Building the digital hospital


it’s going to be a much more exciting much
more positive world that we’re living in if you want to see the degree of change Just
look at what’s been happening outside the NHS look at the way in which we do business
now and the way in which we buy books the way in which we plan overseas travel it has
changed it is liberating sure its more empowering for the patients but its going to be more
empowering for everybody those of you who are trying to manage if you’ve got more better
information then managing is going to be a more fulfilling rewarding task so you know
this is exciting these are exciting times everything is going to change and it will
change for the better it’s not about the tools it’s not about the I T systems it’s about
what you can try and achieve with them so the existing measures that you have in place
will be the same measures that you use to evaluate to assess the improvement it’s about
what these tools allow you to do it’s what they make easy it’s what they facilitate
I think the paperless system is of course
something that fascinates patients the younger generation of patients is very familiar with
the digital world and the older generation is fascinated by it and the ability to immediately
demonstrate imaging imaging reports and actually go through an X Ray with the patient has transformed
the interaction between us in real time we’ve been able to give patients access to the appointment
dates their surgical dates their imaging their blood results and their referral letters are
as visible to them as they’re visible to us the wonderful things about this system in
talking to patients particularly at the bedside and directly in outpatients is that I can
go through with the patients bit by bit and they can cross question me about um plans
and results on them and I can now of course actually shown the X Ray I can show them the
report and they may have specific questions I think that’s improve patient care and quite
clearly on occasion it’s improved patient safety and patient governance and they feel
empowered they feel as if they are involved in their patient records they feel as if they’re
involved in their care well looking through the images it gives you more of an idea of
what’s actually going on and it sort of reassures you One of the things about this digital system
is its ability to store information and to track where the information is going who has
looked at it and in what sort of time scales they looked at it and what action they took
and I think that’s transformed both how we deliver safe patient care but also about how
we think about the opportunities for delivering patient care in the future this digital audit
trail also allows us to identify areas of good practice in the system and areas of poor
practice and the areas of good practice probably have a lot to teach the areas of poor practice
There was an interest in reducing the amount of lost equipment that we had going out of
the trust so we installed RFID the asset tracking system which essentially is just using small
tags RFID tags which beacon out to the wireless infrastructure from any PC on the network
anywhere in any of the hospitals you can log in you can track down an asset to the nearest
few metres it’s been hugely popular to be honest we’ve gone from maybe I think in the
first year we had a hundred of these RFID tags and now we’re close to six hundred so
being able to keep track of what we have we should be able to rent less so that it’ll
cost less for the trust per year so not only do we save money in terms of what we lost
but we are actually spending less on what we rent the medical equipment library are
saying that they are being able to see where things are where things aren’t being used
and be able to go and recover them rather than waiting for them to be brought back they
should be able to track them down a lot quicker and then being able to make them available
for other departments to use the main benefit of the electronic prescribing system in terms
of cost can be summed up in two areas cash releasing and non cash releasing so cash releasing
savings will be around better management of pharmacy drugs and the way we use drugs across
the organisation reducing waste that takes us on to non cash releasing savings the majority
of those will be around saving people’s time and effort in terms of finding drug charts
accessing right protocols making sure that we are prescribing accurately all the time
and it may well even lead to reductions in length of stay which is better for patients
the electronic prescribing system has huge benefits in terms of patient safety we are
moving away form scribbled drug charts to really well documented electronic drug charts
clinicians will have guidance in terms of what to prescribe how to prescribe and the
dose there is some very basic things that the system gives you a very good advantages
on within the J R Site we have automation that has recently been installed that will
have a direct link into the prescribing process so in terms of quality what a doctor prescribes
will be electronically transferred through the pharmacist checking to the robot picking
that same product which cuts out a whole number of areas in which transcription errors can
occur the initial business case the business plan has identified around eight hundred thousand
savings in terms of cash releasing around the medicines management process but clearly
the system is much bigger than just medicines management and in terms of workflow and non
cash releasing there’s about a four point four million pounds has been identified in
the original business case general practice and hospital medicines got increasingly intertwined
we integrate many of the care pathways nowadays and it’s only possible to do that safely and
efficiently if we can all share the same information and that’s become more and more apparent as
we begin to try and cost out of the system which really aims to reduce duplication if
