Here’s the most often asked questions we receive and our answers.
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Why are we introducing an electronic patient record system?
We already store many of our patient records on computerised systems, such as CHIPS, as well as on paper. We are keen to bring all of this information together into one place so that we have access to it when we need it.
We see many thousands of service users every day, with different and complex health conditions. Having up to date, accurate information about this, available to everyone, 24 hours a day, offers a single source whenever it is needed, helping everyone to offer the best care we can and ensuring that service users get the treatment they need. This is why we are introducing a new system. Access to information is only one element of EPR. It will also help us to deliver care in a different way, according to best practice, efficiently and consistently. The NHS 5 year forward view challenges the NHS to work differently, be more efficient and deliver more joined up care. EPR is the tool that will support us to do this. Industry uses information as a way to work in a smart way and the NHS are moving to this way of working too.
What change will EPR introduce?
Every time a service user uses one of our services or has an appointment with one of our doctors, nurses, therapists or other staff we write down what was discussed, any treatments or advice and any procedures. This is the patient record. This information is more than a computerised record – it is a clinical tool to support the delivery of care that will help us to do what we do even better. As a tool to coordinate care it will help us to deliver the best care and be more efficient in our work.
It helps clinicians to take advantage of the knowledge and advice of colleagues, it offers a continuous record of all care and it also tells us things like what medicines have been prescribed, and any allergies. It also has the results of any tests.
At present (before introducing this system) patient records are held in a number of different ways, including paper-based notes and computer records on CHIPS. This means that different sets of information are in different departments and locations.
The system we are introducing, which is called Lorenzo and is supplied by CSC, is able to store more in-depth clinical information on patients. All hospital staff who are directly involved with a patient’s care will have some level of access to this system, and you will be expected to update it each time you deliver an episode of care.
When will the system be introduced?
The system will go live on ROSE Day – 13th May 2017
How will I find out if I need to use the system and how to use it?
We have put together a full list of people who need to use the system. This list contains all clinicians, as well as others who need to access patient records or other related information, to do their job. Anyone involved in the delivery of a patient care, from porters to domestics and booking clerks will use the system to help coordinate work.
We have contacted all people to invite them to book and attend training so that they know how to use it. Staff won’t be able to opt out of training as it is so important that everyone knows how to use it. Using the EPR will become an essential part of doing their job just like learning how to use a risk assessment or care plan. Some people may be able to do the training independently via e-learning, depending upon the level of knowledge they will need.
Will the system be tailored to my department’s specific needs?
The Lorenzo system has been tried and tested in many NHS Trusts and has a standard configuration which we will use. We estimate that for the most part, this will guide us, as it is already based on best-practice across the NHS.
In the lead-up to the introduction of the system, a team of ‘Subject Experts’ – people with a background and knowledge in different clinical service areas – will work in some services to discuss how you currently work. If members of staff are interested in getting involved in this work we’d encourage them to get in touch. We are asking teams to use this as an opportunity to think about how they work. Local adaptions can be made to support your work, however we’ll be asking teams to carefully consider what these are and if current working practices could be reviewed and improved.
Why is keeping accurate patient records important?
Keeping accurate records is a legal requirement and also part of the professional code of health care professionals.
In making an accurate record of care we ensure that service users receive safe, high-quality care and we provide colleagues with the information they need to make good decisions, in real-time. Should anything happen to a service user that results in further enquiry or investigation (serious incident, coroners court case etc), the record will be used as evidence. This is why it is important to have a timely record of care. This principle remains the same regardless of whether records are electronic or paper-based, and this doesn’t apply to just clinical information but also administrative details (appointment times etc).
Royal Colleges and professional bodies offer guidance and best-practice advice on record keeping which should be reviewed alongside the Trust’s own policies and procedures.
What information will be included in a patient’s electronic patient record?
The record will include important information including: Clinical information
- Medical history
- Current prescriptions
- Laboratory test results
- Radiology images
- Immunisation status Clinicians involved in the delivery of care
- Clinician & logistics information
- A record of each episode of care
- Dates of admission and expected date of discharge
- Location of care (ward / bed / clinic etc)
- Appointment times
- Nursing care information
- Observations records
- Care plans
- Some assessments
- Personal information
- Date of birth
- Contact phone number
- Next of kin contact details
- Specific services may also store other information relevant to patient care – this will be discussed with SEs as the system is developed.
What will happen to the patient records that the Trust has from prior to the EPR being introduced?
