EPR Staff Handbook

Getting ready for our electronic patient record (EPR) Created by: EPR Programme

www.cddft.nhs.uk

Contents

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Welcome Chief Executive message

4-13

Understanding our Electronic Patient Record What is EPR, Embracing Change, Clinical Safety & Our EPR, Training FAQs, What will EPR mean to me and What will EPR mean to our patients

14-22

What do I need to do before go-live?

Checklist, Training and What New Applications There Will Be

23-24

What will happen before and at go-live?

Full Dress Rehearsal, Cutover and Help Available at Go-Live

25-41

Change and readiness Your Change Network, Key Changes & Benefits Expected and Glossary of Terminology & Acronyms

42

Contacts and queries

www.cddft.nhs.uk

Improving the way we deliver patient care using technology Working within CDDFT you will see the way that we have brought digital systems into our work, supporting colleagues in delivering the best care for patients.

We aim to be a leading trust in both patient and staff experience and see digital technology as an enabler of this. It doesn’t replace what our people do but in many cases creates more time to care, more time for our people to interact with the public and do what they do best.

With the best systems in the world we still need Nurses to be Nurses, Surgeons to be Surgeons, AHPs to be AHPs, Medical Secretaries to be Medical Secretaries and so on.

The next step in our Health Informatics strategy, a more unified EPR, will smooth the patient journey through our services, give clinicians faster access to more accurate information, and transform healthcare delivery across our region.

It goes without saying that the delivery of the new EPR is a massive undertaking but our ambition and enthusiasm for delivering a better patient AND staff experience is more than up to the task.

I hope that this booklet helps you understand why we are so excited about the system Go Live and the years that will follow.

Sue Jacques Chief Executive

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Understanding our Electronic Patient Record (EPR)

What is EPR? EPR will bring together patient records and many of the clinical systems we currently use into one integrated system. It’s important that we take this step because it will support safe clinical care and will help us achieve our ambition to become one of the most digitally enhanced trusts in the UK. EPR will mean that all the information on each patient will be in a central place, which will be accessible to everyone who needs it. This will mean that patients won’t have to keep giving us their personal and medical history over and over again and if they do need to move around our hospitals there is less risk of losing their hospital notes.

Our clinicians will have access to more consistent information which will help them to offer patients efficient pathways and processes, leading to better clinical outcomes. They will also be able to make use of the live data to monitor their clinics and theatre lists and to help them create correspondence to GPs and patients. They’ll also be able to monitor their patients wherever they are, both inside and outside the trust.

EPR will help nurses spend more time at a patients’ bedside as they will have access to hand held computers, workstation on wheels and to integrated equipment such as vitals link monitors, digital scanners and printers. This new technology will allow them to offer more robust monitoring of quality of care. Fundamentally, EPR will make our services much safer as it provides a great deal of important information at the point of admission, such as flagging the safeguarding needs of patients who are frequent fallers and patients who’ve had infections, which is very important for their safety and that of other patients.

www.cddft.nhs.uk

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Embracing Change • It is normal to have worries and fears when big changes are being made, and is equally important that you raise and address them.

• We accept that everything will be new and, realistically, it may slow you down initially, but, once the new system is embedded in, we fully expect to see significant benefits for everyone.

• As with our current Electronic Patient Records many clinicians will be familiar with them and appreciate the advantages they will bring, and our new EPR will allow us to move forwards into a new era.

We are supporting you at every step of the way and can always be reached on cddft.epr@nhs.net at any time.

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Clinical Safety & Our EPR Whenever a new IT system or technology is implemented in a healthcare setting, as well as creating benefits, it also introduces some risks.

Risk and value – “opposite sides of the same coin” In CDDFT we already have an agreed Clinical Risk Management process for new technology – this process is also being used in the EPR Programme.

We have a dedicated workstream for Clinical Safety – led by Mr Andrew Jennings (Chief Clinical Information Officer) supported by a clinical workstream lead who works with a team of 12 Clinical Safety Officers – a mixture of medical, nursing, AHP staff and others.

This team is scrutinising our EPR product in detail to give assurance to the Trust Board that it is “safe to deploy”. EPR will only be approved for “go-live” once this clinical assurance is given.

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Training FAQs How do I book training?

When is training?

Training starts on 20th June and runs for a total of 16 weeks until Go Live on 10th October. There are two distinct “phases” to the training window. The first 8 weeks (20th June to 14th August) will revolve around online training accessible via ESR and the second 8 weeks (15th August to 7th October) will revolve around support and practice which you will be able to do on a training domain

What training do I need to do?

You’ll need to complete a series of modules on ESR which are being designed and built from a role specific perspective. These modules are being assigned to you based on your role, service and current systems access.

You’ll hear terms such as PowerChart, RPAS, FirstNet, SchApptbook and Capacity Management – most of which will become like second nature to you before long

How long does the training take?

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It depends on your role. You may only have an hour or two, others may have much more. It is all detailed on pages 16 & 17 page which had been sent to the Care Groups.

