Over the last 15 years or so, Adrian Byrne, CIO of University Hospital Southampton NHS Foundation Trust (UHSFT) has pursued a strategy for electronic patient records through integration and evolution. The ultimate aim is to get to HIMSS Level 7 – the final stage of a Electronic Medical Record (EMR) model which is where paper charts are no longer used in the hospital.
“There’s various ways that we’re thinking about achieving that; we have an open mind towards newer technology around the open electronic health record (EHR) and also using a technology called FHIR to effectively open up our legacy platforms,” he says.
While the trust has made progress in terms of its electronic systems use, Byrne says that there needs to be an emphasis on making nursing and care noting documentation digital, particularly on the wards where notes are written on paper and then scanned.
The trust has just gone live with an electronic document management system from Hyland, which allows the company to use digital forms instead of scanning papers. But there will not be a need to scan historical notes, which would have been an arduous task.
“We’ll scan it where we need to; the emphasis will be on dealing with patients who are coming in and then in the future dealing with more and more direct data entry, but you have to do this carefully because you can’t do things that impact on the time of doctors and nurses,” says Byrne.
In fact, Byrne suggests that a lot of the notes currently written on paper are written quickly and are “perfectly adequate”. He insists there isn’t always a need to decode and structure information digitally.
“This gives us a challenge because no matter what anyone says, as soon as you start introducing these digital and real-time processes, you will slow people down,” he states.
But, while the initial cultural impact may slow down processes – won’t things be quicker in the long-term by going digital?
Byrne doesn’t think this is necessarily the case with note-taking, but says technology can help speed up times in other ways.
“You don’t get quicker over time really [with note documentation] – I think it’s more about changing the other factors involved, like using more technology to reduce the caseload of people and that’s where you give them the time back,” he says.
But he adds that data collection is still important for research purposes or for a shared care record in the long-term.
Byrne says he is interested in what lies ahead with AI – such as IBM Watson’s x-ray capabilities, noting that machine learning is a concept he can see being used in the near future at the trust.
“I think we can do a lot around automating the code of some of our basic activity,” he explains.
The Internet of Things (IoT) is another area of interest – and the trust has been working with a number of technology companies in this space.
“We are one of the few hospitals that has a patient-facing secondary care service, so we allow our patients to log in to a personal health record and we send our results to their personal health record and that system has an ability to hook in devices,” he says.
“So some of our doctors are interested in patient weight or blood pressure and there’s a number of things you can now buy that will plug in data about yourself into the personal health record – it’s something we’re interested in and we have a project ongoing with some of our cardiologists around heart monitoring that will also involve internet-connected devices,” he adds.
The NHS trust is also installing a messaging application that will enable staff to communicate in the same way as people do on WhatsApp but also to pull information out of the record and have a meaningful conversation about the patient and push messages back. In addition, a 2012 prescribing system and a pathology system need to be either updated or replaced.
Byrne, who has worked at the trust for 23 years, now has to manage the more mundane system replacements and upgrades alongside the experimentation and adoption of emerging technology, while striving towards HIMSS 7. He and his team have a busy few years ahead.