Existing paper records and/or those on another computer system will be used alongside the new computerised records we are making. In some cases, paper records will be scanned and added to the system
How will the EPR help to manage the hospital?
Because the EPR will hold information about all patients in the hospital, it has the added advantage of helping us to have an overview of the hospital as a whole. Using the information held, we will be able to see how many patients are in the hospital and when we are expecting to discharge patients. This means that we will be able to manage the flow of patients through the hospital better and plan ahead. In addition to this the system will help us with reporting (internally and also to the external bodies we need to provide information to) as well as supporting our audit work. As an advanced scheduling and care management system, what we do in the system will help us deliver care more efficiently
How will the EPR help us to make patient care safer?
Having a holistic view of a service users condition and care will help clinicians make better decisions about the care we offer. The intelligent computer system follows best-practice ‘care pathways’ and takes the information clinicians put into it to suggest next steps in the care of a service user. Whilst computers can never replace the knowledge and good judgement of a clinician, it can help to alert us things we should look out for and act as a guiding hand in our work. It could also alert us if a dose of medicine has been missed or a service user is due for an observation or test.
There are many benefits to using the system, which will be shared throughout the lead up to go-live and beyond.
Who will be able to see a patient’s electronic patient record?
If you are involved in the care of a service user you will be able to access their care record. Those involved in hospital management and appointment administration will also have access to patient records.
- Staff who need to access records will be assigned a secure access method which uniquely identifies them
- Their details will be recorded for every action that is taken on the system and this will be regularly audited
How will the secure access system work?
Access to the Clinical system is by Smartcard only. Smartcards are assigned to an individual. Every time someone accesses a record, a note is made, including how they used it, giving a full audit trail.
Can patients opt out of having an electronic patient record?
No, the electronic patient record is central to the care we offer and all patient care will be recorded on the system.
Will patients be able to ask to see their electronic patient record, once it has been introduced?
Yes. The Data Protection Act 1998 allows patients to find out what information we hold about them. They can request informal access when they receive care from you. This includes under 16s.
We are also planning in the future to have a ‘Patient Portal’ for the system, giving patients access to an agreed set of information about their care.
In special circumstances the law allows us not to show patients their information (if we consider it will be harmful to them). More guidance will be issued on this. Patients can also request formal access to their records and may be charged for this access.
Can a patient request changes to information on their electronic patient record?
If a service user believes that incorrect information is held, please discuss this with them. Staff have an obligation to keep information current and correct and should take every opportunity to update details where required.
Can you add information to a patient’s electronic patient record?
In the course of a consultation with a service user, clinicians will gather information relevant to their care. All of this should be recorded. Clinicians should encourage patients to share as much background as is useful for the delivery of care. In addition to this, non-patient facing staff will be able to update the record with any information they receive.
What are our patient’s rights with regard to their health information?
Under The NHS Care Record Guarantee and The Data Protection Act 1998 we make commitments to keep service users information safe and confidential. If a service user believes that their confidentiality has been breached they should be advised to contact the Trust.
How does it match with what I do now?
At present, people working on the project are working closely with each directorate to understand how they work now. This is a great opportunity for everyone to take a close look at how they work and think about how it can be improved. The new system has been developed based on best practice at lots of NHS organisations and we’ll be taking advantage of this knowledge – this means the new system can be a real trigger to review the way you work in future and we’re encouraging everyone to take advantage of this opportunity.
Integration – how will it work with other IT systems?
In some cases the new EPR will replace existing systems. In others, it will integrate with existing systems. This decision will be made on a case-by-case basis based on best practice and the needs of our patients and clinicians.
What support will there be?
There will be a lot of support for staff over the coming year. Initially, members of the team are visiting work areas and clinical teams to give some basic information about the new system and its benefits. Following this, everyone who needs training will be invited to attend and have the opportunity for hands on learning. We’ll also be offering informal learning and drop in opportunities. During the go live period we will have a team of people to give hands-on support as well as fast response on the end of the phone. Each area will also have super users within the team who will receive additional training to support colleagues. If staff are interested in doing this they can should contact the Trusts Clinical Systems Support.
mailto:Lesley.Birkin2@northstaffs.nhs.uk– Clinical Systems Manager
mailto:Ann.Ekman2@northstaffs.nhs.uk– Clinical Systems Specialist
Will there be wifi connectivity?
The Trust has Wifi across all of its sites. The computers and other devices that people will use will all use this Wifi to connect to the system so that they are as portable as possible. We reviewed wifi connectivity as part of the programme early on. The devices themselves will still need charging (like you would any laptop or mobile phone).