Training will all be accessed online via ESR, just like you do with your essential training now. It will be auto-enrolled for you ready for 20th June. When you log on you’ll see the relevant courses on your Learning Record. The elearning is made up of short demo videos followed by mini practice sessions.

My training allocation seems wrong - can I add or remove training?

You can. You can either subscribe to different modules or unsubscribe from those that have been enrolled for you. There’s been a short video produced detailing how to do that but it is the same as adding or removing current e-learning on ESR.

I struggle to access a PC in my department, how can I complete my learning online?

We have a number of locations available across the 3 main sites (BAH, DMH and UHND) that you can book to use a PC. We have around 40-50 PCs available per day. To book a space for a half or full day, contact cddft.eprtraining@nhs.net.

Alternatively you can drop into one of the Trust Libraries or complete the training at home on your own device.

Are there any classroom teaching sessions?

Not in the first 8 weeks. From 15th August there will be a series of lectures, drop-ins, classes and workshops that you can book onto to get additional support. These will be released over the coming few weeks.

What happens after I have finished training?

Your completions will be recorded on ESR. Following that it is strongly recommended that you undertake practice on the training domain in order to consolidate your learning and be ready for the system “going live”.

How will I get to practice on the system before Go Live?

You will be able to access a training domain so that you can familiarise yourself with the scenarios and situations you’ll be facing when in that real life situation. More information will be communicated in time for the last 8 weeks of the training window.

You can also go back and repeat the eLearning, or parts of the eLearning, as often as you wish as it will remain accessible on ESR.

How do I find out what my staff need to be trained in?

Full staff allocations were sent round to Care Group senior teams in April. If you have not seen these, please contact cddft.eprtraining@nhs.net

Will there be any help sheets/user guides available that we can print off?

Yes, we’ll be producing a large number of quick reference guides (QRGs) which will be available online – sometimes referred to as ‘cheat sheets’.

I am not confident using a computer, is there any help available for me?

The Training & Development Department have partnered with local colleges to offer basic digital skills training. Contact T&D for more information on details.

Can I access ESR from home?

You can. You can access via Trust VPN with your smartcard or with a username and password if you don’t access the Trust network already (when at home). You are able to set your own home access up and also reset your password should you forget it. Visit the ESR home page for instructions or by Clicking Here.

Will there be a trainer I can talk to?

Yes, you’ll see trainers and Super Users in your department on a very regular basis. You can also attend drop-ins, classes, lectures and workshops during those final 8 weeks.

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What will EPR mean to me?

I’m a Receptionist

• Appointment types are replacing clinic codes • Only specific appointment types are visible to the specific referral

I’m a Junior Doctor

• Easier to schedule an appointment as it is no longer episode driven

• Single log-on Shared task lists mean better team coordination

I’m a Matron

• will save time • Consolidate order catalogues will reduce complexity and the need to ask for advice

• Overall view of your clinical area, i.e. number of patients, length of stay, estimated date of discharge and the task and medical timeline so that you can see the expected busiest parts of the day

• Improved reporting • Visibility of all patients and the associated risks

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I’m a Health Care Assistant • The ability to enter vital signs at the bedside as you do now • Can view and enter data into a patients record at the same time as colleagues • A measurement or assessment can be used wherever needed without having to be reentered each time

I’m a Nurse • Drug charts always accessible reducing delays in administrating medication • Immediate access to data entered by others – vital signs

I’m a Pharmacist

• Better visibility of medication and tasks due

• Real time review of prescriptions • Notification as soon as a takeaway (TTA) is written, optimising discharge flow • Medication requests direct from the electronic drug chart

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I’m an Allied Health Professional (AHP)

I’m a Consultant • Notification when test results need action or passing onto others

• Better visibility of a patients condition by using data entered by others

• All information at hand at ward rounds • Access to the patient record at any time, on and off the hospital site

• All inpatient referrals and follow-ups shown on the patient list

I’m a Midwife

• Access to entire patient records from any location

• Faster alerting of deteriorating women • Visibility of all staff who have been involved in the patient’s care

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What will EPR mean to our patients?

EPR will enable us to offer our patients safer care and a much smoother experience. A common complaint is that patients are asked to give their details multiple times and EPR will mean that this will be a thing of the past.

What EPR will do is provide the platform to deliver our ambition for patients to access their medical record, where they will be able to view their own medical records through a patient portal, ensuring they are fully involved in their health and care.

In addition, patients can be confident that they are receiving the safest and most effective care in line with the latest clinically evidenced pathways.

Did you know?

We will be explaining the changes to patients so that they understand the reason for any delays during go-live

“We have been using our current EPR for 20 years, it’s replacement is very much an EPR for the 21st Century & is an opportunity to transform the care we provide to our patients.”

Andrew Izon Chief Information Officer

www.cddft.nhs.uk

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What do I need to do before go-live?

