Clinical and administrative teams across Mid Yorkshire Hospitals NHS Trust Cancer Services are using the flexible InfoFlex toolset, with its capabilities for interfacing with other hospital systems, to continue to improve and streamline their day to day practice. It forms the foundation on which bespoke screens and events are currently being developed and implemented.
- Secure and timely data reduces risk of inappropriate treatment
- Care plans and treatment summaries immediately available
- Up to the minute information available on every patient
- Ease and speed of designing and implementing new electronic solutions to meet departmental needs
- Eradication of paper notes
- Greater efficiency of MDT process
- Easy to generate audits and reports of nursing activity
- Clinical teams “on board”
- First class system for auditing and reporting
- Improved quality of national cancer reporting data
- Reduction in time needed for administration of MDT processes
“It’s about making information about cancer patients available in a timely way to everyone in the Trust who has access to patient notes.”
Keely Clawson, Lead Cancer Nurse.
At the centre of the drive for developments across Cancer Services were the interests of the patient. The MDT process was very time consuming for the MDT administrators, with hours of additional work arising from the requirement to input all decisions post meeting into InfoFlex, to generate minutes and update patients’ notes. Keely Clawson, Lead Cancer Nurse, explained how a lack of timely, up to date MDT information in a patient’s notes could potentially lead to unsuitable treatment. For example, a cancer patient on a care pathway might arrive in Accident and Emergency one evening and be given inappropriate treatment because the most recent MDT information was not available until the following day.
An updating of the existing system was also required because auditors were looking for an improvement in the quality and detail of the data being collected and there were changes to national cancer reporting requirements .
A way forward was also needed to streamline data management across all tumour sites. Clinical staff across the trust were using diverse methods for recording cancer patient data, such as paper based assessments that had to be scanned into 3 different systems.
CNS (Clinical Nurse Specialist) teams wanted a bespoke, electronic HNA template that would reflect their ethos and provide more detail than the initial, briefer HNA already available in the InfoFlex system. It was vital that the assessment, care plan and subsequently the end of treatment summary should be available immediately in the patient’s notes, to inform all those involved in decision making.
Furthermore, nursing staff could see the value of having the means of recording all their contacts with patients, the details and outcomes of which could go immediately into patients’ notes. Furthermore, these records of nurse activity could provide the evidence needed for occupational reviews. Historically, such detailed reports were difficult to generate.
The InfoFlex Cancer Patient Tracking system was chosen initially over other systems used within the region because, according to Keely, “We didn’t think data collection was as good (in other systems) as offered in InfoFlex, and development possibilities are much better in InfoFlex. (Other systems) allow us no control over the development.”
A range of new developments and updates to the existing InfoFlex system have been ongoing at Mid Yorks over the last 2 years, some already in live use. They are the result of collaboration between clinical teams, the IT department and InfoFlex staff.
Live typing MDTs with a summary document generated from the agreed MDT outcome was the first project to go live. The summary document goes directly into WinDIP, the Trust’s electronic note system, and the information is available immediately in the patient’s notes. 11 out of 12 tumour site specific MDTs are now using live typing with the result that the process has been streamlined across the Service and many hours of additional work have been removed from MDT coordinators. In addition external auditors have commented on the high quality and detail of the information produced.
“We had external auditors just before we upgraded and then after. They noticed a marked difference and improvement in the quality and detail of the information we were collecting,” Keely commented.
Over the last year, clinical staff have requested further developments to improve their day to day practice. For example, the lung team are now in the process of testing a bespoke set of forms in InfoFlex: Lung MDT summary, Mini Lung MDT summary, IEP (an image transfer form) and a surgical referral form. The aim is for these to go into the notes system and then to be sent electronically to the Leeds Cancer Centre.
Another development that illustrates how much the clinical teams are “on board” is now live in the Acute Oncology Department. Previously, UKONS paper assessment documents were scanned into 3 different systems. After discussion about how the team wanted the form to look, the IT department transferred it onto an InfoFlex template. The forms can now be filled in electronically, an alert activated if a patient needs to be assessed face-to-face and all information sent straight into the patient’s notes.
The CNS teams at Mid Yorks had agreed that all patients would get an HNA at diagnosis and end of treatment as a minimum and at other points on the pathway where manageable. At initial diagnosis, the Pepsi Cola HNA within the InfoFlex Cancer System is used because it is brief and allows the CNS teams to audit the number of HNAs being carried out at diagnosis as well as analysing their impact. A more detailed Macmillan HNA template has now been built into the InfoFlex system which generates an electronic care plan that is sent to the patient’s notes and is also printed off for the patient, “so everyone is aware of the care plan and what the assessment said.”
An end of treatment summary document based on the Macmillan template has also been created in InfoFlex. When the nurse sees a patient at the end of treatment the template is filled in and the system generates a document that is shared with the patient and sent to their GP.
New events called “Consultations” have been created by the CNS team to record every contact a nurse has with a patient. Again, these appear in the patient’s notes and are available to clinicians immediately. Another benefit is that a report of nursing activity can be generated and used as evidence for clinically led specialist team reviews. Keely said: “The CNS teams are really on board because they can fully see the value of putting information into a system that generates a report about their activity.”
Future developments include an interface with CAMIS, the trust’s outpatient appointment booking system, so that referral details can be generated directly into InfoFlex instead of having to be typed in. Another project is live launch into ICE, the trust’s results system, so that a clinician in clinic will not have to sign into other systems to see results but will open ICE in the Patient Context and make a request.
“The more we put into InfoFlex, the more teams are coming forward asking for something to be put in for them. People are finding it more and more useful and wanting more developments.”
Keely Clawson, Lead Cancer Nurse