Author: Sue Gunn, Head of Clinical and Business IT Applications
Use of the InfoFlex toolset in West Herts Hospitals NHS Trust.
Several years ago the trust identified a growing gap between existing IT applications and evolving clinical support needs. Experience of ’off the shelf’ specialty specific solutions showed that, although they might meet immediate local needs, their benefits were constrained by support and interfacing issues, consequently severely inhibiting the ability to develop cross-specialty information.
The trust sought a vehicle that could be used and shared across specialties. It needed to be flexible, easy to use, cost effective and capable of development in-house to meet both local and external needs. The key objectives of any solution were:
- To record and analyse clinical data not captured by other computer systems to inform & facilitate improvements in clinical practice.
- To produce customised clinical documents & letters to facilitate operational practice.
- To facilitate ad hoc and repeat audits of clinical practice.
- To integrate with data from other trust systems to provide a fuller picture of patient care.
- To be scalable.
The InfoFlex toolset, supplied by Chameleon Information Management Services Limited (CIMS), was identified as a solution which met these objectives. The ultimate aim was to use the toolset to develop and implement a generic trustwide clinical information system interfaced to PAS and other key clinical systems.
This development was implemented on a phased basis taking into account available resources, the capabilities of the Trust Network and the experience to facilitate delivery and minimise risk.
Initially, licences were purchased for use in Gastroenterology and Dermatology to facilitate local clinical needs. This was followed by Breast and Colorectal Cancer to provide Thames Cancer returns. These were implemented as standalone systems and ran on local servers due to network constraints.
The introduction of these systems generated much interest from other clinicians and their support staff so further systems were developed with additional licences being acquired as needed. This interest facilitated the introduction of an interface to the Patient Administration System (PAS) to import patient demographic data; thereby assuring consistency of such data between the two systems.
Continued development soon made it cost effective to acquire a trustwide licence allowing an unlimited number of users to use the system. By 2003 the trust had some 20 clinical systems implemented utilising the InfoFlex toolset. Continuing issues with the trust network meant that these systems remained standalone.
Following an upgrade of the trust network the standalone systems were integrated into a central database. This allowed trustwide information on a specialty basis to be produced and shared easily and related specialties to be linked (e.g. Lung Cancer & Bronchoscopy).
The trust continued to develop systems in close liaison with clinicians and their support staff. Further specialties were incorporated into the central database and existing ones were enhanced as clinical services developed and needs changed. Wherever possible, external requirements such as National Cancer Waiting Times and Colposcopy KC65 returns were incorporated into clinical designs rather than being designed specifically for that purpose. This approach has greatly facilitated retaining clinical support.
By 2003 limitations in the capabilities of Version 4 of InfoFlex were becoming apparent to both the trust and to CIMS. A redeveloped product (Version 5) was released and the trust became the first site to implement V5 in April 2004.
Initial development in Version 5 perpetuated the largely specialty specific designs to meet immediate needs. The trust now had over 30 operational clinical systems supporting some 150 users. Further designs were under development.
The trust however wanted to use Version 5 to gradually transfer the specialty specific designs into a generic one thereby meeting its aspiration for an integrated clinical information system. This would continue to allow data to be recorded by specialty but the integrated design would allow the data to be seen across specialties as authorised. Multiple ‘views’ could be designed to allow greater or lesser access to the data and reports could be developed to translate ‘data’ into ‘information’.
Towards the end of this period work started on identifying a generic dataset to allow the creation of a trustwide Integrated Clinical Design within InfoFlex (the ICD). The objectives were as follows:
- To introduce new functionality which would enable clinicians to see beyond their specialty progressively up to patient level (depending on need and authorisation)
- To expand the PAS interface to include inpatient, outpatient and A&E activity
- To progressively convert the specialty based systems and associated data into the ICD.