This section of the handbook can be used as a  Checklist to tick off the actions you need to take before go-live.  Book time to complete your EPR training Most staff in our hospitals will use the new EPR so it is essential that they receive training on the new system before it goes live in October 2022. All staff who will use the EPR must complete a two-phase training programme: the first eight weeks are dedicated to accessing demo videos and completing e-learning packages through ESR; the second 8 weeks is hands on practice where staff will also have the option to attend classroom training, which will be delivered across multiple sites (UHND, Prospect House, DMH & BAH).

Training began running from 20th June 2022, which was the start of a 16 week period of training and support.

EPR training queries: cddft.eprtraining@nhs.net

Your line manager will have assigned you to specific training courses which have been developed around workflows and staffing groups.

The courses cover the following areas:                        

Anaesthetist Capacity Management for Elective, Non-Elective and ED Deteriorating Patient Resuscitation & End of Life Care (DPR & EOLC) ED Admin ED Doctor ED Nurse Hospital at Night Pharmacy Powerchart AHP Powerchart Clinician / Doctor ADULT Powerchart Clinician / Doctor PAED Powerchart Clinician / Doctor Surgeon Powerchart Clinician / Doctor Outpatients Powerchart Medication Administration Core & Advance Powerchart Nurse ADULT Powerchart Nurse PAED Powerchart Out Patient Nurse Powerchart Prescribing Powerchart View Only RPAS Booking Theatre/ Anaesthesia Nurse Waiting List & Theatre Admin Blood Transfusion Administration Blood Transfusion Clinical

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What new Apps will you be using? (part 1) Role

New Cerner Applications/Apps

What does it replace?

Allied Health Professionals Anaesthetists Any staff involved in the ADT process

Powerchart, Powerchart Touch iCM, eCaMIS eCaMIS Theatres Powerchart, SaAnaesthesia Admissions, Discharges, Transfers in eCaMIS & Capacity Management Symphony Clinicians (not in ED or Paediatrics) Powerchart, Powerchart Touch iCM Clinicians (not in ED or Paediatrics) who perform Powerchart, Powerchart Touch surgery iCM, ecamis theatres Clinicians in ED, Urgent Care Symphony Firstnet Clinicians in Paediatrics Powerchart, Powerchart Touch iCM Clinicians working with outpatients (not in Powerchart, Powerchart Touch Paediatrics) iCM Clinicians working with Paediatric outpatients Powerchart, Powerchart Touch iCM Non-clinical staff in ED, Urgent Care Symphony Firstnet Nursing staff (not in ED, Paediatrics or Outpatients) Powerchart, Medanets iCM, eCaMIS, Nervecentre Nursing staff in ED, Urgent Care Symphony Firstnet, Medanets Nursing staff in Outpatient areas eCaMIS, iCM Powerchart, Medanets

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*if you currently use SystemOne, you will continue to use it after the go-live of EPR

What new Apps will you be using? (part 2) Role

New Cerner Applications/Apps

What does it replace?

Nursing staff in Paediatrics Nursing staff working Theatres Obstetrics/Maternity staff Patient Flow team, AI Team, F1s, F2s Pharmacists Staff administering bloods Staff in the Waiting List Dept, non-clinical staff in Theatres Staff managing clinics Staff ordering bloods Staff required to administer medications Staff required to prescribe medications Staff required to view clinics Staff requiring view only access to powerchart

Powerchart, Medanets Powerchart Powerchart, Medanets Powerchart, Medanets Powerchart Powerchart Powerchart, SchApptbook

iCM, eCaMIS, Nervecentre eCaMIS Theatres, iCM iCM, eCaMIS H@N Nervecentre iCM ePMA iCM

eWLM, ecamis theatres eCaMIS, OPS, OPSM Revenue Cycle iCM Powerchart Powerchart, Powerchart Touch iCM ePMA Powerchart, Powerchart Touch iCM ePMA eCamis OPS view only Revenue Cycle eCaMIS read only, iCM read only Powerchart *if you currently use SystemOne, you will continue to use it after the go-live of EPR

www.cddft.nhs.uk

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Prescribers

Where can you do your training?

You can access the training anywhere you can access ESR but we encourage you to find somewhere quiet where you will not be interrupted for at least an hour at a time. We are aware that some staff will do the training from home; others in the workplace where they have a device available; some in their usual work department/service area. Alongside this, we are providing some additional training space with a device that can be booked for staff who might need it.

Top Tip Before logging on for the first time, we encourage you to visit the EPR StaffNet Intranet site and view some of the materials. This can be found by going into StaffNet, clicking the down arrow next to systems (on the right of screen) and selecting ‘EPR’

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Those staff required to prescribe medications will need to complete a short face-to-face prescribing assessment once they have completed their e-learning. These assessments will not take long, however are vital for us to sign prescribers off with that competency. Prescribers must complete their assessment before go live (10 October). There are a few ways that assessments can be carried out; 1. We will have assessment classrooms available at Prospect House, DMH Memorial Hall and BAH Education Centre. If people wish to attend those sites, they will need to book a place, please contact cddft.eprtraining@nhs.net

2. We can also arrange to send trainers to your location if we need to capture staff in bulk, line managers are making those arrangements when necessary – please check with your line manager to ensure this is happening.  Completed face-to-face prescribing assessment

Ongoing access to training materials The Training Team will be monitoring completion levels and will be able to offer extra support to areas of the Trust which are struggling to complete training. Once complete, all training modules and demos will remain on your ESR so that you can revisit them to refresh your knowledge at any time.

