In our latest interview we asked Dr Afzal Chaudhry from Cambridge University Hospitals NHS FT a few questions to hear about some of the organisation’s recent successes and what is coming up for them over the next 12 months.
Could you tell me about a recent project you are working on?
We have recently been accredited by NHS Digital to send structured Transfer of Care messages using FHIR based messaging and have now built this to work with our Trust-wide electronic patient record system (Epic). The specification for this is a combination of text and structured data. As soon as the GP systems become compliant and certified, we will work with our local practices to send this structured information when a patient is discharged from hospital instead of sending a PDF document. This means that individual elements of the information will appear in their own local system in a structured format.
Separately, there is a new medication specific message that ultimately will be used to share medication information between GPs and hospitals. We have been working with NHS Digital to test this medication documentation as a proof of concept using the new FHIR based standard. This has meant testing the functionality and all possible varieties of medication prescriptions to ensure that the structure of the medication data can meaningfully and safely convey the clinical message. Some elements of the message are human readable text, but there is also coded data using SNOMED CT and dm+d codes. We are now looking to test further with NHS Digital and other hospitals as to what this might look like in an actual clinical workflow.
Could you tell me about a significant achievement over the past few years?
In 2015/16 we were looking at our data around sepsis and we knew we weren’t as good as we could have been. We did a piece of work that started with our acute medicine physicians, in conjunction with our infectious disease team and the Trust’s in-house eHospital digital team, and thought about how we wanted to construct a workflow that could be really supportive of our clinicians, and utilise technology to quickly identify patients with sepsis to ensure that their treatment was better.
We know that if a patient receives antibiotics in the first hour of being diagnosed with sepsis then that’s a really good thing, and for every hour antibiotics are delayed there is a 7-8 per cent increase in the risk of mortality. We adapted our clinical workflow, reconfigured our Epic system to incorporate innovative sepsis alerts and action features and trained staff in how to use it. Since introducing this in-house configured functionality within our Epic electronic patient record, there has been a 70% increase in patients receiving antibiotics for sepsis within 1 hour of arrival in our emergency department and a 50% increase in inpatients receiving antibiotics within 1 hour of the alert triggering in the system. This has resulted in at least 64 lives saved in the past year and a 42% reduction in sepsis mortality across our two hospitals – Addenbrooke’s and The Rosie.
How is your organisation sharing information with patients?
In the past year we have been focused on getting more patients signed up to our patient portal, we started the year with about 3,000 patients registered and now we have over 19,000.
We are working with them to get their feedback on the system and its capabilities and have now started to switch on more functionality.
One recent change to the portal is that we have introduced automatic results release, so our patients receive their results at the same time as their doctor.
This has made a positive change and resulted in a more educated group of patients that are more empowered to understand what their results means, whether their results have got better or worse, and what it means for the future.
We have received a number of good stories from patients particularly that they are more confident in their care because they have seen the information in advance and can have more focused and meaningful conversations during appointments with their clinicians. Patients also have a bit more time in advance to think about what they might want to ask.
The portal provides patients with access to diagnoses, medication and allergies. If any of those are incorrect they can make a change and it is flagged up for their clinical team to review and discuss with them next time they attend for an appointment. They can also see their results, letters, discharge summaries and appointment details. We want to move to self-scheduling of appointments next and provide patients with the ability to upload pictures in to the portal, such as if they have a rash or a wound, to help support better care and treatment.
What advice would you give to others?
Start to understand your current workflows and then think about what the revised workflow would be with new technology.
Make sure you get your methodology right, make changes in an incremental way, in a small way piece by piece. It is important that you operationally understand the problem and that the statistics and data are properly understood each time you make a change.
I would advise creating a working task group and facilitating discussions around workflows of what the process is now, what should the process be, what that new process looks like clinically, and then finally how technology can support the delivery of it.
It’s vital to have good education and awareness, so everyone buys into the change and understands the rationale for making the change, to ultimately change behaviours in a sustainable way for good outcomes. With our sepsis programme the level of clinical support and education was paramount to achieving such good outcomes.
Often people in the NHS talk about value for money, and if we are not careful that can sometimes become the minimum acceptable level of care for the cheapest cost. However value can be measured in many other ways including patient benefit, and patient and staff happiness. With our sepsis work, identifying sepsis earlier with the utilisation of technology has made a huge difference to our patients and their outcomes, with many examples of very positive feedback from them.
It is important that we are as safe as can be. We can all be very comfortable sometimes with our day to day habit of doing something, and that’s natural, but it might not be the best way. Technology brings immense opportunities to consistently improve and deliver high quality care. My advice is to involve operational and clinician colleagues of all professions and grades to work together to understand what the opportunities are. Don’t necessarily think of a quick fix, and then immediately jump to implementing that – it is important to think of the long term for the benefit of all.
