Acute care software solutions: CareCentric at Poole Hospital NHS Foundation Trust
Poole Hospital NHS Foundation Trust and Graphnet have been working in partnership for 13 years. Over that time, Poole has successfully used the CareCentric product suite to implement an electronic patient record system which is tailored specifically to meet the Trust’s needs, working practices and pathways. The system is now used by over 5,000 users at the hospital itself and in clinical networks, GP practices and social services across Dorset.
Poole Hospital NHS Foundation Trust
The Trust is a 621 bed acute hospital which treats some 47,000 inpatients and 27,500 day cases a year. It has around 70,000 new outpatients annually and 60,000 people attend A&E.
It serves a population of 272,000 people.
Poole Hospital is the trauma unit for East Dorset, with a 24-hour major accident and emergency department. It also provides a broad range of district hospital care and a number of core services, such as child health and maternity for a wider catchment area, including Bournemouth and Christchurch. In addition, the hospital provides specialist services such as cancer care to patients from across Dorset.
What is in the Poole EPR?
The Poole EPR holds a large and comprehensive body of data for the Trust’s patients. Today the system holds over 65m documents for 1.7m patients and this data represents a primary source of information for clinicians. The value and importance of the data can be seen by the fact that on average, there are over 9,000 accesses to electronic patient records each day with peak daily access volumes of around 14,000.
CareCentric accepts automated feeds from numerous local systems. Data fed in automatically at Poole includes PAS activity and outcomes, pathology results, radiology reports, GP referral letters, A&E discharge information, neurophysiology results, medical photography and cardiorespiratory results.
In addition, Poole has built a large number of specialist clinical solutions around the EPR using CareCentric’s form building capability. There are now 65 specialist data collection form sets in use. These include oncology, immediate discharge summaries, medical photography images, MDT documents, VTE risk assessments, psychological assessments and wristband printing. A further twelve form sets are under development.
The specialist systems support is in response to requests from service users and the solutions are used to drive clinical practice and create care pathways. A clinical user forum ensures the data forms used are fit for purpose and relevant, and that the information captured is consistent with changing clinical practice. This combination of automated data feeds and extensive specialist clinical data provides an extremely rich clinical record.
The Poole EPR includes the following
- Patient Administration System Information including Inpatients, Outpatient, Clinical Coding
- A&E Attendance Information
- Discharge Letters and Clinic Notes
- Pathology/Radiology Results for both Poole & Bournemouth Hospitals
- Numerous XDOC Clinical Notes
- Immediate Discharge Summaries
- Scanned GP Referral Letters
- Community Clinic Notes/Letters
- Hospital Care Plans
- Cancer MDT Reports
- Electronic Sign Off for Inpatient Results
- Multimedia including Medical Photography Images and Videos
- Critical Patient Information (Patient Alerts)
- Clinical Documents from external sources (Word, PDF)
- Neurophysiology and Cardiology Results
The Poole EPR: Who uses it?
The Poole EPR is used extensively by clinicians and clerical users across the Trust. It is also used by GPs to access hospital records and by clinicians working in clinical networks across Dorset. Users of the system include:
- Most clinicians and clerical staff at Poole hospital
- Specialist clinicians at other local acute Trusts including Royal Bournemouth & Christchurch Hospitals NHS FT, Dorset Healthcare University NHS FT and Dorset County Hospital NHS FT. Clinicians in Hampshire have been given access to it for cross-border patients
- 500 users across 50 GP practices
- Community hospitals (eg in Swanage, Wimborne)
- Specialist community services and clinics (eg children’s)
- Social services
- South West Ambulance Service as part of the Single Point of Access process (SPOA)
By providing more complete information, and reducing the time spent casting around for information, the EPR at Poole delivers important benefits both in terms of the quality of care provided and the efficiency of Trust services.