Lisa Ward Chief Nursing Information Officer

“The new EPR system will be a real asset to Nurses & AHPs, bringing new workflows & also building on the mobile functionality we have now making their work easier and safer.”

Top Tip Book time in for your training early and stagger it over the weeks as this will make it easier to fit into your work schedule

Did you know?

If you have not completed your assigned courses you may not be allowed access to the EPR system when it goes live

As well as the training courses, you will have access to workflow checks, quick reference guides and practice activities to help you to familiarise yourself with the new EPR.

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 Have your NHS smart card ready Most staff will access our EPR using a “single sign on” system called Imprivata (this is being implemented in CDDFT now).

However some of our staff will need an NHS care identity service smartcard to access EPR: this is likely to be admin, clerical and receptionist staff, we will confirm this before go-live.

If you haven’t yet registered for one, and you are in one of the roles mentioned above, it makes sense to get smartcard in advance.

To get a smartcard, you need to first get sponsored (approved) for a card by an RA Sponsor, after this is done you will need to see an RA Agent, present some ID confirmation documents, get your photo taken and have a card printed.

Your line manager will be able to advise who is the RA Sponsor and RA Agent in your area – alternatively you can find info here: Smartcard/Registration Authority - Home 20

“I am very excited to play my part in the Trusts EPR Implementation programme. We have an amazing team of experts all involved to deliver a successful programme that will improve patient care & Staff experience”

Tracey Hardy Transformation Programme Director

 Phase 2 of Training We will be dropping in – As part of the approach to support the training practice phase we will have teams of trainers and change leads roaming across the trust, dropping into wards and departments. This approach has been really successful in the previous engagement activities so hopefully you will look forward to seeing us throughout August and September.

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 Phase 2 of Training (…Continued)

Training support and getting ready for go live – dedicated support for your service – just ask!

As part of the approach to support the training practice phase we will have teams of trainers and change leads roaming across the trust, dropping into wards and departments. This approach has been really successful in the previous engagement activities so hopefully you will look forward to seeing us the second phase of training.

There will be drop in and lecture theatre sessions that you can access to learn more about EPR. To make a booking please email: cddft.eprtraining@nhs.net

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 Think through the impact that EPR will have on you and your team Think about how you and your team will be using EPR, i.e. what you will stop doing on paper and what you will start doing digitally. If you’re not sure how a clinical process will work for your team, ask your line manager or contact one of your change lead colleagues. You can find these listed on page 16-17.  Check you’re up to date with your department’s business continuity plans

Ask your line manager what business continuity plans are in place for any downtime over go-live and familiarise yourself with them.  Acquaint yourself with devices We’ll be making the most of existing medical devices by integrating many of them into the EPR. This includes the introduction of more workstations on wheels (WoWs) in clinical areas, vitals signs monitors, barcode scanners, smartcard readers and printers for labels and wristbands (see next page).

“I’m looking forward to having a modern electronic system to enable us to improve our care for all patients.”

Andrew Jennings Chief Clinical Information Officer

Thank you for your patience.

Work will be carried out to install additional power sockets and improve the wireless network. New kit will also need to be installed to allow connection to bedside medical devices. We appreciate your patience while this work is being undertaken.

If you work in an area where you are likely to be using new equipment you will receive training to help familiarise yourself before the EPR goes live.

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 Keep up to date with the EPR Programme Hopefully you will have attended some of the EPR events that have been held over the course of the last year, such as the virtual Q&A meetings, pop-up roadshows, ward engagement events and departmental leader sessions.

Similar types of events will continue to be held right up until go-live so please attend as often as you can.

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Also, find out all the latest news on the trusts Week Ahead newsletter, EPR StaffNet page, the dedicated EPR Bulletin and through the trusts social media channels. If you see an EPR pop-up event around the Trust which are continually happening up to go-live, so if you’re passing, please stop and say hi.

Top Tip If you can’t remember how to do something on EPR, check out the user guides and e-learning videos available on the EPR system.

What will happen at go live?

System cutover and downtime

Full dress rehearsal From the 05/09/2022, we will be running a full dress rehearsal to make sure that all technical, clinical and operational requirements and dependencies are included in the detailed go-live plan. We will check that the new EPR is technically and operationally functional for go-live. The full dress rehearsal will include replicating live patient care in the EPR allowing clinical and operational teams to prepare for go-live.

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The changeover from our current systems onto the EPR system will happen over a weekend. A detailed schedule of how this will work will be circulated nearer the go-live date.

