Frimley Park Hospital

For many years, the Trust's therapy services had recognised the benefits that could be realised by installing a computer system but had been unable to secure funding due to the Trust having higher spending priorities.

The Challenge

Frimley Park Hospital is committed to a ‘patient first' ethos that sees excellence placed at the heart of its service. It has won recognition for the quality and efficiency of its healthcare, named NHS Trust of the Year in the Dr Foster Hospital Guide 2013.

For many years, the Trust's therapy services had recognised the benefits that could be realised by installing a computer system but had been unable to secure funding due to the Trust having higher spending priorities.

Occupational Therapy Manager, Val Sharples, said: "Looking back, it's hard to believe that so far into the 21st century, many areas of the hospital still relied on paper for records and administration. The will to change it was there but the finances simply weren't."

The catalyst for change was in 2009 when the local Primary Care Trust stipulated that outpatient activity needed to be reported electronically.

"We knew this was a huge opportunity. Funding was cleared and we were determined to procure a system that went beyond just recording evidence of patient examinations for financial purposes, and would provide full electronic patient records [EPR]."

The Solution

Frimley Park settled on Tiara9 - a system developed by Leicester based software house, Ethitec, to provide full clinical information management and EPR.

"Ethitec had a great track record in EPR: Tiara9 had been enabling healthcare organisations to operate in an entirely paperless way for over a decade, and, although it later became clear that the system was appropriate for all clinical management disciplines, the fact that it was born out of the therapies, with extensive clinician input, made it particularly suitable for us."

With funding secured, deployment proceeded rapidly and, within two months, Tiara9 was installed.

The next challenge was managing the change to a new way of working. "Initially, staff were nervous about the move to EPR," explains Val. "But once they'd got to grips with it, they soon recognised it was a far quicker and more efficient way of working. Today, I frequently hear clinicians say they would never go back to paper records."

The original plan was to roll it out team by team, starting with A&E therapists, but Frimley Park quickly realised that compartmentalising departments in this way was a challenge, as therapists in other teams would need to access the patient record and keep it updated.

Instead, the approach adopted was to roll out the system to all teams, but phase in which parts of the clinical record would be used.

"We started with the initial interview and basic assessment forms, then gradually expanded use of the system to build in the assessment forms. This meant that, at first, we were scanning lots of documents and attaching them to the record, but now this is very rare. Scanning is mainly limited to test results and we have plans in place to create these as screens on the system too."

Today, at Frimley Park, around 250 clinicians use Tiara9, throughout Occupational Therapy, Physiotherapy, Dietetics and Speech and Language teams, plus the nursing staff who view the therapy record.

The system is also used offline for community outreach; this means that clinicians download their case notes for planned appointments to a portable device at the start of the day, update records electronically as they visit patients in their homes during the day then upload the updated record back to Tiara9 at the end of the day when they are back online.

"In Occupational Therapy, Tiara9 has enabled us to eliminate paper entirely," concludes Val. "All contact with the patient is recorded electronically, from in-patient treatment, through outpatient follow-up appointments to community visits. The system provides all management information for billing purposes and is a great tool for reporting outcomes."

The Benefits

Frimley Park Hospital's therapy teams have reported huge improvements since the move to EPR.

"Without doubt, the greatest value is in having one joined-up clinical record for each patient that can easily be accessed by multi-professional teams, so they can see immediately the interventions by other colleagues," confirms Val.

"This has significantly reduced duplication; we have been able to ‘hard code' certain fields, so that once this information has been collected by a clinician, the data is automatically populated in forms across other disciplines, as well as in discharge summaries. This saves time and also improves the patient's experience, as we are not having to ask people to provide the same information over and over."

The introduction of a clinical information management system has also enabled the Occupational Therapy team to halve its response times, without increasing staff. "We can immediately see which wards are busiest and deploy staff more effectively to the hotspots where they are needed," explains Val. "Whereas, previously, it could take up to two days to get to see patients, we are now able to respond within a day."

On a practical level, Tiara9 has also improved the quality of documentation, making them more consistent, easier to read and follow, and harder to lose. It has also become easier to respond to complaints as all the data is easily to hand.

At another level, the use of EPR at Frimley Park has demonstrated the power to change clinical practice. "The ability to add new fields and make them mandatory means it's become much easier to collect information. This can help with audit and clinical governance purposes. For example, we were recently asked to establish what provision of service patients had received prior to coming in to the Trust; we were able to address this immediately by adding a question about previous therapy treatments to our assessment forms.

"Indeed, having the flexibility to customise the assessment forms so easily is a huge advantage in itself, and ensures we can not only collect the data we need, but build forms that reflect the workflow in our teams."

The Future

Frimley Park has plans in place to extend its use of Tiara9 within the therapies, to integrate more effectively with other Trust departments and to pioneer integration with GPs through the NHS e-Referral system (e-RS).

"The main limitation in terms of our EPR roll-out has been lack of available hardware," explains Val. "We prioritised areas such as strokes, where a multi-professional approach is essential, and we are continuing to procure more hardware as budgets allow."

There are also plans to extend the joined-up approach to clinical records by interfacing Tiara9 with other systems used at Frimley Park. "Unfortunately, we came across Tiara9 too late to implement it right across the Trust," explains Val. "And it's probably fair to say that we didn't fully appreciate its potential as a wider clinical EPR beyond the therapies. However, we still anticipate that we will be able to link up clinical information in a patient-centric way, as the Trust is working on a hub that allows the different systems in place to speak to one another."

The Frimley Park Therapy Services have recently introduced direct access appointment booking via the NHS e-Referral System. Val explains: "We worked closely with Ethitec when Tiara9 was in the process of securing NHS e-Referral System accreditation and were the First of Type site who trialled the system. This means GPs are able to book therapy appointments in with us directly and we expect to extend the use of electronic referrals going forwards.

"Ethitec is a great organisation to work with. Deploying Tiara9 was quick and straightforward and the system does everything they said it would do. It's great to know that if we ever ring up and say: ‘It would be great if we could just do x, y or z', then Ethitec is ready and willing to accommodate our requests. We just can't fault them!"