EARLIER this month we revealed how bedside charts are to be replaced by computer tablets like iPads at hospitals across Oxfordshire as part of the move towards a paperless digital future. Health reporter OLIVER EVANS talks to the man overseeing the change and how technology is changing how hospitals operate.
DOCTORS have long been the butt of jokes about their handwriting. But hospital managers say new technology could put an end to spidery scrawls as well as helping staff communicate quicker and improve safety.
Oxford University Hospitals NHS Trust’s latest project – to record patients’ vital signs via a bedside tablet computer like an iPad – illustrates the benefits of going digital.
The scheme, which is currently going through final trials, is to be rolled out through the year with up to 500 tablet devices bought for staff at Oxford’s John Radcliffe Hospital, the Churchill Hospital and Nuffield Orthopaedic Centre and Banbury’s Horton General Hospital.
It means they can instantly share information within vast sites like the John Radcliffe Hospital, allowing doctors to make much quicker decisions about a patient’s condition based on readings like heart rate and blood pressure.
- John Skinner
The director of IT at the Trust, John Skinner, said: “Hospitals need to move from having the prime record being a paper record to having a digital record.
“The NHS hasn’t invested as perhaps it should have in technology. I think we are beginning to get a better level of investment.”
A major step towards this was the introduction within the last decade of patient bracelets with a unique barcode which is scanned by staff, positively identifying the patient to make sure doctors and nurses are treating the correct person.
Mr Skinner said: “If you transfuse the wrong blood you are endangering the patient – you have to make sure it is all safe.
“We were one of the first trusts in the country to get a very high compliance with electronic systems for transfusion.
“Tesco does everything through barcodes. If you follow what the big supermarkets do you get a much more efficient system.”
A major step forward was the introduction from 2007 of a picture archiving and communication system (PACS), a computer network which stores and shares digital images of X-rays.
- A video by the OUHT about building a digital hospital
The trust now has half-a-billion images stored on 50 terabytes, the equivalent to more than 10,000 DVDs.
Mr Skinner said: “Before that we had X-ray negatives that had to be filed and retrieved. They could only be in one place at a time and could be misplaced. Now they can be stored across the network. It can be shown to the patients, the doctors can review them and they are available 24/7.”
That project was part of the ill-fated National Programme for IT, an ambitious project to connect the entire NHS that began under the Labour Government in 2002.
A Commons committee last September branded it one of the “worst and most expensive contracting fiascos” in public sector history, costing the NHS at least £9.8bn in delays and wrangles with IT firms.
While no longer a national scheme, remnants of the programme remain in Oxfordshire with the most significant the electronic patient record (EPR), a trust-wide database patient record that is still being added to.
The EPR is planned to record prescription information from July, Mr Skinner said, to ensure a smooth transition between doctors’ requests for drugs for a patient and their administration by nurses as well as a further check against mistakes, such as software spotting allergy to a drug.
This does not link to other NHS services like GP surgeries and community mental health teams.
Yet a basic summary of information – the programme’s “summary care record” – is being carried out across hospital departments to share with community NHS services.
Mr Skinner said: “We are moving towards a much more joined up system, but we are not totally there yet. I’m sure more could have been done under the national programme, but we have made good progress in Oxford.”
While the trust’s budget is not being cut, savings are having to be made but Mr Skinner is hopeful of more investment if it can be shown technology is improving efficiency and saving cash.
He said: “It is a very, very big change and will take some time.”
Robot to assist with patient prescriptions
- A robot at Oxford’s John Radcliffe Hospital will package patient prescriptions
A ROBOT will package prescriptions in a new project bosses say will cut drug request turnaround times by an hour.
The trust has been given £200,000 by the Government’s NHS Technology Fund to link the existing robot to electronic patient prescriptions.
This will pick medicines and label and pack them to go to wards after being checked by a clinical pharmacist.
Managers hope the system will speed up how quickly patients can be discharged from hospital, helping tackle Oxfordshire’s chronic “bed blocking” problem, they say.
Mr Skinner said: “By cutting prescription preparation time we not only help patients leave our hospitals at the right time, we reduce pressure on bed numbers and improve services throughout the emergency department.”
Millions of paper files
- Library supervisor Debbie bridges retrieves patient files
BOSSES hope the increased use of digital technology will stop expansion of the trust’s 3.5 million paper medical records.
Some two million covering about 20 years are at the John Radcliffe’s library while the rest are in a hanger at a former US Air Force base at Upper Heyford, near Bicester.
Trust director of IT John Skinner said it plans to scan key parts of some records.
He said the vastness of the archive “really makes the point” about the need for computer systems.
He said: “If you look at the paper record, people think it is like stepping into the Dark Ages.”
Mobile phone monitoring
- Michelle Wilson
PATIENTS who have suffered a stroke or mini-stroke are using mobile phones to help provide readings to hospital staff.
Visitors to the John Radcliffe’s Stroke Prevention Research Unit are given a monitor to take their blood pressure three times a day for a month.
Readings are then sent via bluetooth technology to a mobile phone – provided by the hospital – back to doctors.
Clinical research therapist Michelle Wilson said: “Monitoring patients in real-time allows us to ensure they are responding well to existing medication and make adjustments if that is not the case.
“The system also flags up patients where readings fall outside an expected range, meaning we can initiate early treatment tailored to the individual.”
It is one of many projects developed by Oxford Biomedical Research Centre with Oxford University.
The centre has been given £100m by the Government to devise new systems over five years.