All clinical areas will have a plan for the activation of any new equipment, and the medicines management team will co-ordinate the switchover from the current drug trollies to the workstations on wheels (WoWs) which will be set up to replace them.

Help available at go-live To support you before, during and after go-live, many colleagues have put themselves forward to become Super Users. While they are not system experts, your Super Users – who come from different specialties across our hospitals – will play an invaluable role in the implementation of EPR. A list of Super Users will be circulated and you should know who to approach in your area if you want to find out more about EPR or need some help with things such as training. You will recognise them easily as they will be wearing distinctive EPR Pink t-shirts. In addition, we also have a group of staff who are Super User PLUS, these staff will be supernumerary at go live and will be able to help to get EPR embedded as we move forward.

Also look out for colleagues in orange t-shirts they can help with EPR questions and will be floating around the Trust at go live. We will also have support from Cerner who will be on site and we will have a command centre in place to make sure go live and beyond is as smooth as possible.

Change and Readiness

Find out about your change network Andra Dragan

We have a team of clinical and non-clinical staff leading the design, development and implementation of the EPR.

ED & UTC (Change Management Lead)

Kate McGregor Anne-Marie Lenagh

Order Comms.

(Change Management Lead)

Workstream Lead (Change Management & Benefits) POC for Clinical Documentation

Alex Brown Theatres, Anaesthetics, Supply Chain & ICU (Change Management Lead)

Mark Herkes Workstream Lead (Organisational Readiness)

Tanya Allan Theatres, Anaesthetics, Supply Chain & ICU (Change Management Lead)

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Change Leads Anne Boyle PAS – Patient Flow (Change Management Lead)

Mandy Patten PAS – Patient Flow (Change Management Lead)

Joanne Stronach ePMA (Change Management Lead)

We have a Change Lead for each workstream of the EPR programme. They are experts within their clinical field and work alongside colleagues to develop business and process changes to implement our EPR and support new improved ways of working to deliver all the available benefits that the new system will bring.

Chloe Williams Outpatients (Change Management Lead)

Maria Dent PAS - Inpatients (Change Management Lead)

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Key Changes and Benefits Expected from EPR The following pages provide the core aspects of change that will result from the implementation of the trusts new Electronic Patient Record (EPR) solution. Overall, the solution will bring into one place various tools that can improve clinical decisions and thus favour a safer, more effective and more efficient patient experience.

The transformational change approach adopted by CDDFT has helped to shape the solution to meet trusts needs and aid the adoption of more streamlined ways of working across all sites.

Please see the main changes expected, the benefits and what it means for key roles within each of the following areas: • • • • • • • • • •

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Clinical Documentation Order Communications Emergency Department Medicines Management Patient Flow Theatres & Anastasia Paediatrics Outpatients Inpatients Allied Health Professionals

Snapshot of what is changing

Snapshot of what is changing

Key benefits the reason why we change

Clinical Documentation

CHANGE

•

• •

• •

59+ approved workflows mapping out new agreed ways of working Moving from paper to Powerchart for clinicians; in PowerChart, nurses can use CareCompass to help organise & plan patient care; with mobile Nervecentre functionality moving to Medanets Provides visibility of planned actions and outstanding tasks to allow nurses and doctors to effectively prioritise and plan workload Powerful decision support that utilises predictive algorithms to fire rules and alerts: • Care plans will now be suggested based on information entered • E-Referrals without leaving clinical workflow Significant reduction in use of paper documents (paper lite) Users will have options to create a personalised platform with time-saving quick links: • Auto texting • Favourites • Tagging of documents

• •

What is changing for a nurse: Many elements of routine daily patient care will now be collectively planned, documented and viewed in the Carecompass What is changing for a doctor: Assessments, diagnosis and medical/surgical management plans will be documented and delivered using Powerchart

• • •

Benefits

•

• •

•

Significant reduction of paper- based processes Harmonised ways of working across all Trust sites Improved efficiency in accessing clinical documentation Patient record can be viewed by more than person at a time New Sepsis detection on Mobile platformimproved observations algorithm and alerting-leading to more timely identification and treatment Increased compliance with falls risk assessment within 24hrs potential for reducing number of avoidable falls

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Order Communications

•

CHANGE

•

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• •

• •

•

12 Workflows approved mapping out our agreed ways of working.

Placing all orders now will be done electronically, an order can be a request for samples to be sent to Pathology or a request for diagnostic testing such as Radiology Imaging, Cardiology or Endoscopy investigations.

Several orders can be requested together using Order Care Sets based on medical condition.

As a result of implementing EPR, the following paper documents will cease to be used unless in times of BCP: • 122023 Blood transfusion request form • LP169856- Blood Transfusion Pathway – Adult • Standard Blood Form • Paper request forms for Cardiology and Radiology An alert will appear on the desktop where any orders have been duplicated for the patient.

You can visibly track the progress on an order in the system which will cut down on the need for telephone calls and chasing

• • •

You will now have to place an order for diagnostics directly into the new system called Power Chart or FirstNet. Reduction in scanning documents, following paper methods for results, call back or printing off referrals.

