Nick Roots and Liz Ward of Prospitalia h-trak, a healthcare information company working with the NHS and private hospitals, took time out recently to chat to HTN for our latest feature on interoperability.
Focusing on how accurate data capture can enhance interoperability within hospitals, they shared a case study on the adoption of their h-trak point of care system, which identifies and captures products used in surgical procedures.
Using a handheld scanner and barcode technology, clinical teams capture data on consumables and devices, staff, procedure codes and key timers in surgical settings. They then use this rich information for a range of processes – stock management and replenishment, procedure costing, resource planning and patient safety – by ‘tracking and tracing’ clinical implants at patient level.
“Capture the data once and use it in many ways”
“Our key message is ‘capture the data once and use it in many ways’,” says Nick, Prospitalia h-trak’s Business Development Manager, who believes this very idea is “at the heart of interoperability”.
“You can’t be interoperable if you haven’t got the data in the first instance. Our h-trak data can be fed into a trust’s existing procurement, procedure costing (PLICs), theatre management and electronic patient record (EPR) systems. When people talk about interoperability, nobody wants to get down to the nitty gritty of data but this is the key to it all; never underestimate the need to get data right or how much effort is involved with it. Once you’ve achieved a high level of accuracy, the information is very powerful.”
Providing further context on what the h-trak system can enable trusts to do, Nick explains: “It may look like a simple handheld scanner but it’s a computer in its own right. Everything starts with the patient. In an operating theatre, a clinician or healthcare assistant scans the patient’s wristband to identify them and then they can capture a variety of data fields.
“They’ll always capture the devices that have been used – it may be a knee implant, a pacemaker or a defibrillator – they’ll scan the barcodes on the packaging and our database identifies what that product is, its lot number, to identify exactly which production run it’s been in and the expiry date.”
Trusts not using a scanning solution tend to capture this information manually, typically using a notebook in which staff place stickers from a product or device’s packaging, alongside a patient’s details or enter the data manually into their local systems.
This can be problematic if there’s a recall, he explains, citing the PIP breast implant and pelvic mesh scandals. “At the moment, most trusts have to flick through all the books they’ve got from a certain date to see if they can find out which patient has been affected. You have to rely on someone manually flicking through this book and finding the right information,” he says.
“Whereas, if this data has been captured electronically it would take them two minutes to find out if that patient has had that manufacturer’s product implanted into them in the last three years and the lot numbers that are affected – in the same way supermarkets will put out a recall if there’s a foreign body in a yoghurt.”
Liz, Prospitalia h-trak’s Marketing Manager, adds that – following the recent pelvic mesh cases – the “safety of medical devices is very topical at the moment, including the need to track and trace.”
“There’s actually a new medical device directive”, she says, referring to The Independent Medicines and Medical Devices Safety Review, chaired by Baroness Julia Cumberlege, and its report from July 2020, entitled ‘First Do No Harm’. This has fed into legislation in the Medicines and Medical Devices Act 2021.
Data meets interoperability
Discussing how trusts can utilise h-trak to support better patient safety, Nick says: “Hospital trusts can capture a lot more information – that might be the surgeon who is performing the procedure, the procedure itself, how long the operation has taken, if there are any problems, or the infection status of a patient.
“This is where interoperability comes in. If we capture all this information on this mobile computer, at the end of the operation, a member of staff just has to tap a button and the data is synchronised from the handheld computer up to our server, which will then trigger what needs replacing on the stock side and generate the purchase order to the finance system.
“With that same data you’ve then got that traceability from the product to the patient. By scanning once you’re going to check the inventory level, generate a new order, have the ability to provide a high level of patient safety by having traceability of products, and you can also produce reports.
“If it’s a knee surgery, wouldn’t it be really useful to understand how each of the surgeons operate – whether they use different products, have different staff there, and whether that means an operation might cost more or take longer? The clinical staff can have reports that let them see if one surgeon’s knee replacement is more expensive than others.”
