The Importance of Local Records in Improving Patient Outcomes – the Wirral Example Patrick Reed, Director of Informatics Wirral Health Informatics Service

Jump to first page Current Systems n PCIS – used across whole Trust to support administration and clinical care n Departmental systems e.g. Triple G, JAC etc all interfaced to PCIS n EDR – our data repository which hold every transaction that occurs on PCIS n EHR – the Wirral wide Electronic Health Record n WROCS – a remote ordering system used by GPs across the Wirral All have in common: n Ongoing involvement of clinicians n Multidisciplinary use n Good standards of security and confidentiality n Integral to ways of working

Jump to first page PCIS Decision Support n Incorporate National or Local Guidance into ordering pathways n Promote best practice n Reduce unnecessary/inappropriate investigations

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Electronic Prescribing n One of the big successes of EPR project n Clinician buy in from day one n Improved patient safety u Legibility u Supports getting product and dose correct first time u Decision support u Involvement of risk management n Improved Medicines Management processes

Jump to first page Methotrexate Pathway n Can only prescribe oral Methotrexate e.g. for Rheumatoid Arthritis n User can select dose n Will be prompted for a start date n Then they only have one option for frequency – once weekly

Jump to first page Methotrexate Pathway *All prescriptions free-typed  93.5% adherence to prescribing pathway 1 (0.1)30 (3.9)Number of Errors (%) 878  758*Number of Prescriptions After Pathway Introduced (11/03-10/04) Before Pathway Introduced (7/02-6/03)

Jump to first page Paediatrics Pathway n High rates of prescribing errors in Paediatric patients F Very limited margin for error n Small number of drugs accounted for majority of prescriptions n Radical overhaul of Paediatric Prescribing Pathways n Re-audit to evaluate effect

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Formulary Management n Supports Formulary Management process n Enables Trust to control escalating Drug costs n Encourages prescribing of most cost effective therapy n But does not formulate policy…..

Jump to first page H2 Antagonist Usage

Jump to first page Wirral EHR n Contains data from primary and acute care settings n Read only, reference system n Supports continuing care across boundaries u A&E and IP discharge summaries u Pathology and radiology results u Appointments and TCIs

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Wirral EHR Benefits 1 n Joined up working between organisations n Accessing patient information from a single source n Quicker access to some information ie x- ray Better patient treatment/journey, reduced test duplications n Knowing what allergies and recent/repeat medication history (especially for 24hr emergency services) n Providing community services with patient information (instead of faxes and letters)..

Jump to first page Wirral EHR Benefits 2 n Improvements around administration n in GP practices, less phone calls to lab n Reduction in phone calls to A+E for CAS card n Improved clinical interaction n Increased access to information n Quality improvement for patients n Support services ie Quality Outcomes Framework…

Jump to first page WROCS n Wirral Remote Order Communication System (WROCS) n Allows users in primary and community settings to order pathology and radiology investigations n More efficient ordering – no request forms n Reduces effort in lab and radiology reception n Reduces duplication of investigations n Results are sent electronically to GP systems, PCIS and EHR n Secondary care clinicians can see results on admission e.g. MRSA screening n Patients can have investigations performed before OP appointments and the results are then available for review during the consultation

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Summary n Provides information for improving services and care. n Implementing pathways and guidance. n Reducing risk – prevent errors. n Share patient information to reduce duplication and speed up access.