The system will alert you when results are ready to be reviewed and endorsed.

The system helps you to enter all mandatory information required.

You will be guided to follow standardised workflows and prompted if information is missing.

• •

Benefits

•

• • • • •

Removal of paper-based processes in favour on integrated electronic solution Real time notification on diagnostic results from the Lab & Radiology Placing orders electronically Sample collections for Phlebotomy drop Inpatient on to a collections list for wards Reduce duplicate requesting of tests Prompts if another test is also required All patient information is available at one glance

Emergency Department •

CHANGE

•

•

•

• •

33 workflows approved ready for adoption as the agreed harmonised ways of working Administration staff will now see a reduction in scanning documents as information is entered at point of care As a result of implementing EPR, the following paper documents will cease to be used unless in times of BCP: • Ambulance pre arrival form; • Ambulance hand-over form; • TRAUMA booklets; • Results call back paper process Nurses will assign themselves to patient and triggers will prompt for assessments and outstanding tasks that need to be carried out e.g., medication administration Discharge summary is auto populated with patient information captured within Millennium and discharge letters generated electronically to GP surgery Patient care plans will be completed in real-time and patient safety checklist automatically Dashboard will give real-time overview of all ED activities which will improve patient flow, reduce telephone calls and improve data handling

• • •

• •

Clinical Coding will be done real-time at point of care TEWV will continue to have access to add notes to patient records ED Admin will now see a reduction in scanning, following paper methods for results call back or printing off discharge being done direct into EPR Task lists will be utilised throughout which trigger and direct where resource is needed to deliver patient care Nurse/HCA will be utilising mobile device & solution •

•

Benefits

•

• •

• • •

Improved efficiency and accuracy of clinical coding Efficiency in patient arrival to being seen in Triage Contributing positively to improving Length of Stay timings Helping eliminate avoidable admissions / readmissions Improve the patient journey from ED to inpatient as data captured once at point of care and visible throughout Improved Patient documentation At a glance view of the nurse / doctor caring for the patient

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• 1 workflow – interim way of working due to delay in integration to other systems that is needed • Clinicians will have view only in EPR so that patient history can be accessed – this will provide a stepwise approach to the bigger change once the integration is delivered • Outpatient clinic appointments will be done via EPR

• Clinicians / nursing staff will have read-only access to EPR so that patient history can be accessed • Admin staff will utilise RPAS within EPR for outpatient appointment bookings

• The intended benefit of ‘A reduction in avoidable Urgent Treatment Admissions / Readmissions’ (LOS2) cannot be realised until the integrated solution with 111 has been delivered therefore deferred

Benefits

CHANGE

Urgent Treatment Centres

Medicine Management

CHANGE

•

Administration of medications using barcode scanning for in-patients

•

Approximately over 100 Order Sets built to ensure more accurate prescribing with supporting information all in one place

•

•

Faster and more efficient medication request process

•

Fully digitalised complex meds prescribing including diabetes and parenteral feeding management

• • •

•

Digitalised prescribing in ED

•

Investigative services including X-ray, Cardiac Day Unit and Endoscopy moving to digitalised prescribing

•

18 Workflows mapping out our agreed ways of working

•

Fully digitalised medicines reconciliation process

•

Dashboard for pharmacy staff giving an overview of patient workload – Pharmacy Care Organiser More effective and quicker medicine request and discharge process for patients New built-in dose calculator automatically pulling in patient's height and weight Enhanced alerts ensuring right balance of relevant alerts Instant access to information at the point of prescribing Relevant results available at the point of prescribing

•

Benefits

•

• •

•

Closed loop prescribing Right patient, Right Medication, Right Time Sustainability matters – Contributing positively to Our Green Plan by using less paper Instant access to information at the point of prescribing – saving precious time Patients Matter – enhanced alerts = improved patient safety

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Patient Flow What’s changing for a nurse is....

CHANGE

•

• • • •

23 workflows approved ready for adoption as the agreed harmonised ways of working As a result of implementing EPR, the following paper documents will cease to be used unless in times of BCP: • Excel whiteboard spreadsheet/paper chart in AMU • Ward Clerk paper records of patients coming to the ward, bed allocation and transfer information • Patient Flow paper list of patients for discharge/potential discharge/internal & external transfers/Day attenders Capacity Management will enable harmonised ways of working across all sites.

Visibility of bed availability & status across all locations.

Targeted discharge dates can be recorded in EPR to improve visibility of potential bed availability.

Patient Flow can use the system to view which patients for admission and discharge to manage the beds in real- time and submit an updated bed report when needed.

One System Approach No paper trail Better knowledge of requests for speciality bed across sites.

Easy access reservations

What’s changing for a doctor is....

• •

One System Approach Sooner recognition of patients deteriorating condition/sepsis etc enabling speedier treatment for the patient

Ward clerks.....

