Oncology noting direct to the Electronic Patient Record
This is an abridged version of the case study, you can read the full version on the NHSX Digital Playbook.
The Bristol Haematology and Oncology Centre, part of University Hospitals Bristol and Weston NHS Trust, is a specialist non-surgical treatment centre for people with cancer and blood disorders serving people from the southwest of England. The centre treats around 5,000 new patients each year and is well known as a centre of clinical excellence.
The hospital was experiencing increasing risk with paper documents missing from the patient case note, case notes missing, and delays to GP communications.
In the Oncology and Haematology services the aspiration was to deliver timely capture of clinically relevant information in one place that can be instantly accessed by staff across specialities. The existing system relies upon duplication on paper and local desktop solutions, with a combination of handwritten and dictated records resulting in delays to transcription.
Solution and impact
The Bristol Haematology and Oncology Centre introduced a transactional digital pathway, implementing clinical notes, workflows, and a suite of business intelligence reports with the intention to use the model as an approach for a Trust-wide transformational change.
Some of the early benefits were the reduction in time taken for clinical letters to be distributed to patients and GPs across Bristol, which improved communications and helped to provide high quality care. Patients and GPs are now receiving communications within three days. Previously, communications relating to a patient appointment could take anywhere up to 21 days, with many letters missing the seven-day target.
Clinicians are now able to record electronic data in real-time by typing or dictating with voice recognition, into bespoke structured forms within the Electronic Patient Record (EPR). The information is then instantaneously available to other staff members at any desktop PC who can access patient records about their patients securely from anywhere, at any time, transforming care delivery. The notes can be designed for direct checking and submission by the clinician or for later sense checking, and dispatch by secretarial staff. In the latter case however, the notes are still accessible for reference instantly from the time of creation, usually minutes after the patient has left the clinic, rather than days later.
The digital clinical notes also provide a structure for data capture and letters, improving consistency and clarity, meeting PRSB standards, as well as providing a resource for data analysis. Data from previous notes can pre-fill the forms reducing recurrent data entry.
Pharmacy and clinical nurse specialist teams have discovered their own use-cases, with early benefits to support their ways of working. Pharmacy are now able to prescribe, review and approve medication quicker as they no longer need to interpret handwriting, but also screen patients due for treatment who are on the wards a lot quicker as all the information required is in one place. Delays due to transfer of paper records and missing, incomplete or illegible records are minimised.
The digital chemotherapy pathway includes a number of digital solutions.
CareFlow Electronic Patient Record provides a standalone advanced patient administration system provided by the British health and social care software and services company, System C. CareFlow EPR has interoperability and integration capabilities with many of the Trust’s clinical systems providing users with a single patient record. The system boasts clinical functionality, such as clinical noting and workflow, which was paramount for this project. Having the ability to complete clinical notes within the patients’ EPR in real time that can be accessed by anyone, anywhere, is what made this project so successful. One advantage was allowing the internal IT department to configure bespoke forms. Some EPR vendors do not allow this local configuration, instead relying on time consuming and potentially costly change requests. An issue which has arisen is that currently the dictation is not recorded and so cannot be referenced by secretarial staff. This means that the clinician has to take greater responsibility for checking at the time of dictation, but in turn this removes the need for further checking of communications days later.
Business intelligence (BI) reporting
Removing the dictation, transcription and document production process within the Trust’s current dictation software, and replacing the workflow using CareFlow’s business intelligence functionality introduced new ways of working for the clinical and secretarial teams. The tool set is fully integrated within the CareFlow EPR and can be used to create and manage highly-configurable reports or dashboards, pulling together information from different data sets. Using the BI technologies, the team were able to start to pull data from within the clinical notes. This aspect of the project however is at an early stage and requires significant further optimisation to generate timely and user-friendly reports.
I have been delighted by how easy it is to use digital clinical notes. The digital change team have been really responsive and helpful, allowing us to make changes and tailor the notes to different clinical settings.
Dr Laura Percy, haematology consultant, University Hospitals Bristol and Weston NHS Foundation Trust
The changes have made communication between doctors and nurses clearer, we’re now able to sit with patients as we complete the digital form, improving the patient experience.
Katherine Davis, senior staff nurse, oncology day unit, University Hospitals Bristol and Weston NHS Foundation Trust
Read the full case study on the NHSX Digital Playbook.