Inspectors put digital trust centre stage

Cambridge University Hospitals NHS Foundation Trust (CUH) is, for the second time, the first in the UK to achieve a quality standard that recognises the use of technology to deliver high quality patient care.

It comes as figures from the Trust, which introduced its advanced Epic electronic record system in 2014 as part of its revolutionary eHospital digital transformation programme, shows adverse reactions to medications, and deaths as a result of sepsis, are tumbling.

The Trust, which runs Addenbrooke’s Hospital and The Rosie, has officially “validated” against the new Stage 6 criteria of the Healthcare Information and Management Systems Society’s (HIMSS) international Electronic Medical Records Adoption Model (EMRAM).

Earlier this year HIMSS changed its EMRAM criteria, making it more difficult for hospitals to reach the set expectations. Stage 6 has been made tougher as it now includes the use of “technology enabled medication, blood products and human milk administration, risk reporting and full clinical decision support”.

The achievement was announced today by HIMSS, which is an international organisation dedicated to improving healthcare quality, safety, cost-effectiveness and access, through the best use of information technology.

Its inspectors, who last visited in 2015, were in the Trust’s hospitals on Tuesday (30 October) observing staff using Epic in departments including paediatrics, pharmacy, care of the elderly, transfusion, radiology, accident and emergency and medical records.

Stage 6 means that the Trust has established clear goals for improving safety, minimising errors, and recognising the importance of healthcare IT and puts it on course to achieve Stage 7, the highest EMRAM status – an accolade currently held only by a handful of overseas healthcare institutions.

CUH Renal Consultant and Chief Clinical Information Officer, Dr Afzal Chaudhry, said: “We are absolutely delighted to be validated and would like to thank our hard-working staff and our Epic colleagues for making this happen.

“Clinical decision support combined with electronic prescribing is helping prevent at least 850 significant adverse medication reactions a year with allergy-related alerts triggering a change in prescriptions, and we have reduced sepsis mortality by 42 per cent with electronic alerts designed and built by ourselves within our Epic system.

 “Today over 99 per cent of all our clinical activity is recorded in a patient’s health record within Epic, in real-time, using integrated computers, laptops, handheld and mobile devices.”

This year barcode medication administration - international best practice for safety with the scanning of both a patient’s barcode wristband and medication barcode – went live across all inpatient wards and critical care areas of the Trust’s hospitals, and in May 2018 CUH became the first NHS trust to implement this patient safety initiative in an emergency department.

Also, as of last month, staff in paediatric, neonatal and maternity areas now scan communally-stored expressed human milk to ensure the right babies are given the right milk each and every time.

CUH is the one of only three NHS organisations to achieve EMRAM Stage 6 in the UK, and the first of the three to validate against the new staging criteria.

Dr Ewen Cameron, Executive Director of Improvement and Transformation, added: “To validate against the new criteria shows how far we have come over the years since we implemented Epic and since our last HIMSS inspection. Our aim now is to further advance our use of technology to provide even greater benefits to our patients and staff and, as a result of doing this, become the first stage 7 trust in the UK.”

HIMSS Analytics Regional Director for Europe and Latin America, John Rayner, said: “It was a real pleasure to return to Cambridge after three years to successfully revalidate the Trust against the international EMRAM standards. This organisation has made enormous progress since their initial go live in 2014. I can see genuine value and benefit to patient safety and to the overall quality of clinical care following their move from paper to electronic records.

“They are making good use of electronic clinical decision support and there are well calibrated alerts and warnings in their Epic system to improve the quality of inpatient medication prescribing, and an extensive array of order sets to enhance and improve the standardisation of clinical care - a good hospital with dedicated clinicians and staff.”

Image:  A nurse using a handheld device, integrated with Epic, to administer medication (barcode medication administration) a key requirement of EMRAM Stage 6.

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