EH 4_2015

EUROPEAN HOSPITAL  Vol 24 Issue 4/15 8 IT & TELEMED Martijn Antonius, Vice President of infor­ matics at Epic in the Netherlands Electronic medical records Patients wholly embrace EMR access Who really uses electronic medical records? At most European hospitals, even the physicians and nurses have trouble accessing the hodge-podge collections of mismatched data. Yet, once a hospital installs an EMR sys- tem that is truly robust and capable of reporting up-to-date information about patients, it turns out that the patients are looking at their records more than their medical carers – by a ratio of 8 to 2. The report comes from the soft- ware firm Epic, which has surged ahead over the past five years as the preferred provider for e-health sys- tems at major hospitals in the United States. Among the firm’s 354 cus- tomers are prestigious medical cen- tres such as the Mayo Clinic, Johns Hopkins, the Cleveland Clinic, and Kaiser Permanente, to name just a few. The company claims that 56% of the American population has a digital record on one of its systems. To gain a better understanding of patient portal usage patterns, Epic monitored the online traffic during 30 days among 12 of its participat- ing medical centres. The results were staggering, according to Martijn Antonius, Vice President of informat- ics in the Netherlands. ‘We saw some- thing like 150,000 caregivers using the records, but when we looked at how many patients were accessing records, we saw there were 680,000,’ he said. ‘We learned that, through the patient portal, patients are doing all kinds of things to participate in their treatment and to become more responsible for their health. We think this is extremely important, and so do our customers, because patients not only embrace their role in healthcare but also, once they can be integrated into their healthcare, they become engaged in that care. ‘Looking at Europe as a whole, this is an area where there is potential for considerable growth,’ the Vice President said. Earlier this year the first European hospital to go live with a full Epic system for managing EMRs achieved the highest ranking for its ability to share complete patient records in real time among physicians and care-givers. Radboud University Medical Centre in Nijmegen, the Netherlands became only the third in Europe to receive a Stage Seven Certification from HIMSS Analytics, based in Leipzig, Germany, a branch of the Healthcare Information and Management Systems Society based in Chicago. Radboud University Medical Centre, shares this distinction of meeting the highest requirements for the European EMR Adoption Model with the University Medical Centre Hamburg-Eppendorf in Germany, which runs a system developed in- house, and the Hospital de Dénia- Marina Salud in the Alicante Province of Spain that runs an EMR system from Cerner, another American health IT company. Nine years ago, after landing in Europe with a Dutch team, Epic won deployments for its system with the Amsterdam Medical Centre and Vrije Universiteit Medisch Centrum (VUMC; Free University Medical Centre), also in Amsterdam. The company’s track record in the USA, and the increasing impor- tance of opening EMR to patient access, have fuelled its recent success. Leading centres that are ahead of this curve are discovering they need to rip out pieces of their homegrown health IT systems and turn to an established, proven system. In the United Kingdom Epic has installed a system with the Cambridge University Hospitals foundation trust. In Denmark, Epic won the contract to install its systems in the Copenhagen and Zealand regions, covering more than 20 hospitals with 44,000 car- egivers. That contract specifically assures the hospitals receive the most advanced EMR features developed by Epic. ‘The patient portal is more than a nice touch; it becomes an important tool for hospitals. It is much more than being patient friendly; it’s about making the patient part of the treat- ment team, and it can mean much greater efficiency,’ said Antonius. He cites examples where patients can schedule visits themselves, and can complete questionnaires to provide essential information in advance and online. The patient portal giving access to an EMR is going to become even more important in the near future, he suggested. When Apple, Inc. wanted to devel- op the HealthKit, it turned to the Mayo Clinic and Epic as its leading partners. That system has now gone live. Antonius: ‘It can gather patient information from the iPhone, is now fully integrated into the patient por- tal, and is opening a vast new area of possibilities.’ He cites the example of a patient who has recently had a prosthetic knee implanted with the recommen- dation from the surgeon to be more active. The iPhone can push results from step-counting to the EMR. For a patient for whom the cardiologist is concerned about weight gain, the daily results from a weight scale can be pushed into the EMR for later review. ‘With rising costs, hospitals understand now that demands for higher quality and greater patient engagement they can only deliver great healthcare if they are a data- driven organisation,’ he pointed out. ‘To do this, they really need to have their act together in terms of the infrastructure supporting a patient portal and the EMR. This is the chal- lenge right now.’ When real medical records go live more than eight in ten users seeking information are patients, not their caregivers. UK hospital reaches Stage 6 of EMRAM Applause for digital maturity Report: Mark Nicholls A senior consultant spearheading a UK hospital’s drive to become paper-free has stressed the impor- tance of seeing the process as a clinical transformation, rather than merely an IT project. St George’s University Hospitals NHS Foundation Trust, London, has been recognised for the sig- nificant progress made towards paperless-ness and has been vali- dated by the Healthcare Information and Management Systems Society (HIMSS) at Stage 6 of the Electronic Medical Record Adoption Model (EMRAM). However, Dr Martin Gray, the Chief Clinical Information Officer at St George’s, said it was critical that clinicians were seen as being a key part of the process of the hospital becoming ‘digitally mature’. Gray, who is also a paediatric intensive care consultant, said: ‘There are a large number of clini- cians from this organisation without whom this project would not have succeeded. It does help having cli- nicians from varying roles bridging the gap between IT and change management, and the clinical “shop floor”.’ St George’s, which has more than 1,000 beds and serves a population of two million, has become the sec- ond and largest trust in the UK to be validated at EMRAM Stage 6. It is paperless in the paediatric intensive care unit – apart from con- sent and child safeguarding forms. In the renal, cardiac and neurosciences wards it is almost paper-free. However, on general medical and surgical wards while patient admin- istration and ordering of tests is paperless, much of the patient’s journey is still on paper. ‘For us, as a hospital, this accredi- tation puts us on the map,’ Gray added. ‘There has been a lot of hard work over a number of years by both clinical and non-clinical personnel within the organisation working to develop an Electronic Medical Record and digitise the hospital. ‘The recognition by an interna- tionally-accredited body that we have reached that level of digital maturity is important; but it also helps to set the agenda for what we have to do to reach the next level.’ The next phase sees the further extension of digitisation of health throughout the hospital. ‘It’s also about opening up the digital records to enable patients to access their own electronic files and allowing cross agency working with GPs, community health, social services and with our network hos- pitals in South West London through inter-operability,’ said Gray. With consent forms, however, third party documents and referral documents still in paper format, the goal of becoming wholly paperless remains some time away. He explained that the journey towards a paperless NHS is not about implementing software but about a clinical transformation. ‘It’s about changing the way people work, looking at processes and sys- tems and how you build a digital workflow for the delivery of care within the healthcare ecosystem.’ Gray admits there were challeng- es with clinical engagement, com- munication about the project and bringing all departments on board with the project, which began in 2010 with the implementation of the Cerner patient administration system. Ordering and reporting diagnostic tests followed in 2012 and, in 2014, St George’s moved to electronic pre- scribing, medicines administration, and clinical documentation. Care digitisation has proved par- ticularly effective with the Cerner Millennium closed loop medication management system; when medica- tion is ordered electronically for a patient it is verified in the pharmacy by a clinical pharmacist, then dis- pensed automatically by robot and delivered to the ward and, at the point of administration, the right patient and right drug are identified by barcode scanning. The solution has resulted in increased accuracy of prescribing, fewer missed doses, and savings in time to complete the drug rounds. ‘One of the softer benefits is that nurses now have more time to explain to patients about the drug they are about to take,’ Martin Gray gladly underlined. Dr Martin Gray is a Consultant Paediatric Intensivist at St George’s University Hospitals NHS Trust in London and its Chief Clinical Information Officer. Trained in the UK, Australia and Canada, his role is in clinical governance and col- laborative research, with a strong interest in healthcare IT solutions and commission- ing and contracts. Within the Paediatric Intensive Care Unit, his interests lie in traumatic brain injury and neuro-critical care. The system has also improved the efficiency of patient flow by cutting down the time patients spend wait- ing for drugs before discharge. The centralised Electronic Patient Record system now has more than 5,500 users including nurses, con- sultants, doctors and administrators, and means access to documentation and notes is possible from anywhere in the hospital, or even remotely. Gray’s conclusion: ‘While it’s still in the very early days in the process, we are starting to see efficiency sav- ings and quality improvements.’ Copyright:Epic/10FACE/Shutterstock.com Epic MyChart gives patients controlled access to the same Epic medical records their doctors use, via browser or mobile app

Pages Overview