patients have a better journey through their episode of care because either the out patients
department or the emergency medical unit or the discharge service have got information
from primary care and other sources to hand when they’re doing their part of the care
that is to improve the appropriateness of what care the patient receives from GP point
of view all that helps the patient get good care and therefore is less likely to have
to be tidying up the loose ends afterwards so I think oxfordshire care summary is the
future it’s going to be an interesting journey because it depends on good quality information
and that’s the exciting thing is it begins to make you look at what is the information
that adds value to clinical care GP coin actually stands for Community of interested networks
so the whole project is about bringing them on to what we have already an Oxford COIN
that’s what we’ve been doing for last six months and this is pretty much complete and
bringing on all those Oxfordshire G P’s and which will have a single network infrastructure
across Oxfordshire in the last six months we’ve gone from having eighty six sites to
one hundred and ninety sites so the network has grown quite significantly but what this
allows us to do is we’ll have a single wireless infrastructure to all the GP’s and all the
acute hospitals and community hospitals so any staff moving between GP’s community sites
OUH sites will be able to work seamlessly and in addition to that we can do IP telephony
for all the GP’s free telephone calls between GP’S and the acute hospitals is quite significant
saving for GP’s is but will also improve the working relationship between GP’s and the
acute hospital as well we’ve seen quite good improvements GP’s accessing PACS and casenotes
and blood results that’s the main driving force behind this about improving their connectivity
to OUH resources The SEND project is about making nurses care more efficient we record
patients OBS straight into the electronic patients record which eliminates errors and
the speed of the time we can act on abnormal errors the SEND project is about improving
the quality of care for patients SEND allows us to do this in three ways the first is by
making it easier and faster for staff at the bedside to enter patient information the second
is that it improves communication for staff on the ward and have a discussion with a doctor
on a remote ward and both of them can be looking the same chart at the same time discussing
what’s best for the patient and a third way that it improves care is by strengthening
clinical governance allowing managers of the hospital to have a real time view what’s happening
in the hospital and whether processes need to be improved Because you scan your patients
ID badge and you scan yours you can track and use within the record there’s no risk
of putting record in the wrong patients paper copy because the ID is right on the patient
Once you are entering data the system is doing the plotting for you so there is no risk of
plotting errors and it’s also checking what you are typing so if you type in a value that
is clearly wrong the system will alert you allow you to correct it so there’s no danger
of writing in the wrong column or not treating the patient when the patient is deteriorating
it tells you automatically the colour changes you can’t miss it it’s faster to enter data
in SEND because you don’t have to do the manual plotting you don’t have to look up and down
the graph to make sure you’re putting things in the right box the computer is taking care
of that all for you leaving you more time and focus to make sure you get the data right
well big data is about aggregating putting together a large sources of disparate data
so once you have all the data linked together you can start looking for unusual patterns
or abnormal patterns so big data is about linking all of these different sources of
data together allowing you to know much more what’s happening to the patient journey in
your hospital so once you know more what is happening to the patients from the moment
they come in through the front door to the moment they are discharged then you can actually
make the hospital more efficient you can optimise resource allocation across the hospital on
different types of wards you can reduce the risk of re admissions which is going to be
something that is to become more and more important you can reduce the length of stay
of patients you can minimise the risk of having adverse events due to inappropriate or dangerous
use of drugs so there’s a whole host of benefits from simply having the knowledge about every
patient within the organisation at any one time is probably not any longer an option
not to invest in information technology one of the the big advantages for me of big data
is going to be the fact that we’re going to link databases which so far have not been
linked then we’ll be able to track the whole patient journey marry all that information
in which it can be very important to improve patient care and optimise the management of
the patient at the hospital making sure that we use the data that gives us to innovate
to make sure um patients within our population get the best possible care and medication
for their diseases what we need to be is seeing the system as one joined up database that
allows the clinician to get access to the patient record as he needs it to provide good
care that is obviously difficult but it’s the nirvarna that we need to get to it’s transformed
the way I deliver health care it’s transformed the way we think about health care and transformed
the way we’re planning health care for the future there is no area of OUH’s operations
can be unchanged by this information revolution everything you do is going to be advanced
but this these are the new tools that help you in every aspect of patient care and service
delivery

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