How has the introduction of the Electronic Patient Record driven improvements to Children's Services?

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Approaching a year after deployment, Lisa Baxby, Early Start Manager and Bernadette Rainford, Health Visitor from the Middleton Health Visiting Team reflect on the benefits of introducing TPP SystmOne to Health Visiting Services within Leeds Community Healthcare Trust. 

The Challenge 

There were a number of key drivers behind the deployment of The Phoenix Partnership (TPP) SystmOne Community solution into Leeds Community Healthcare NHS Trust. These included improving productivity, record keeping, freeing up organisational estates, increasing efficiency to release time to care, and raising the quality of care and services through the introduction of electronic patient records.
The 18 Health Visiting Teams in Leeds Community Services provide care for 0 — 5 year old children. The journey has included a significant change in process, transitioning from paper and family based information to recording individual child specific electronic documentation to support over 50,000 children across Leeds.

Key Benefits

- Efficiency
Ability to document, find and capture patient information at the point of care or in multidisciplinary team (MDT) meetings has released staff time enabling greater productivity in patient management. Trust wide, due to the ability to instantly document into the record within MDT meeting, there is the potential to save 3,640 hours annually.
Remote working, reduces travel expenses and staff time traveling. For example in some teams mileage costs have reduced by up to 50% .
Agile working has allowed staff more flexibility in how and where they wish to work, for example, swapping the distractions of the busy office for home working. This has also given a positive consequence in improved parking availability at office bases.
- Acceptable/Patient Centred
Realtime access to a more complete and accurate patient record, including instant referral and letter communications facilitates clinical decision making and allows prompt response to patient queries.
- Effectiveness
Increased compliance with national targets, through the introduction of streamlined electronic processes. For example, the proportion of new births seen within 10-14 days has increased from 38.5% to 79.3% over 6 months (September 15 to March 16).
Through greater visibility of workload, the ability to reprioritise, transfer and action the work of absent staff and better manage workloads has improved performance and reduced delays.
Agile working has also seen an increase in job satisfaction and importantly a reduction in stress levels, with the expectation that sickness rates will reduce.
- Safety
Key patient information is more up to date, for example, contact details, and the electronic record is legible and succinct. These safer standards of record keeping provide benefits to; patients, a recommendation of the Francis Report, staff and the organisation, improving professionalism and regulatory compliance as well as being a safer place to work.

Implementation / Deployment Overview 

Leeds Community_Health Visiting Service_v1 4As part of the National Programme for Information Technology (NPfIT), TPP SystmOne Community solution was deployed at Leeds Community Healthcare NHS Trust to support the care and management of children within the Early Start Service.
SystmOne Community solution was deployed to 280 clinical and non-clinical users within 18 geographical teams, over a 2 month period in June and July 2015.
Six months prior to deployment, the service alongside a business analyst, SystmOne developer and staff representatives met weekly to review current process and documentation. This enabled the development of paper-lite and streamlined future work processes, and the creation of digital core contact templates.
SystmOne trainers provided a series of full day training sessions for 3 or 4 teams at the same time. The service also developed a handbook for staff to guide them along the new processes within SystmOne. The deployment was rolled out team by team and on-site support was provided directly from SystmOne trainers for one week after ‘go live’.
To fully support agile working, SystmOne Mobile was also implemented through a combination of 4G and WiFi connectivity. Users can access an ‘offline’ mode in the Mobile functionality to support working where connectivity is unavailable or unpredictable. Its use however has been mixed with staff predominantly accessing and inputting into the live system.

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Lessons Learned

- It takes time to define the current ways of working in order to prepare templates and processes for ‘go live’.
Involve multiple staff where possible to support this preparation and definition work.
- Ensure that appropriate and reliable hardware and IT support is identified to support the service in remote working
- To aid the implementation of new processes, with a new system:
Create a user guide that combines process steps with system instructions
Avoid SystmOne training in the modules of Community and Mobile at the same time
Stagger the roll out of changing processes, giving the new system around 6 months to bed in, before deploying mobile working
- Switching from a family based record, to an individual patient record involves increased data input into multiple records. This increases the time spent record keeping as well as the need for attention to detail when adding information. 

Future Plans

The Continuing Strategic Direction of Travel
-Continue the roll out of agile working, with full deployment across the Health Visiting service by the end of July 2016
-Continue the rationalisation in estates, as office space is freed up from an increase in mobile working as well as the reduction in paper recording and storage. This will help the Trust to realise a key objective of cash releasing savings through the decommissioning of desktop devices and recouping of software licences as well as a reduction in the need for offsite storage
-Further increase the richness of patient information available to clinicians, by linking in SystmOne with the Leeds Care Record, a city wide initiative to share patient information to improve the care of patients