By collecting all this data, h-trak illustrates that everything within the health setting can be connected – be it finance, operational resourcing, clinical or procurement – and that organisations can utilise the same data to provide themselves with an overview to potentially boost efficiency across a range of clinical settings.
The captured data could even have yet more uses, such as infection control – to find out which members of staff, for example, were with infected patients on a particular day, to record reasons for stock wastage so it can be minimised, or allow trusts to claim the correct amount of money back from their local primary networks and keep more accurate funding levels.
Nick and Liz also described how one customer uses the technology to track timing points to measure theatre utilisation and identify inefficiencies in their processes. This could include understanding the reasons for gaps or delays between each surgery, known as “turnaround” times, and to identify potential bottlenecks, enabling better resource management.
However, Nick stresses, “we don’t fix the problems for clinicians and hospital managers – they’re the experts. But h-trak gives them real rather than anecdotal data to work with, and lets clinical staff decide the best actions to take to solve the problems that they identify.
“They can enrich their own information, so that they understand the whole patient pathway.”
“In terms of interoperability, you don’t have to install any big IT infrastructure, because our system is offered as ‘software as a service’ (SaaS) – it works over the web so actually we can transcend the usual IT interface issues,” adds Liz.
Case study: University Hospitals of Derby and Burton NHS Foundation Trust
Prospitalia h-trak works with a number of healthcare providers, including London North West University Healthcare NHS Trust, the South West London Elective Orthopaedic Centre and Gloucestershire Hospitals NHS Foundation Trust for Genmed, as well as at InHealth’s diagnostics units at St Peter’s Hospital and Epsom Hospital. Most recently, h-trak began being implemented in East Kent Hospitals University NHS Foundation Trust’s new elective orthopaedic centre in Canterbury.
The University Hospitals of Derby and Burton NHS Foundation Trust (UHDB), a leading GS1 Scan4Safety demonstrator site, which was the first in the UK to use h-trak, has implemented it throughout 39 theatres at the Royal Derby Hospital.
Originally purchased as a stock management system, because UHDB needed to control its spend, make savings and maximise revenue, the trust now harnesses h-trak’s data capture for a variety of uses.
Existing systems did not allow the trust to develop accurate patient-level costing and financial control for stock and stock usage. And staff also found it difficult to trace items implanted or used on patients.
Through the h-trak system, the trust developed an automated supply chain solution, so that staff at the trust can record patient details – capturing all consumables, instruments and implants, as well as the staff involved and codes that help log the actual rather than apportioned spend related to a surgery. The h-trak materials management software also detects stock usage so that requests can be sent to UHDB’s procurement system.
To date, the trust has captured and costed over 240,000 procedures.
On the trust’s case study, Nick added: “They use the data well – they use it within procurement to make purchasing decisions, the clinical director of surgery uses it to analyse his team and look at the variations in clinical performance and products, and they developed new products or amended products based on the data they found. For their finance team, the data gets fed into their finance system and they do an analysis, and it gets fed into their patient-level costing system.”
The Director of Finance and Performance at UHDB, said: “Implementing the h-trak system at Derby was originally meant to just improve stock usage and control information. It has now evolved into a system that improves patient safety in theatres and produces detailed patient-level costing information.”
However, Nick says, Prospitalia h-trak does not simply hand over the handheld devices to trusts and walk away – instead they work with hospital customers to ensure that the system is embedded and that everything is in place before go-live.
“It’s got to be a simple, repeatable process to capture data – if you make it complicated or long-winded, people don’t do it. It has to be simple for it to succeed,” he comments.
“We undertake a business process review – understanding the trust’s processes, suggesting improvements and matching up data, products and barcodes based on what the trust is buying. There’s so much information you’ve got to get right before you go live.”
Training on h-trak can take as little as half an hour, says Nick. “It is important that the nursing teams adapt the use of the h-trak handheld into their daily routine. A core aspect of our service offering is to support this change process, and this goes beyond the Go Live stage, as our customer service team are always available to help trusts when they need it.”’
To find out more about h-trak, visit www.prospitalia-htrak.com or call 0330 127 6240.