Lessons Learned from Scotland s Electronic Health Record Programme Greater China e-health Forum 7 th October 2011
InterSystems Established in 1978 Headquartered in Cambridge, MA Healthcare solutions headquartered in Sydney Worldwide leader in healthcare IT 30+ years of profitability and customer success 1,300+ partners Consistent growth and profitability Private, no outside investors, no debt Offices in 30 countries England Office Opened 1985 Scotland Office Opened 2010 Over 1,400 employees Over 800 TrakCare Sites
InterSystems Offering Regional / National EHR Patient Care Infrastructure HealthShare Platform for healthcare informatics and regional/national health information exchange TrakCare Web-based healthcare information system Caché Database and application development Ensemble Integration and development platform DeepSee Actionable Analytics
Partnering with Leading Local Healthcare Providers United Family Hospitals Premier network of six clinics and four hospitals in Beijing, Shanghai, Guangzhou and Tianjin TrakCare selected across all sites for unified patient administration, clinicals and lab WCI Series of Polyclinics running TrakCare as a Software-as-a-Service model Hong Kong Baptist Hospital 900 bed private hospital in Kowloon Currently installing TrakCare across the hospital network for unified patient administration, clinicals and lab
Hospitals Then
Hospitals Now
Theatres Then
Theatres Now
Medical Records Then
Medical Records Now
What is Required?
International Clinical Requirements Single clinical view EPR Clinical information at the point of care eprescribing Decision Support Order Communications Acute care Primary care Community care Discharge Summary Online patient bookings and scheduling Real-time clinical & business analytics
What is Needed to be Successful? Business commitment with administrative & clinical champions Access to a single Patient Record (EPR) A strong implementation process We need doctors to enter the key clinical information How do we get them to do it? Needs to be intuitive Needs to be entered unstructured Needs to be presented structured & in context Needs to be quick Needs to provide the right information at the right time and place Realistic budget, business plan & cost savings
TrakCare - Healthcare Information System TrakCare is one product not multiple products connected Application Ensemble Caché Multi-language system designed to be sold internationally Easy to change appearance of screens and workflows Easier to tightly integrate to other applications Can be sold as a true enterprise solution Positioned in the Visionaries quadrant by Gartner, Inc. in their 2011 Global Enterprise EHR magic quadrant Customers in 25 countries with over 800 sites worldwide
TrakCare Benefits Information at the point of care Browser-based for everywhere access User interface flexibility Multi-media Messaging Active decision support Freedom of choice Many settings one solution Investment protection Foundation implementation Embedded analytics
Applications For All HealthCare Settings Primary Care Clinics. TrakCare Clinic - registration, appointments, clinical (SIDRA, Hong Kong). Community TrakCare Community - vaccinations, home nursing, allied health, home monitoring, social care, mental health, ambulance (Victoria Australia, NHS Lothian) Acute Care Hospitals TrakCare - PAS, Clinical, Departmental, Labs. (Austin Health, Einstein Hospital, Bangkok General Hospital). Tertiary Care Hospitals. TrakCare - PAS, Clinical, Departmental, Labs (Molinette, NHS Lothian) Regional Healthcare TrakCare - PAS, Clinical, Departmental, Labs (GDF, SWARH, SSMOC) HealthShare EHR Clinical Record. (BHIX New York). National HealthCare TrakCare PAS, Clinical, Mental Health (Scotland, UK) HealthShare EHR Summary Clinical Record (Sweden)
Customer Challenges Worldwide economic crisis Huge cost cutting UK 20% effecting NHS frontline services Fast moving complex environment: Stringent targets Improve efficiency Reduction of paperwork Reduction of errors Improve patient experience/safety Old disparate systems = multiple sources of information
NHS England Connecting for Health Centralised Procurement & Design Massive Scale, Scope & Budget National Messaging Infrastructure National Demographic & Access Services Choose & Book Electronic Transmission of Prescriptions 100% PACS deployment Single-Solution Vision for Care Records Reconfiguration to allow solutions choice Re-evaluation of existing systems Driving a focus on integration
NHS Scotland
NHS Scotland s Approach A consortium of five NHS health boards was formed to lead the procurement (Ayrshire & Arran, Borders, Grampian, Greater Glasgow & Clyde, Lanarkshire) The remit of these boards was to act on NHS Scotland s behalf and procure a Patient Management System which was: Affordable Clinically acceptable Could be implemented across five health boards in two and half years
