Electronic hospital discharge summary rolls out

Tags: AIM Discharge summaries EMIS GP GPs INPS Vision

05 Mar 2007

Gloucestershire hospitals have come up with an answer to the age-old problem of getting discharge information over to GPs quickly when a patient goes home.

The hospitals' newly-installed Info-flex system from Chameleon Information Management Services (CIMS) collects the relevant clinical data and produces a discharge summary. The summary is sent electronically via the Anglia Healthcare messaging service from the discharging hospital directly to the patient’s GP as soon as the patient leaves.

Project manager Rob Graham says the system was designed to use Gloucestershire Hospitals NHS Foundation Trust’s existing pathology messaging software. He added, “Our department has worked closely with clinicians, Anglia Healthcare and CIMS to create software that can be used easily by our doctors and ward clerks.

“Thanks to the new technology we aim to issue the vast majority of discharge summaries in one working day which is a significant improvement, and a good example of how IT developments directly support patient care.”

The trust says that the system is thought to be the first to offer such a comprehensive service delivering electronic discharge summaries so quickly.

Consultant paediatrician Dr Miles Wagstaff who was involved in the implementation of the new software said: “For a long time we’ve wanted to improve the way we communicate with GPs. At the moment, we do not always tell GPs promptly when their patient is discharged unless there are special circumstances.

“This sometimes means the transition of care isn’t as smooth as we would like it to be. We’ve worked with GPs on this new software and believe it will make a real difference to patient care.”

Gloucestershire GP, Charles Buckley added: “Although we have very good relationships with hospital doctors, finding out when our patient was discharged and with what drugs can be time consuming. Improving our communication channels can only be a good thing and it will be the patient that feels the real benefit.”

For the new system to work it also had to be compatible with the different GP systems used by doctors in Gloucestershire – and for two-thirds of them this meant EMIS GP systems. The company developed a module to enable the discharge summaries to be recognised by the communications element of its GP software systems.

Sean Riddell, EMIS managing director, said: “The module we have developed enables the discharge summaries from the trust to be understood and accepted by the doctors’ own system and we’re delighted to have played a part in this important project. The new scheme took a year to design and implement, with full involvement from consultants and GPs, who favoured the paperless solution.

A trust spokesperson explained that the discharge summaries can go directly to the patient record in EMIS and INPS Vision systems, but other systems are not excluded and can receive the summaries as e-mails.

CIMS chief executive, Marc Warburton, said: “We are delighted at the progress made within the Gloucestershire Hospitals NHS Foundation Trust on the discharge summaries project. The system will have approximately 1000 PCs utilising InfoFlex, enabling GPs to receive appropriate clinical data electronically, minutes after the patient has been discharged from hospital.”

The new discharge summaries system has been running in three hospital departments since November and will be used throughout Cheltenham General and Gloucestershire Royal Hospitals by March 2007.

Links

CIMS

EMIS

Gloucestershire Hospitals NHS Foundation Trust

Reader's Comments

Sounds good

05 Mar 07 09:03

Useful; local; has clinical buy-in; builds on existing systems and expertise. Presumably nothing to do with CfH / NPfIT then?

Long history at Gloucester

05 Mar 07 13:03

Gloucester has long been a pioneer in this area. I was a junior doctor there in 1997 and they had a locally produced system called GPFax. This allowed the discharging doctor to order drugs to take home and write a brief summary. The discharging nurse pressed a button and it was faxed to the GP virtually instantly. It could also be accessed in case of repeat admission. It was simple, highly effective and ran over VT100 terminals. 90% of the time no further discharge summary was needed. It is good to see the hospital team continuing to innovate effectively.

Is good...

doug.northwood@uhl.nhs.uk

05 Mar 07 13:03

At Lewisham, we've completed the roll-out of such a system - this time one from Revive, now iSoft. All departments complete a summary for every episode and delivery to GPs is similarly electronic - and the system is searchable in the middle of the night!. Key for us is support from Pharmacy - without them we'd not have got off the ground.

Sounds Good

bob.curtis@glos.nhs.uk

05 Mar 07 13:03

No, nothing

Well done, but not quite as pioneering as this suggests

05 Mar 07 14:03

The sending of discharge summary information to GPs, electronically and an a format recognised by EMIS and INPS, has been taking place for over three years through the Indigo 4 Keystone messaging solution. In addition, Indigo 4's Review solution also enables GPs in the Buckinghamshire area to view discharge summaries via a web browser over N3.

