trust has been implementing Medisec digital dictation over the last year, using Olympus devices. It is an upgrade from the previous analogue system, as part of the trust’s broader efforts to digitise and speed up clinical correspondence.

It has implemented an electronic prescribing system for discharged patients, allowing that data to be captured electronically.

Its new discharge summaries are currently being faxed, but that process should soon be automated, while letters that can be delivered electronically will go to the GP practices and everything else, such as outpatient appointment letters, will go via the trust’s outsourced service.

EPS project manager Heather Swanston has been implementing these digital improvements, and she explained: “We’ve bid for money from the strategic health authority for what we’re calling the ‘paperless office’, which will bring in all our outpatient clinic letters as well.

“So we’ll be sending the discharge summaries electronically, and our outcome letters, full discharge letters, one-offs and miscellaneous letters will come out through the digital dictation system and will go out via the same route.

“We’re setting up this CDA – the Clinical Documentation Architecture – to pull in clinical documents and send them where they need to be. It will either be electronic, or via outsourced services, but essentially will be paperless for the trust itself.

“The paperless office will allow us to browse for content we can attach to the letters.

“If the doctor asks for test results to be included, that can be easily dropped into the letter, so they’re not having to be sent out separately.”

ITK2 compliance

The trust also won £25,000 as part of the Information Sharing Challenge Fund, launched last summer as part of the Interoperability Investment Programme (IIP). The winners were announced at the end of November 2012, across five categories – ADT (Admission, Discharge & Transfer); Clinical Correspondence; Clinical Dashboards; HSCI; and Telehealth PHMR (Personal Health Monitoring Report).

NHS Connecting for Health said: “The ISCF attracted a larger than expected response, with almost 100 individual applications requesting a total of £5.6m.

“These were reviewed by an independent evaluation panel and recommendations made to the Interoperability Investment Board. At the end of this process 43 projects were offered funding.”

Alder Hey’s project was called ‘Hub-to-Hub Clinical Documentation Architecture’, and involves making the Medisec system it uses ITK2-compliant.

ITK2 is an advanced interoperability standard for clinical correspondence, ensuring different NHS organisations’ IT systems can ‘talk’ to each other, no matter the type of system.

Charles Gutteridge, national clinical director for informatics at the DH, said during the launch of the ITK2 standard 18 months ago: “This toolkit – building on existing national standards and developed with local trusts – will help NHS organisations produce key patient information delivered to GPs within 24 hours of discharge.

“We now have a discharge summary that is approved by the Academy of Royal Medical Colleges and can be provided by any hospital or clinic.”

Swanston said: “It’s the way forward: knowing systems have ITK2 accreditations means you’ll know you’ve kind of got all the security necessities in place, the information governance – that’s all part and parcel of how you get accredited.”

Swanston said the trust was particularly pleased to win the funding with its partner Medisec, considering how over-subscribed the ISCF was. “They did say they thought the bid was very comprehensive,” she said.

“I think they were quite impressed.”

Launching the fund, health minister Lord Howe said: “We want to support doctors, nurses and healthcare professionals to be innovative in the NHS. That is why we have created this fund to encourage NHS organisations to come up with new digital ideas that not only improve services for patients but help create an environment where local IT information can be more easily shared across the NHS.”

Interoperability

Talking about what the project will mean for the trust, Swanston explained: “It means we’ll be able to talk to our surrounding hubs, which is especially important, because the trust is a tertiary unit, nearly 30% of all our patients live outside our local catchment area.

“That’s a high percentage: most district general hospitals are going to be more like 10%.

“At the moment we’re sending out to MIG – [the HL7 and ITK-compliant] healthcare gateway system being put in by Informatics Merseyside, which will cover us for North Mersey. But of course a lot of our patients come from the Isle of Man, north Wales, Cheshire, Greater Manchester.

“If a patient can’t be ‘found’ it means it can check with the neighbouring hub.

“Essentially, this project is to make our system interoperable with any other clinical gateway.”

In Cheshire – where all GPs are already using the same system – such communication is already happening, between them and Staffordshire.

Moving on from paper

Swanston explained more about the advantages of digitisation, such as the benefits compared to the previous paper-based system for discharge summaries. They were always somewhat flawed, she explained: “You’d write it out on a four-page paper form, the patients would get the bottom copy (that they couldn’t read anything on!), and sometime later they would turn up at their GP saying they’d run out of whatever drug they were given.

“The GP wouldn’t have the first idea what any of them are, because 1) they don’t know that the patient has ever even been an in-patient and 2) if they did, they haven’t had that discharge summary, so they don’t know what drugs they’ve been put on.

“Under the new system, the doctor and the patient, upon discharge, will be given a beautifully produced discharge summary that details all the reasons for the admission, the treatment they’ve had, any drugs they’ve been put on, and the pharmacist can add any special notes as well about that drug.”

This last factor is particularly important at Alder Hey, whose patients are exclusively children.

Although some can be treated as adults, others have special requirements, such as having tablets quartered or administered via oral syringe.

Swanston said: “In the past the parents were given leaflets and pieces of written paper: the electronic discharge summary is obviously 100% legible, the parents sign that they’ve received a copy on their way out, and they leave the hospital with something they can easily read.

“At the same time, their GP is sent that same information. We want the GP to receive it electronically within a few minutes of that discharge happening.

“The benefit for the patient is immense: there shouldn’t be any delay in treatment.”

A final element of the digitisation journey is a new project to allowclinicians to leave dictations using a landline or smartphone, over a secure system. Swanston said that will “complete the circle”, with everything digital.

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