NHS Scotland Procurement Process Tender submitted (October 2008) National tender for PAS and Clinicals including Accident & Emergency, Mental Health, Orders, Prescribing Optional modules 1600 page response Vendor shortlist (January 2009) Workshops commenced (February 2009) Application presentations Technical discussions & presentations Down to three vendors (March 2009) Application presentations Technical discussions & presentations Commercial & legal discussions Best and final offer (September 2009) Contract awarded (February 2010)
TrakCare - PMS Scotland This contract will enable Health Boards across Scotland to implement a single, nationally available patient management system that will play a major role in improving patient services. Clinicians and patients will both be winners from a system which will track patient journeys from referral to discharge. It means clinicians will have easier and quicker access to medical records and patients will benefit from having more time with healthcare professionals. Nicola Sturgeon, Health Secretary
TrakCare - PMS Scotland PMS/PAS incl. Mental Health Clinical Support Tools Order Communications Clinical Mental Health A&E Maternity Neonatal HEPMA Pharmacy
TrakCare - PMS Scotland Clinical Tools A&E Maternity Neonatal Clinical Mental Health PMS including Mental Health New Ways SMRs & ISDs Simplecode & QAS Order Communications Reporting and Management Information DeepSee Business Objects Interfacing & Interoperability National CHI SCI Store / SCI Gateway Carestream PACS Special Needs (SNS)
NHS Lanarkshire - Some Metrics 7 miles of records on acute sites 5 miles of records in Secondary Store Each year create further 1 mile of records Retention Periods: 3 Years after death 25 Years For Obstetrics, Children and Psychiatry 6 Years Everything Else
NHS Lanarkshire - Some Metrics 85wte ( 1.5m) directly handling pulling and filing of 1.5m case notes per annum 4wte ( 70K) maintaining secondary store - alternative to commercial storage Each new record costs 1.30 order 75,000 per annum 5 minutes to pull and prep a case record for a clinic 25% of records missing at first pull Other costs secretaries, ward clerks, porters, transport, clinical, labels, energy, paper Incomplete, inaccurate, inaccessible, inconvenient
Implementation Process
The Process
TrakCare Implementation Key Strengths Speed of the installation Implementation methodology Staff experience PIOVTC10A
Implementation Plan Series of 10 steps Aimed to get live in an agreed timeframe Foundation is key to this approach: Provides certainty with deliverables Eliminates a large number of tasks from the project plan Changes to Foundation are analysed and agreed
10 Steps to Go Live! 1. Prepare Infrastructure & Install TrakCare Foundation 2. Project Kick Off 3. Local Data Collection Training 4. Local Data Collection 5. Population of Pre- Production Environment 6. User Acceptance Testing 7. Super User Training 8. Site Implementation 9. Final Installation and End User Training 10. Pre Go Live Check & Cutover
TrakCare Delivery Principle Implementations can be delayed through overconfiguration and system complexity We can make the mistake of trying to become system experts before implementing the system Methodology aims to develop expertise of customers through the implementation process This delivery principle ensures the customer achieves Go-Live in the fastest possible time
Implementation Based on Foundation TrakCare Local Configuration TrakCare Scottish Foundation TrakCare Global Foundation Core, Optional & Additional Modules Proven software Scottish Functionality New Ways SMR/ISD/Data Dictionary National CHI SCI Store / SCI Gateway A&E 4 Hour Wait Carestream PACS SNS ereferrals Unrivalled Flexibility User interface Workflow Interoperability
Implementation Schedule
Results To Date
NHS Scotland - Results Office opened in Edinburgh (May 2010) TrakCare implementation team Program Manager 6 Project Managers 2 Healthcare Architects 45 Application Specialists 5 Integration Specialist 5 Technical Specialists Foundation completed on time (August 2010) Boards Go-Live PAS, EPR & A&E First Board Borders goes Live on time (November 2010) Lanarkshire, Grampian, Lanarkshire & Glasgow (stage 1) all Live September 2011 Go-Lives next steps LanarkShire Lab November 2011 Mental Health Grampian by March 2012 Order Comms. All Boards by July 2012 Additional Boards start (Late 2012)
The Differentiation Factors
Solution Summary The procurement process was open & honest - allowed greater understanding of customer requirement Commitment nationally; clinical & admininstrative champions at Boards Direct access with the customer Experienced staff on both sides - no nurse Nellys Unified application with portfolio of modules, with one shared data model, on one database. Enabled enterprise standardisation Ease of connecting existing applications with embedded integration platform National product Foundation resulting in better timely role out Unmatched flexibility for screen layouts and workflows Proven in large and complex health environments
Thank You & Questions