As the age of paper-based patient record systems comes to an end, a number of electronic patient record systems have emerged as potential alternatives. However, almost all to date have come with their own share of problems and difficulties which negatively impact upon the ability of healthcare professionals to provide the care that patients deserve on a day-to-day basis.
As PatientSource has been developed by doctors & nurses with years of experience in providing frontline care we believe that it avoids the pitfalls encountered by legacy electronic patient record systems through its intuitive nature and resemblance to traditional paper charts, whilst also standing out due to its innovative cloud-based structure and tablet-compatibility.
What’s more, we estimate that PatientSource could potentially save the average NHS Trust £16.5m per year. That translates to ~4.7% of the average NHS Trust’s annual budget. If you’d like to learn more then feel free to visit www.patientsource.co.uk and check out our online demo!
For generations healthcare professionals have relied on paper-based systems for patient record keeping, prescribing and noting of observations. However, it has become more and more apparent that paper-based patient record systems are associated with a number of limitations which render them outdated. These restrictions include but are not limited to: the inability for multiple healthcare professionals to simultaneously access an individual patient’s notes, the likelihood for patient notes to go missing, and the misinterpretation of writing in drug charts which inevitably leads to adverse drug events.
If we look at the 2013/14 statistics for the Royal Berkshire NHS Foundation Trust (a Trust which can be considered to be of an average size nationally in terms of income, number of beds and staff numbers) we see that 29.3% of inpatient notes were not available at the time of an audit, 55% of notes were not filled properly and 87% of pages were missing a patient identification label 1. Whilst this may be only one Trust, it is clear that nationwide, numerous NHS Trusts are struggling to operate efficiently, with the number of NHS Trusts in deficit increasing from 21 to 157 between 2009/10 to 2015/16 [Figure 1], with NHS providers and commissioners experiencing an aggregate deficit of £1.85 billion in 2015/16 (three times that of the previous year) 2.
In light of these facts it is clear that adoption of an effective electronic patient record system offers a promising strategy in ensuring the continued survival of NHS trusts. However, there is no denying that there are several examples of NHS trusts adopting electronic patient systems only to experience a drop in quality of care and financial deficit.
Junior Doctors have been sharing their experiences of legacy electronic patient record systems. One member of the "Digital Doctors Collective" group on Facebook observed that “It is horribly obvious that most of the medical software we use has not gone through a period of real iteration and improvement in real world tests.”
A member of the Facebook group "Junior Doctors Contract Forum" shared that his Trust “brought in an electronic record management system that was scrapped after it proved unfit for purpose. It was unusable in clinic, trying to slowly pick through 500 unsorted PDFs at a snail’s pace."
Another Junior Doctor in the same group feels that "it would be an infinitely smaller, or indeed non-existent, list of people who had not experienced an IT system in some way adversely impact their ability to deliver patient care on some level."
The topic of Addenbrooke’s hospital’s adoption of the £200m Epic electronic patient record system was also raised, as it has become well known that Cambridge University Hospitals NHS Foundation Trust had to be put into special measures following a Care Quality Commission report which outlined problems caused by its introduction, many of which are put down to staff’s lack of familiarity with the system 3, 4. We spoke to Locum A&E doctors in Cambridgeshire who have refused to take up shifts at Addenbrooke’s because they feel the Epic system slows them down; it is our opinion that the system may have a similar effect on other departments.
This is not the only example of a legacy system resulting in difficulties for an NHS Trust. One need only look at The National Programme for IT’s funded product, Lorenzo, an electronic patient record system which has been in use at 11 NHS trusts and associated with persistent problems including: “duplicating patient records, losing patient records, not registering when patients have had surgery, booking in the wrong patients for surgery, and causing problems with booking and scheduling more generally” 5.
So what exactly does PatientSource do to improve upon the problems associated with a paper-based system whilst avoiding the pitfalls caused by legacy electronic patient record systems? Well, for a start we’d like to emphasise that PatientSource stands out as the only electronic patient record system which has been developed by doctors and nurses with years of clinical experience. This means that PatientSource takes inspiration from paper drug charts and observation sheets in order to provide a user experience which is intuitive for healthcare staff, but free from possible misinterpretations that may arise due to illegible writing, thus avoiding the problems caused by staff unfamiliarity with the system as was the case in Addenbrooke’s 3, 4.