A model was successfully designed with active clinical support. A working group was formed which consisted of four specialties chosen to represent different activity requirements. These were:
- Surgery – Inpatients
- Dermatology – Outpatients
- Gastroenterology – Endoscopies
- Elderly Care – Combination inpatient, outpatient, day hospital and domiciliary visits
This went live in mid-2008 on a phased basis; incorporating one specialty at a time. The work was completed over a three year period due to the number of specialty systems that had been developed and the ever increasing number of users.
CIMS were also successful in winning the contract to provide a Bed Management System and work started on defining trust requirements at the end of this period. Originally it was intended that it would go live initially with a unidirectional link to PAS but it was subsequently agreed with the clinicians and clerical staff that a bi-directional link was needed at the outset. This ensured that both PAS and Bed Manager would be synchronised and minimise the need for staff to log into two different systems. This and changing trust requirements led to some delay in implementation.
In April 2010 the Therapy team was transferred from the Community to the Acute Trust. Whilst within the Community this team were using a third party system which was not used by the Acute Trust. A design was developed for the Therapy team within the Integrated Clinical Design and implemented within three months to coincide with the move. This also utilised the InfoFlex Scheduler module for arranging appointments and group sessions.
Further specialties were added to the ICD and a great deal of work was undertaken to facilitate the production and emailing of discharge summaries to meet CQUIN targets.
The Bed Management System went live in August 2011 in the Acute Admissions Unit. It will be rolled out to other areas of the trust in early 2012 along with an electronic whiteboard.
2012 and beyond
A clinical portal will be implemented across the trust in early 2012 using a phased approach. This portal will display data from key systems on one screen; namely PAS, InfoFlex, RIS (Radiology), CliniSys (Pathology), and Sunquest Ice (order communications). All documents created within InfoFlex will be available to view by those who have access rights and the user will be able to drill down directly from the portal to add/amend data and produce correspondence. This will be invaluable to clinicians as they will be able to see data recorded in InfoFlex alongside that recorded in other key clinical systems. It should reduce the time clinicians spend logging in and out of various systems and improve their uptake of IT to inform their clinical decision making. The second picture above is a screenshot of the Clinical Portal showing the InfoFlex portlet.
Major developments in cancer are also planned for 2012. These include implementing internal electronic referrals between the consultant and the MDT team at the time the patient is identified as having cancer; and the development of an electronic MDT agenda which accommodates real time data entry during the MDT meetings. Alongside this a patient summary document will be developed and displayed in the clinical portal which will alert clinicians of the patient’s cancer status.
Significant work will also be undertaken to implement the new cancer dataset which will be published in April 2012 together with the implementation and enhancement of the many cancer audit datasets, e.g. BAUS, Cancer Registry, DAHNO, LUCADA, etc.
There is also a full work programme of enhancements to the ICD in response to service needs.
In the past 13 years the uptake of InfoFlex has risen from a handful of users to well over 1,000. It is used by clinicians; nurses; therapists; secretaries; ward clerks; and clerical staff in all areas.
It has grown from a small specialty specific standalone system to one which is now used as an integrated system trustwide, having been endorsed by the trust as its key clinical information system. Over the years, and working in partnership with CIMS, we have managed to meet our clinicians’ needs and respond to the ever changing service models. Numerous clinicians’ systems have been replaced and transferred to an InfoFlex platform. These include both ‘in house’ and ‘third party’ commercially supplied systems.
In all of these transfers the clinicians’ needs have been fully met, with the additional benefits derived from utilising a standard solution but with sufficient flexibility to accommodate specialty specific differences. The costs of supporting and updating the replaced systems have been saved.
The wealth of data that has built up over time has proved invaluable to our clinicians, not least in responding to their Colleges’ reporting requirements but also in providing them with appraisal data, supporting bids for additional resource, gaining Cancer Centre status for their specialty, auditing their practice and helping them to provide high quality care to their patients.
The development of the ICD has been an iterative process and the flexibility of InfoFlex has ensured that the system could be modified as service needs have changed.
The integration of InfoFlex into the clinical portal is another exciting development and will be a major contributor towards a trustwide Electronic Patient Record.