Putting patients at the heart of a digital hospital

Over the past ten years, we have focused efforts on enabling our staff, across Cambridge University Hospitals, to use advanced digital technology to improve patient safety and support the delivery of consistently and ever-increasing high-quality patient care.

Relying previously on paper patient records and multiple aged IT systems with limited integration and capabilities, our eHospital digital maturity programme, established in 2010, was born out of our desire for data-driven clinical care and safety improvements through the use of digital technology. In 2013, following business case approval and external assurance, we embarked upon an NHS first-of-its-kind digital transformation; comprising a ‘built by our hospital staff for hospital staff’ fully integrated electronic patient record (EPR) system combined with a trust-wide refresh of our entire computing estate and IT service support.

Investing in our people has been essential from the outset. Over 100 hospital staff with varying skills and expertise – clinicians, clinical support staff, administrators, operational, managerial and analytical staff – joined the eHospital programme team in 2013 and configured the Epic Foundation System for the UK. The recent (2019) Epic implementations undertaken by Great Ormond Street Hospital and University College London Hospitals have been based on this UK Foundation platform, as will the Royal Devon & Exeter implementation due this summer (2020).

A digital revolution

Since implementing our EPR in October 2014 across our two hospitals, Addenbrooke’s and The Rosie, the delivery of patient care has been completely transformed. Clinicians have access to comprehensive electronic health records for their patients, in one place at the touch of a button, enabling them to view and document all clinical information, in real-time, whenever and wherever required. This has reduced our use of paper patient records across our hospitals by 99%.

At the time of implementation, we introduced over 800 integrated handheld and mobile devices to enable clinicians to document care in real-time and at the bedside. We also connected all physiological monitors and ventilators in 40 theatres and 148 high dependency/critical care beds with our EPR to automate the flow of data from medical devices directly into patient records.

By whichever route a patient arrives at one of our hospitals – as an outpatient, through our emergency department, or admitted as an inpatient – the team caring for them can see their health record in its entirety in the system. They all have access to the same information about the patient, which is vital to timely and consistent care as well as safety.

Supporting others across the NHS

Increased digital maturity supports improvements to patient safety, care and experience, and helps to reduce unnecessary duplication of tests and delays to care and treatment. Within a year of EPR implementation we moved from a HIMSS EMRAM Stage 1 rating to Stage 6. Digital maturity is not though solely about the technology implemented. For us this achievement reflected our digital and clinical collaboration to bring about profound benefits to patient care through the adoption of supportive digital technology.

Since achieving EMRAM Stage 6 in October 2015, we have been focusing on providing continuous care improvements through our digital maturity efforts.

For example, in 2015/16, when reviewing our data on systemic sepsis, it was clear that there were opportunities for real improvement. Work started with our acute medicine physicians, in conjunction with our infectious disease team and our in-house eHospital digital team, about how we could construct a workflow that would be really supportive of our clinicians, utilising technology to quickly identify patients with sepsis and so ensuring that their treatment and outcomes were better.

We know for every hour that antibiotics are delayed in patients with sepsis there is a 7-8% increase in the risk of mortality. We adapted our clinical workflow and reconfigured our EPR to incorporate innovative sepsis alerts and action features and then trained staff in how to use it. Since introducing this in-house configured functionality, there has been a 70% increase in patients receiving antibiotics for sepsis within one hour of arrival in our emergency department and a 50% increase in inpatients receiving antibiotics within one 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.

Through further clinical and digital engagement and collaboration we explored, devised and implemented closed-loop medication administration workflows across all of our 51 wards, five critical care areas and the emergency department; enabling staff to ‘scan for safety’ to help ensure the right medication and dose are given to the right patient and in the right way, each and every time. We have since introduced closed-loop human milk administration across maternity, paediatric and neonatal areas.

These efforts, among others, have led to national and international recognition – including validating against the tougher HIMSS EMRAM Stage 6 standards in October 2018 – for the collaborative work across our hospitals in embracing and adopting new technologies and capabilities to continuously put patients at the very heart of our digital hospitals.

To help support other digital maturity work carried out across the NHS, we recently published our eHospital digital journey. These topics will be explored in more detail at the HIMSS Digital Maturity (DM) event taking place in Cambridge on 28 January.

Dr Afzal Chaudhry, director of digital and CCIO at Cambridge University Hospitals NHS Foundation Trust, will be speaking at the HIMSS DM event later this month. Healthcare IT News is a HIMSS Media publication.