• • •

One System Approach Easier Admission/Transfer/Discharge Process No duplication of work using admission book • • •

Benefits

•

• • • •

• • • • •

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Improved time taken from bed reservation request, assignment and completion Removal of paper-based processes in favour on Integrated electronic solution Real-time 'at a glance' view of clinical information to support Patient Flow Optimised processes by providing an overview of multiple clinical and nonclinical services Improved porter turn-around time Improved patient experience - right place right time first time Easy view of bed/cubicle cleaning to expediate flow of patient Contribute positively to infection control & turn-around time

• 12 Workflows approved, mapping out the agreed ways of working.

• Moving from Paper to PowerChart/ SaAnaesthesia.

• Carry out pre-op checks before procedures.

• Perioperative record is completed electronically capturing real time data points like case times, personnel present and any changes between schedule and completed procedure.

• WHO safety checklist is integrated.

• Provides clinical safety and facilitating informed decision making.

• Allows us to see a patient’s past medical, social and medication history at the click of a button.

• Allows us to access notes whenever we need them and to record simultaneously.

• Prompts reminds us which tasks we need to complete e.g. airway assessment.

• Information sharing across a range of care thus providing integrated care tool.

• • • •

All nursing documentation is required in live and real time during a surgical case.

Surgeon/ Physician will now be required to place orders and medication relating to the case, pre, intra and post allowing planning in advance.

Easily edited if any changes addendum.

Pull all data to the EPR so you get a full wave form for the case so you can review full details of the patient case.

• •

Benefits

CHANGE

Theatres & Anaesthesia

•

•

Reduce the amount of cancellations on the day of surgery.

Reduce late start and monitor the percentage of time lost per late start patient.

Different standards of anaesthetics being used per anaesthetist in theatre will be standardised therefore offering savings and improvement Improve compliance of the WHO checklist removing the need for paper forms.

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Paediatrics

•

• • •

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As a result of implementing EPR, the following paper documents will cease to be used unless in times of BCP: • Inpatient Documentation Records • Fluid balance charts • Paper Care plans • Safety checklist • Theatre Checklist • An additional 13 paper documents will no longer be utilised Moving to PowerChart for doctors; Care Compass within PowerChart for Nurses and Healthcare Assistants; mobile functionality will change from Nervecentre to Medanets The EPR will enable easy identification of tasks due, to help prioritise care There is powerful decisions support that will suggest Care Plans based on information entered GrowthChart is a key feature of the EPR solution

•

Benefits

CHANGE

•

While some paper-based records will remain the changes that you can look forward to by role are: • Nurses and Healthcare Assistants will move from paper-based records to electronic records • Doctors will document electronically instead of the paper-based records • Ward clerks will have less paper notes to prepare for scanning

• • •

Increased efficiency in finding patient record and multiple users can access same record at one time Harmonised ways of working across trust sites Increased compliance with care planning and recording care given More time for safer patient care

Outpatients

CHANGE

•

•

•

• • •

New streamlined appointment booking system 12 workflows approved to support new ways of working Moving from eCamis to RPAS therefore the main change is around familiarisation of new system and terminology being used e.g. stop using term booking appointment, start using term schedule appointment Creating a pathway is simplified and once referral information is added, no longer need to assign to clinician as it is no longer episode led. This makes scheduling appointments an easier simplified process.

Ability to introduce an electronic partial booking for follow-up appointments. This will be a more efficient and effective controlled process allowing a smoother transition for patients.

Gives an accurate, automated list of patients waiting for a follow-up appointment with their due date replacing manually maintained spreadsheets.

Ordering a follow up appointment can be prioritised ensuring a patient who is classed as urgent or on a cancer pathway can be monitored.

Much more streamlined process for updating replacement clinicians at times when clinicians leave

•

• • •

•

Training will be much quicker where new staff or bank staff are required Clinic codes are being replaced by appointment types meaning that staff no longer need to learn clinic codes and treatment codes The worklist request system functionality enables us to stop using manual triage list from information department Can view clinicians different clinics in one view without having to keep searching for different clinics RPAS is linked to the NHS spine ensuring patient demographic details are kept up to date with GP practices.

• •

Benefits

• •

• • •

Streamlined process for creating referral pathway, more simplified process for scheduling an appointment Reduce error rates and less chance of putting patients into wrong clinics Reduction in scanning medical records for Outpatients Referrals can be viewed either individually or with multiple specialities Unactioned clinics are visible and therefore will reduce the number of attendances not fully managed which will have a financial benefit.

