WITH all the focus on a “re-build” one of the biggest overhauls at Hereford County Hospital will go on behind the scenes – affecting every patient past, present, and future.

This week, Wye Valley NHS Trust confirmed that it was finally ready to implement the electronic  holding of patient records.

For years, the trust and its predecessors have held such records on paper – accessed and carried around by hand, stifling clinical innovation, and having the potential to compromise patient care.

Around 250 clinical incidents relating to delayed, misfiled, unobtainable or missing, inadequate, or illegible healthcare records were logged by the trust between March last year and February this year alone.

Another significant consequence of paper notes is that salient patient information cannot be readily shared with the trust’s partners in health and social care provision – heightening both clinical and safeguarding risks.

All this changed at the stroke of a pen and the signing of a “landmark” contract between the trust and software specialist IMS MSXIMS to implement a system allowing medical records to be accessed via computer from all buildings out of which the Trust operates.

NHS funding streams are being channelled into the £15 million project, the costs for which are covered.

“Clinicians from across the trust will be able to access relevant and appropriate information within a single electronic patient record, at the point-of-care, to help them make more informed decisions on the diagnosis and treatment of a patient,” said trust project manager Simon Lind.

Dr Jake Burdsall, consultant lead for IT at the trust said: “To have visibility of a patient’s record, especially in emergency situations, is fundamental for improving care.”

“You can’t underestimate the importance of having clinical information, be it past attendances, episodes or diagnostic results, to help make immediate and future decisions on a patient’s care.”

The implementation of the electronic patient record system (EPR) will replace the current Patient Administration Systems (PAS) by the end of next year.

During this period the trust will work closely with IMS MAXIMS to implement software supporting the integrated records across the acute and community hospitals.

Eventually, the system is intended to integrate across multiple care settings, including social and primary care.

By reducing its dependency on paper notes, the Trust is working towards the national ambition within NHS England’s Five Year Forward View to ensure electronic health records are fully interoperable and supporting health secretary Jeremy Hunt’s challenge for the NHS to be paperless by 2018.

Shane Tickell, CEO of IMS MAXIMS, said the Wye Valley contract was “another significant step” in the adoption of open source technology within healthcare.

“At a time when the NHS is looking to improve patient outcomes whilst becoming a more efficient service, Wye Valley NHS Trust has taken the very considered and astute decision when selecting its approach to clinical technology.

Wye Valley NHS Trust will have software that meets the needs of clinicians and is flexible in its implementation, helping to save and manage precious hospital resources more effectively,” he said.

The contracts for the trust’s two Patient Administration Systems (PAS and also the theatres system are due for renewal in July 2016.

These systems were installed as part of the National Programme for IT, so the contracts are between the supplier and the Department of Health (DoH).

Consequently the contracts for these systems, which do not meet the Trust’s strategic needs, cannot be novated or extended without considerable cost implications to the Trust  - estimated to be in the region of £1.4 million a year.

An outline business case (OBC) documented the options for achieving an electronic patient record (EPR) and recommended “commercial engagement” with IMS MAXIMS as the front runner supplier.

Since approval of the OBC, work has confirmed that the majority of the trust’s requirements would be met by MAXIMS.

But that approval process also saw a reassessment of the programme plan and underpinning costs, including the addition of a contingency sum.

The capital investment required has been put at £14.8 million with additional annual revenue costs ranging from £200,000 in 2015/16 to £2.4 million recurrently from 2019/20 – including capital depreciation and cash releasing benefits.

Already, the trust has been awarded £1.3 million from the NHS England Technology Fund (Tech Fund) with the rest of the cash confirmed as coming from the NHS Trust  Development Authority.

One of the largest components of  cost relates to clinical backfill, as this venture needs to be constituted as a major clinical business change programme rather than an IT endeavour for its own sake.

Releasing front line clinical staff to be involved in the EPR Programme is recognised by the trust as a “significant challenge”, it  envisaged that having a planned requirement at the beginning of the programme will make it more feasible.

Experience from other trusts has been cited as reinforcing the need for clinical involvement to ensure that the solution appropriately supports practice once live.

EPR -  BACKGROUND

An investment of £14.8 million capital and £2.4 million annual recurring revenue costs -  net of cash releasing benefits – was identified as required for the Programme.

The business case put to the trust board earlier this year recommended the replacement of existing systems with  EPR in line with their contract end date.

Annual maintenance and support costs for these systems are currently paid directly by the Department of Health, so  any replacement system will incur additional costs which will impact the funding requirements of the Trust.

The cost of extending the current systems is estimated at £1.4 million a year.

This  would not move the Trust forward in terms of meeting information management strategy or improving clinical safety.

An EPR system is pitched as a “key enabler” to improve productivity and enhance integrated working.

Implementing the recommended EPR is also expected to enable £3.4 million a year worth of non-cash releasing benefits.

Though these have been accepted as “unlikely” to fully convert into cash releasing benefits, they are seen as having an impact on improving productivity.

In July last year, a bid to the NHS Tech Fund for match funding for the EPR Programme was created, and £6m requested.

The Tech Fund outcome was finally confirmed at the end of February this year, but the amounts available nationally were significantly less than first announced.

Wye Valley was awarded £281,000 for 2014/15 and £1,069,000 for financial year 2015/16.

The board backed funding being sought for the £13.8 million  remainder of the capital value.

As part of the Tech Fund application process the trust had to demonstrate an understanding of the potential routes to market so it could proceed with the procurement and contract activities shortly after the Treasury announcement.

Significant work was done with NHS England, trust’s procurement team,  and the supplier to identify the preferred option - in terms of speed and financial effectiveness – was to procure via a national framework called G-cloud[1] or SBS[2]  - depending on commercial advantage - for an initial five-year period.