Quality of care
- Instant access to a detailed care record, with information on treatment, medications and tests. All fed from multiple sources to ensure the information is up to date and accurate. No loss of records
- Information is entered once and shared with relevant parties, ensuring accuracy, a rich record and an improved patient experience
- Tabular trends and results graphing - allows ‘out of range’ results to be highlighted, facilitates tumour marking, charting facility makes it easier to spot deterioration in vital signs and acts as early warning system
- Alerts ensure timely intervention
- The Immediate Discharge Summary (IDS) allows a pharmacist to sign off drugs - which means they have a complete picture including allergies, conflicts etc
- Easy identification of results that have been viewed but not signed off by clinical staff leads to greater accountability
- Improved communication between stakeholders supports better patient safety achieved through
multi-disciplinary care pathways
- Duplicate requests are flagged in the EPR, leading to a reduction in appropriate procedures and minimising unnecessary patient discomfort
- Supports new legislation, best practice and guides staff through the clinical processes
- Audit trail of use of documents
- Considerable time-savings have been identified as a result of staff being able to view records on the EPR - no more chasing notes or test results
- There is a significant reduction in paper - eg the filing of paper results slips from pathology for inpatients has been eradicated
- Electronic requesting - eliminates duplicate requests, prevents handwriting errors, ensures all request forms are complete
- No loss of records
- Bar-coded wristbands are produced on the ward by CareCentric. Ensures instant access to the patient’s records, and reduces the risk of wrong-pulled patient notes.
- Multiple feeds from other electronic systems in the CareCentric EPR has reduced duplicate data entry
- The Immediate Discharge Summary uses traffic light reports to make sure pharmacists are kept up to speed with discharge priorities which brings forward discharge times
- Supports new legislation, best practice and guides staff through the most effective clinical processes
- Use of BI tools to audit activity data means that overheads associated with the collation and analysis of audit information has been significantly reduced
The Solution: The CareCentric EPR
CareCentric Highway - This can integrate data from a wide range of health and social care IT solutions and makes that data available on a single platform. Highway is being used to link and integrate data from hundreds of systems across the UK.
CareCentric Gateway - this is the electronic patient record and portal which presents users with a unified view of the data extracted by Highway. It provides a single care record which allows multidisciplinary teams from single trusts or multiple care settings to work together to deliver a coherent, integrated service to patients and clients.
Key features include:
- Structured clinical summaries - eg A&E summary with items such as current medications and active diagnoses from the GP record with latest test results and previous A&E attendances from the acute systems.
- Patient lists such as current inpatients, planned admissions, patients with selected conditions
- Alerting and notifications allowing clinicians, providers and other carers to be notified about key events such as an admission or abnormal result
- Charting - can put GP data into graphical form, or merge data from multiple sources into one chart
- Third party system integration - Gateway supports the calling of third party systems with single sign-on and patient context support
CareCentric CAMS - this is a comprehensive care management system which can be supplied preconfigured to support specialty activity (eg rheumatology, podiatry, physiotherapy, occupational therapy, district nursing, end of life management and Common Assessment Framework) and also configured for local requirements.
It is the CAMS forms building capability that has enabled Poole to write its own specialist clinical systems. CAMS functions include data collection, assessments, results reporting, workflow, electronic document management and care pathways. The CAMS functionality supports clinicians working within or across disciplines and organisations.
Round the clock access to a shared patient record
CareCentric is a web-based solution, so detailed patient information is available around the clock, wherever there is a secure link. Access is over N3 and is available to users not on the N3 network via secure VPN tunnels. This means that the record can be used by all appropriate clinical staff, regardless of location. Clinicians with a secure connection can access it from home when on call.
This easy access makes it straightforward for the system to support cross-county activity. Cancer patients can decide where to go for treatment, for example, and the record is available at all points of care. Staff at the county-wide renal unit, which is based at Dorset County Hospital, can likewise access full records for Poole patients under their care.
Multi-agency access makes the system a good platform for the support of multi-disciplinary care pathways. In Poole, the palliative care teams use CareCentric to record and plan care.
For further information about Graphnet, the CareCentric product suite and the HHR, please contact us.