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Waiting Lists / Inpatients

CHANGE

• •

• •

• •

•

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15 Workflows approved as new ways of working Removal of mortuary spreadsheet recording for deceased patients with electronic capture associated details e.g. location of death direct into the system for improved record keeping and accessibility to information All waiting list and appointment booking will be done direct in the system giving full visibility of the demands being placed on the trust On attendance either in an inpatient or outpatient overseas status question captured direct in system, if patient answers ‘not UK’ as the place they have lived for the previous 6 months, the patient then fall onto a worklist for overseas team to complete full questionnaire to determine their eligibility to free NHS treatment There will be no need for paper diaries to be used e.g., elective surgery as these will be managed electronically within the system Patients can be pre-admitted and added to TCI list, beds can be reserved for the patient of a ward can be allocated for bed on arrival, subsequent appointment can be given at discharge Consultants will access Powerchart to capture information that is currently recorded by handwritten Theatres ATWL forms

• •

Consultants will no longer need to estimate the duration of procedures or record in handwritten forms as procedure duration will be defaulted to national average. This is then replaced over the course of x10 procedure carried out by individual consultant to determine their average time which is then mapped automatically within the system.

You will no longer have to manually select printers to print letters and letters will automatically send letters to 3rd party printer if required Once letters are printed, you will be able to view the body of the letter - which cannot currently be done via CaMIS

• •

Benefits

•

• • •

Recurring appointments can be output on one letter Reduction in errors, breaches and paper outputs which have a positively impact on the CDDFT green agenda Visibility of appointments and demands placed on trust Removal of paper diaries Reduction in scanning medical records for Inpatients

AHP

•

• • • •

•

Approved workflow for AHP – which sets out the new ways of working for the following: • SALT • OT • Dietetics • Physio Moving from paper to Powerchart for AHPs; with some functionality moving mobile on to Medanets Provides visibility of planned actions and outstanding tasks to allow AHPs to effectively prioritise and plan workload Care plans will now be suggested based on information entered Significant reduction in use of paper documents (paperlight) Users will have options to create a personalised platform with time-saving quick links: • Auto texting • Favourites • Tagging of documents Availability of clinical assessments within the system to provide for efficient and easy accessible documentation

•

•

Benefits

CHANGE

•

What is changing for a AHP: Many elements of routine daily patient care will now be collectively planned, documented and viewed in the Carecompass Access and visibility of all nursing and medical documentation including results

• • • • • • •

Significant reduction of paper- based processes Harmonised ways of working across all Trust sites Improved efficiency in accessing clinical documentation Patient record can be viewed by more than person at a time Increased compliance with falls risk assessment within 24hrs potential for reducing number of avoidable falls Able to contribute to the MDT discharge Reports will be can be produced by the system, minimising manual reporting

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Glossary of Terminology & Acronyms The table below is a quick view of some of the most common terms: Term Conversation DCW DDM Dynamic Documentation Encounter Events FirstNet Millennium MPage

PMOffice PowerChart PowerForm/iVi ew PowerNote

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Meaning Data Entry Screen Data Collection Workbook Design Decision Matrix Clinical Note creation relating to care delivery Equivalent to Hospital Spell Tasks to perform on patient / decisions made Emergency Medicine Application EPR – integrated electronic patient record Provides consolidated view of information contained throughout the electronic medical record Person Management Office Application Patient Electronic Record Assessment

Structured Clinical Noting

The table below is a quick view of the most common acronyms: Acronym

Description

Acronym

Description

18WW ACA BAU CCN CDS CHO CR DBA DCW DDM DSCN DTA ED EDSE EKM Rule

18 Week Wait Ambulatory Care Area Business as Usual Contract Change Note Commissioning Data Set Child Health Organisation Change Request / Change Record All access login (used for build and config) Data Collection Workbook Design Decisions Matrix Data Set Change Notice Decision To Admit Emergency Department ED Single Encounter Logic ‘behind the scenes’ that triggers a certain action Patient’s visit/stay in the system Ear, Nose and Throat Enterprise Registration Management Enterprise Scheduling Management Foreign Systems Interface Health Information Management

HL7 LOS NACS NHS NN4B ODS OWA PAS PDA PDS PECA PM Conversation PMO RDDS RTT SE SME SR TCI TtT WIP

Health Level 7 Length of Stay National Administrative Codes Service National Health Service NHS Number for Babies Organisation Data Services Onsite Workflow Assessment Patient Administration System Preliminary Design Assessment Personal Demographic Service Process for Executing Change Approval Actions to create/modify the patient’s encounter

Encounter ENT ERM ESM FSI HIM

Programme Management Office Reference Data Domain Sync Referral To Treat System Engineer Subject Matter Expert Service Request / Service Record To Come In Train the Trainer Work In Progress

www.cddft.nhs.uk

Contributing to the delivery of:

Best outcomes, Best experience, Best efficiency and Best workforce

www.cddft.nhs.uk

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Contacts and Queries Your super users, digital champions and floor walkers will be your first line of support if you have a programme-related query at go-live.

If you have problems accessing EPR or have any other IT related issues, please contact the ICT service helpdesk in the usual way, by phoning 0191 3332777.

If you have a problem with your smartcard, please visit http://intranet/sites/hrod-ESB/SRA/SitePages/Home.aspx

If you have any general queries about EPR, please email cddft.epr@nhs.net If you have any queries about EPR training, please email cddft.eprtraining@nhs.net

If you have any feedback on this handbook or would like further copies, please email cddft.epr@nhs.net

www.cddft.nhs.uk