Well done Gloucester, but at least thirteen NHS trusts have pipped you to the post.

We do it too

06 Mar 07 19:03

Yep well done but others are there as well. In North Notts. we use Orion software and encrypted email to electronically complete the discharge and notify GP practices. The attachment is incorporated into the electronic GP record as usual. And yep - nothing to do with CfH.

A view from far back

jonathan@bayly.org

06 Mar 07 20:03

Well done Glos PCT/GAHT - not unique but weren't we looking at systematic clinical messaging twelve years ago at least? Why has it taken so long! Does anyone remember ERDIP - how much did that cost?

The key point is that cross-boundary information flows need to be structured and coded whether they are a letter, a fax, an X400 or XML message. That is the hard part - the rest is easy by comparison and doesn't need £16 bn or whatever the latest cost estimate is!

Jonathan Bayly Gloucestershire Primary and Community Care Audit Group

Real world NHS

07 Mar 07 09:03

The comments above reflect this; a) most hospitals are struggling to deliver something of value without wasting significant funds whilst awaiting CfH non-delivery. Summaries all the way back into GP systems has been a universal priority, and of far more import than the Summary Care Record.

b) This is not unique at all, is the "news" really just that the supplier wants to advertise an achievement to other Trusts who are not doing this yet ?

In response to the last comment

07 Mar 07 09:03

In response to the second point above its worth stressing that EHI Primary Care is a business-to-business publication covering developments in the supplier community and customer developments - as a result not every implementation reported will be a first, but will we hope be of interest to our readership.

We do not by contrast report every Choose and Book install or N3 upgrade.

Regards

Jon Hoeksma EHI Primary Care

Real world news

07 Mar 07 10:03

I believe that the fact that more and more NHS organisations are achieving local implementations is, in itself, newsworthy. Each new local non-CfH iniative adds to the concerns about the value of the central programme in meeting the needs of those at the NHS front-line. It's surely also useful to be aware of sites from which lessons might be learned by others trying to follow.

Clinical Safety?

07 Mar 07 11:03

Has any of this been through formal Clinical Safety Assessment? All CFH systems have to be formally assessed by qualified safety clinicians. These then have to be peer reviewed before approval to release for deployment testing can occur.

Oh No I forgot everything outside of CFH is rosy! Lets hope that system suppliers outside of CFH read the Corporate Manslaughter BIll very very clearly! Perhaps then we'll see a more formal approach to clinical safety outside of CFH as well as inside.

Qualified safety clinician?

07 Mar 07 11:03

For my education, could someone explain what one of these is? What exactly is the qualification? Who accredits / validates / revalidates it? How is it attained?

Qualified Safety Clinicians

07 Mar 07 16:03

They are probably trained to behave like the Information Governance people i.e. acorn hits you on the head and the whole sky is falling down.

I shudder at the thought of how CfH will turn the necessary process of software safety management into a collection of cockeyed documents and requirements that have no place in a real and risk balanced world!

Perhaps not so useful after all

jonathan@bayly.org

09 Mar 07 07:03

Further to my comment above this is how it works - I have had a demo! The practice receives an electronic document which can be viewed on the screen. You can do no more than that with it. You cannot associate it with a medical record, you cannot even print it out without archiving it and un-archiving it. Then the practice scans the printed output, as they do with all discharge summaries, attach it to the relevant record, eyeball it for important coding opportunities and then shred it. There is no embedded Read or SNOMED coding to maintain data quality and as far as a step forward it is probably less useful than a timely fax in its present state of development!

not so useful?

13 Mar 07 11:03

well .. if you count the fact that the GP can most likely actually read the thing as not useful.. unlike a good proportion of the photocopied hand written scrawl that passes as a discharge note. as for the SNOMED / Read .. and data quality. .. well a fair point .. but surely the single most important thing is that the GP is well informed as to what has happened to the patient, and what action is needed by primary care.

How to eat an elephant

13 Mar 07 15:03

The litigation argument from CfH is facille. The patient is far more likely to sue for the correspondance not having arrived at all because we all sat patiently awaiting the master plan to roll out.

Is it not better to adopt the Schumacher principle, small is beautiful. Once the communication is electronic and legible, one can add in the coding (Read coded until the GP systems do SnomedCT), and the more structured and integrated elements.

Eat an elephant one small chunk at a time. That would have been a far better philosophy to achieve forwards movement to an electronic future.