Furthermore, unlike other electronic patient record systems, PatientSource is browser-based and tablet-compatible. This means that doctors and nurses are able to spend more time at the patient’s bedside rather than in front of a computer screen or searching for and deciphering paper notes. Additionally, thanks to the various different modules offered by PatientSource, (which at present include: Case Notes, Patient Administration, Observations, ePrescribing, Investigations (CPOE), Electronic Discharge and Auditing), healthcare staff will no longer have to worry about the clunky process of repeatedly logging into various different systems to carry out basic tasks. Perhaps the biggest feature which sets PatientSource apart from its peers is the fact that it is the first cloud-based hospital electronic patient record system, thus making it easier for doctors and nurses to share records with colleagues in other hospitals whilst also reducing pressures involved with running the infrastructure of a local system.
At this point you may understandably be wondering how this translates in terms of financial targets and clinical outcomes. If once again we take the Royal Berkshire NHS Foundation Trust to represent the model of the average NHS Trust, then we are able to estimate that the savings which PatientSource would offer a Trust are likely to be in excess of £16.5m per year [Figure 2] a value equivalent to ~4.7% of the average Trust annual budget, which is notably higher than the savings of 2-3% per year required to meet the Five Year Forward View challenge and substantially greater than the national average of 1% over the past 35 years 6. Beyond this, it is possible to estimate that over 3,700 wasted bed-days are likely to be prevented annually. Clinically, it has been observed that integrated CDSS (clinical decision support systems) and CPOE (computerised physician order entry) systems, such as those present in PatientSource, are capable of reducing the likelihood of medication error by 48% 7.
At the time of writing, we are conducting trials of PatientSource in NHS Acute Trusts. Whilst we look forward to sharing the results of these trials, if in the meantime you would like to try out our electronic patient record system then an online demo is currently available on our website which allows access to three of our current modules: Case Notes, Patient Administration and Observations. If you would like to get in contact with us or have any questions about the statistical methods or data used to generate Figure 2 then feel free to contact us at email@example.com.
Royal Berkshire NHS Foundation Trust. “Annual Report and Accounts 2013-2014”. April 2014. [ONLINE] Available at: http://www.royalberkshire.nhs.uk/Downloads/About%20us/Annual%20Report%2013-14.pdf
Dunn P, McKenna H, Murray R. “Deficits in the NHS 2016”. The King’s Fund. July 2016. [ONLINE] Available at: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Deficits_in_the_NHS_Kings_Fund_July_2016_1.pdf
Shah S. “REVEALED: The breakdown of costs of Addenbrooke's Hospital's £200m Epic IT system”. September 2015. [ONLINE] Available at: http://www.computing.co.uk/ctg/news/2427408/revealed-the-breakdown-of-costs-of-addenbrookes-hospitals-gbp200m-epic-it-system
Care Quality Commission. “Cambridge University Hospitals NHS Foundation Trust Addenbrooke's and the Rosie Hospitals Quality Report”. September 2015. [ONLINE] Available at: http://www.cqc.org.uk/sites/default/files/new_reports/AAAD0111.pdf
Heather B. “Lorenzo: the end of the beginning”. Digital Health Intelligence Limited. July 2016. [ONLINE] Available at: http://www.digitalhealth.net/clinical_software/47852/lorenzo:-the-end-of-the-beginning
Alderwick H, Robertson R, Appleby J, Dunn P, Maguire D. “Better value in the NHS – The role of changes in clinical practice”. The King’s Fund. July 2015. [ONLINE] Available at: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/better-value-nhs-Kings-Fund-July%202015.pdf
Radley DC, Wasserman MR, Olsho LEW, Shoemaker SJ, Spranca MD and Bradshaw B. "Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems". Journal of the American Medical Informatics Association. 2013 May; 20(3): 470–6