24 September 2009
Delivering a Single Record for GP and Community Care in South West Essex
Article written by NHS South West Essex
The 'World Class Commissioning' programme anticipates that more and more health services will be taken to the patient. Community based services are delivering health care and wellbeing solutions to patients in their local community and own homes in a continuing trend designed to improve patient care and outcomes. But this is only possible by virtue of a substantial and efficient infrastructure that moves around staff, supplies and, importantly, patient information.
NHS South West Essex is at the forefront of ensuring the right information about the right patient gets to the right people at the right time. This is done by ensuring the information GPs hold can be used and updated by those providing community health services, and vice versa.
For some time, it was recognised that the inherited system used for recording and reporting on community services' performance met neither local needs nor the principles of the National Programme for IT. Its processes were paper-based and labour intensive; reporting was poor and not able to support direct patient care. A new, local solution was needed.
Central to identifying a solution was the recognition that 83 percent of general practices in the area were already SystmOne users. This underpinned the PCT's decision to continue the investment it had already made in rolling out the GP and Child Health modules of SystmOne by implementing the Community module.
Ian Dobson, Associate Director of IM&T/NPfIT, drove the transition. He says, "The SystmOne Community module offered a single patient record across primary and community care. Eventually it will interface with the Lorenzo Secondary and Mental Health solutions on offer from our Local Service Provider, CSC."
The principle of the system to achieve a single patient record is simple – each patient has an electronic record that can be accessed and updated by appropriate clinicians involved in a patient's care.
The intention was for community services using the inherited system to be migrated onto SystmOne Community, with completion by 31 March 2009 when the inherited system's contract expired.
Ian Dobson established a project board with the aim of meeting the March 2009 deadline. The project board first met in September 2007 with representatives from community services, IM&T, Registration Authority, and the GP community.
Dr Jon Tuppen, a local GP and an ardent supporter of integrated, community-based care, was a natural recruit to the project board. "I had long recognised the potential of the Community module and its interactivity with SystmOne GP," recalls Jon. "But I felt it was important to emphasise the importance of reciprocal sharing as another mechanism to ensure patient consent andensure we realised the new module’s potential."
A small team led by Annette Gaches from SWE Community Services developed a project plan, and began the phased approach to rolling out the new system.
The project began to deliver results in December 2007 with Community Matrons, Collaborative Care and pilot programmes for Health Visiting and Paediatric Services becoming part of the first phase of the switch over. The project requirement to implement SystmOne across all community services using the inherited system within strict timescales meant the pace of implementation had to be significantly increased.
Project Manager Julie Shkreta took on day-to-day responsibility for the project in July 2008. "I’ve been involved in a huge range of projects over the past 10 years, both in the DoH and the local NHS," explains Julie. "Such a large-scale and complex project as this called on much of my experience. One of the biggest challenges was managing the multiple relationships and competing needs across the project arena."
Julie's role also extended to ensuring the project was supported by the right IT equipment and infrastructure. "We installed almost 700 new PCs, laptops and peripherals," says Julie, adding, "Moving away from a paper-based system needs system connectivity and for this project an additional 127 SystmOne Community and GemPlus software installs had to be made."
A key aspect of the project's success was engaging with those who were responsible for the day-to-day use of the Community module. Forty-seven service leads and clinical champions were engaged. Agreements were negotiated to provide them with 'protected time' to ensure they were able to focus on and commit to supporting the project.
From May 2008 to the end of March 2009, 45 services were migrated onto SystmOne Community. These are arranged under four group headings: Health Visiting, School Nursing, District Nursing, and other service areas ranging from Collaborative Care and Looked After Children to Diabetes and Epilepsy.
PCT community services are housed on 30 sites, spread geographically across the area - from Tilbury in the south to Billericay in the north; covering single-site services such as the Minor Injuries Unit in Orsett to multi-site services such as Musculo-skeletal on three sites.
The success of the project means that there are now more than 1,300 users of the community module.
Mandy Steele works in Thurrock Day Hospital as a clinic administrator. Her first impression of the new system was "mind-blowing!" But the transition to SystmOne went well. "I’m not so at home in classroom training," says Mandy. "I work best with hands-on training. Nick Grey, the Business Change Trainer, made it all seem so clear and was always there when we needed it."
Besides the obvious benefits, like improved reporting times for bloods, the new system has given Mandy an improved perspective on her work. "It’s not all perfect yet, but SystmOne has really helped me to see I am part of something bigger, and I feel better about what I do because of it."
The Primary Care Trust’s commitment to ensuring that implementation of the new system was a success was reflected in the project resources deployed. Eight business change leads and seven training staff were assigned to work with the service leads and their teams. Their wide-ranging brief included carrying out operational impact assessments to identifying the existing business process through to identifying any risks or issues relating to the service moving over to SystmOne.
As well as leading the project, Ian Dobson has the responsibility of ensuring the strategic integration of SystmOne across the PCT: "As anticipated, the implementation of the Community module is now supporting the development of other patient centred activities, such as the Integrated Care Project being deployed at our new Brentwood Community Hospital (BCH)."
The BCH Integrated Care Project, whose clinical lead is Dr Jon Tuppen, focuses on adults and older people with long-term conditions. "The use of the SystmOne Community module with its real time, two-way connectivity is central to ensuring my patients can be treated in their own homes or at local, community-based facilities such as BCH, with shorter waits, continuity of care and better clinical outcomes."
So, has the transition from the previous system to the SystmOne Community module delivered what was anticipated of it when the project was started back in December 2007?
According to Mandy in Thurrock Day Hospital, "It was like saying goodbye to an old friend, but we're learning more and more about the new system all the time. It's certainly better for the patients and everyday it gets easier for us."
"At times it was more like a way of life than a project," says Julie Shkreta. "But the amount of buy-in at every level really helped to empower the project. The board were clear about what they wanted, and the team were as certain about making it happen. Completion on time was due totally to the commitment and enthusiasm of everyone involved."
As the person ultimately responsible for ensuring success of the project, Ian Dobson explains his strategy: "With so many of our general practices using a common system, the vast majority of our population now have a single patient record spanning primary and community care. In time, this single record will span across secondary care and mental health."
Ian's final thoughts? "Thanks to everyone who worked so hard to deploy SystmOne, IT is doing exactly what it's supposed to in the NHS… seamlessly supporting patient care and providing clinicians across all care settings with the information they need, where and when they need it. In effect, the fundamental vision of the National Programme for IT."
