Meeting requesting efficiency goals

West Suffolk Hospital is a 460-bed hospital located on the edge of Bury St Edmunds. Serving a 600 square mile area, with a population of around 275,000, the hospital has seen significant expansion in recent years and continues to grow to meet the developing healthcare needs of the community. The hospital’s initial expectation was that the pathology, radiology, and cardiology requesting system would be supplied by the National Health Service (NHS) National Programme for IT (NPfIT), an initiative from the UK’s Department of Health to move the NHS toward a single, centrallymandated electronic healthcare record for patients and to connect 30,000 GPs to 300 hospitals in the UK. The initiative, now known as NHS Connecting for Health (NHS CFH), has had well publicised difficulties in delivering to planned deadlines. While it has provided a spine of patient information, including an electronic network onto which primary care GPs can upload basic information that can be accessed from any UK healthcare facility, the initiative has not yet fully provided the systems necessary for secondary care facilities. Indeed, the scope of its future plans to do so have been scaled back, leaving secondary institutions with a serious void. According to Mark McNally, West Suffolk Hospital’s project manager: “The original electronic care record initiative was intended to offer a set of integrated systems for secondary care, starting with administrative systems, but quickly extending to departmental and Trust-wide clinical systems that would allow sharing of information with the GP community. These included order communications and electronic prescribing systems. “This was, and remains, a worthy goal, but there was an underestimation of the complexity of hospital environments and several years of delay in achieving that goal has resulted. This left a vacuum for us in meeting the needs of our local healthcare community and we found we had to go out into the marketplace ourselves to find the systems we needed.” One of the core systems required was electronic requesting (order communications) and this was first in line for development 18 months ago. West Suffolk Hospital had a variety of goals for the order communication system, and chief among them was achieving efficiency in the pathology laboratory. Secondly, it wanted to improve the quality of requesting by being able to stipulate the exact information needed from the doctor, with the intent of ultimately reducing the number of duplicate tests ordered. The third goal was to reach out to GPs, making it easier for them to send in requests and faster for them to receive results. Last, but not least, the system had to address the requirements of National Patient Safety Agency (NPSA) Directive 16, which stipulates that radiology departments require test requesters to read and take action on any tests requested.

Selecting a system

West Suffolk Hospital’s head of information technology worked hard to raise awareness of the need for the Trust to make progress on core systems, and received approval of a business case for purchasing a third-party order communications system. The procurement process began in the Autumn of 2009. The evaluation team considered a number of order communications system products in the marketplace and eventually selected Sunquest Integrated Clinical Environment (ICE), a suite of web-based services developed to deliver a range of software applications for use in primary and secondary care NHS Trusts. The evaluation team have begun to implement ICE Requesting & Reporting, a web-based order communications system that enables requests to be made from wards, clinics and GP surgeries. Requests can be made for all specialities, and West Suffolk is using the system for all pathology, radiology, and cardiology tests. In the future the application could, potentially, allow the use of mobile technologies, using tablet PCs and PDAs at the bedside to further speed up requesting and reduce errors. During the procurement process, the implementation team visited several hospitals to see how the systems were used at the reference sites, and determine how their environments compared to that of West Suffolk Hospital. One feature is the OpenNet module which allows two hospitals running ICE to view a consolidated patient record showing all the test results for a patient from both hospitals simultaneously. Many patients from the West Suffolk Hospital, for example, will also visit other hospitals such as Ipswich Hospital and Addenbrooke’s in Cambridge, and this type of sharing provides potential for collaborative patient care in the future. Consultants often work at two hospitals and such a system would enable them to view patient results from either location.