George Eliot Hospital Turns Clinical Evidence into Standard Practice with Lorenzo
Client:George Eliot Hospital NHS Trust
- Improving and transforming the way diabetes patient care is delivered by using an EPR
- Driving focused clinical change in specific areas through use of an EPR
- Reducing reliance on paper and primarily manual processes
- Clinical directorates competed to develop a project using the trust’s Lorenzo EPR
- Diabetes outpatient department developed the Lorenzo-Diabetes solution to improve routine clinical care by capturing structured clinical data in a single record underpinned by the award-winning Alphabet Strategy
- The diabetes outpatient service is now more streamlined, and clinical decisions can be made more quickly
- Patients now have individualised, integrated electronic “year of care” plans that can be shared with all health professionals who care for them
- The department is working “paper lite”
George Eliot Hospital NHS Trust in Warwickshire, England, serves a population of 300,000. In 2014 the trust implemented CSC’s Lorenzo Electronic Patient Record. The trust wanted to use Lorenzo to improve and transform the way services are delivered to patients.
Clinical engagement was seen as a key element in making that implementation a success. To drive this, the trust held a competition asking clinical directorates to bid for funding that would enable them to develop solutions based on the electronic patient record (EPR). One of the winning projects came from the diabetes outpatient department.
Modernising Diabetes Care
People with diabetes often receive care from several departments. While they want to see the right person for the care they need, all of the information about their care should be in one place to support their long-term healthcare needs.
The diabetes outpatient pilot set out to achieve this. As the diabetes outpatient department was already using the Alphabet Strategy to collect information about patients, the diabetes team set about developing an electronic system to collect the same information wherever the patient presented — emergency department, outpatient clinic or on a ward. The new system needed to be user friendly to support the creation of a patient-centred record that could be shared effectively, whether with the patient’s general practitioner (GP), podiatrist, nurse or other specialists.
Lorenzo was a key stepping-stone to standardise data collection, reducing the level of variation between healthcare professionals, and ensuring the information is conveyed uniformly. The team developed Lorenzo-Diabetes as an electronic diabetes record. It pulls in existing patient data from a patient administration system and prompts healthcare professionals to directly enter diabetes-specific standard data. Once captured, the data can be automatically added to standard letters for GPs and patients, using Lorenzo’s Clinical Documentation capability.
The Lorenzo-Diabetes solution helps reduce duplicate data entries, removes paper processes, facilitates two-way communication between primary care physicians and specialists, supports clinical audits — which can now be done daily at the touch of a button — and improves patient care. It also offers a model for other services and other trusts.
From the start, the Lorenzo-Diabetes solution had the backing of senior managers and clinicians. The whole diabetes team, from consultants to secretaries, was involved in the design of a system to support patients along the diabetes pathway.
Consultants now collect standard information electronically about, for example, blood pressure, eye health or prescription drugs, putting the data directly into Lorenzo-Diabetes. Nurses who see patients in the outpatient clinic have instant access to this information. Health professionals who need to follow up with patients can also see the record.
Patients can go home with their clinic letters on the same day, and GP letters are ready by the end of the clinic. GPs and patients can follow up on clinic recommendations without delay.
Real-time audit helps clinicians understand why patients are attending clinics to make sure patients’ needs are met. It also ensures adherence to best practices. Patients now have electronic documents setting out their “year of care” plans.
Patients who are willing to take part in research are easily identified; this has increased participation in clinical trials, a key performance indicator for all NHS trusts.
When clinics get busy, clinicians can resort to a paper template closely aligned to the electronic form, which can be entered into the system later. This means patients can be seen in a timely manner without compromising on capturing data electronically and securing all the benefits that can be achieved from the solution.
Dr Vinod Patel, consultant in diabetes, says, “Patients feel more engaged [because] they can see information is captured about them electronically and will be shared with their GPs and used in future consultations or wider treatment. They also value that this information is available to them at the end of their consultation.”
Health professionals and patients aren’t the only ones benefiting from the new approach. Medical secretaries no longer have to type up hand-written notes, and within the first week of implementation, the secretaries’ workload was cut by 50%. The department is now “paper lite”, with GP letters and patient letters no longer produced on paper.
To share the learning, George Eliot NHS Trust has already presented to CSC’s Lorenzo user group.
As Dr Patel says, “The key to our success in achieving benefits from our EPR for this patient group was the multi-disciplinary engagement, including medical secretaries and outpatient healthcare assistants along with the nurses and doctors. This ensured a ‘bottom-up’ approach as well as buy-in from all the stakeholders. Everyone was excited even before the project was launched, ensuring complete buy-in. The project therefore provides an ideal solution for many diabetes teams across the NHS to simply incorporate the template.”
Dr Ponnusamy Saravanan, associate clinical professor and honorary consultant physician in diabetes, endocrinology and metabolism, adds: “Any trust that has Lorenzo will have the ability to implement the same approach in their organisations. We are keen to share the learning, and trusts that already have Lorenzo, or trusts that are in process of implementing Lorenzo or thinking of deploying it, are very welcome to visit us and to view the pilot firsthand.”