Observations On A New Hospital EMR At RNSH From The Point Of View Of A Curious Patient!

Note: All these notes are based on discussions with a range of staff at various levels from Consultants to Ward Porters – overall probably chatted with 10-15 different people.

Was good to see pretty strong privacy focus – to the extent of taking some fast talking to get to be able to access my record!

All this is E&OE as I may or may not have accurately grasped what I had been told. (I was a might sick for a good part of the time!)

Key Points.

Initial Implementation was in A&E and have managed to become paperless with clinical charting, patient records, results (image integrated with text etc.). Implementation in the wards is quite recent (months)

Screens are impressively clear and high resolution – and speed is really good.

System works by selecting ward census then patient and then has lots of tabs down left side to move into different functionality.

I was easily able to look up my new results with no training at all so it works pretty intuitively!

The COWs are a feature. Residents and registrars glide them around and make notes and place orders as they see patients. Battery powered and fully secured with scrub-able illuminated keyboards and full size high-res screen on really secure trollies. (COW = Computer On WheelS)

WiFi for the computer system is everywhere and fast!

There appear to be secure Wi-Fi points for clinicals, byod, mob-xray, and data. As well an open guest account I assume I was not meant to use!

Acceptance of the system is broadly aged based and seems also very much related to the level of typing skills.

Was interesting to note placing a ‘request on the system’ was almost seen as having done what was requested and needed. The workload communication was widely used.

Negatives:

Some staff worried about privacy of the large screen census boards on the wards.

Senior staff can find navigation (menus can be rather deep) and system freezes frustrating.

Was a bit sad to see observations which were gathered by superb and very smart trollies being manually typed into the system rather than being interfaced!

Lessons:

Where possible specific tasks for senior staff might be set up as scripts.

It is important to minimise system unresponsiveness as this can frustrate staff.

Organisation of free text information is still a challenge. Reports are fine and findable – progress notes seem to be a different story – suffer rather from the PCEHR pile of notes issue.

It was not clear just how useful the search functions were.

Technology:

All the Clinical Ward PCs run an enterprise level version of Win 7 – but I did spot the odd Win XP screen in radiology.

Each PC is named and has a unique IP address and while many are wired at desks – the COWs all run wi-fi in the Hospital.

The number of terminals / COWS seems nicely over-provisioned – there is access everywhere that seem reasonable.

Security:

Log on is username / password to the relevant domain.

Once logged on the username does not expire but password does pretty quickly.

(user name is 8 or 10 digit staff number)

Home Nursing Service – Remote Visit Support:

Using a laptop the initial admission to the APAC Service was done on line to another copy of Cerner Millennium – over a remote WiFi link.

The laptop provided access to all information held in my record within the hospital – and worked well.

Overall:

This implementation is clearly a very complex EMR with very rich functionality that is really working pretty well indeed. I have often wondered would I ever see at least some of the potential I knew was possible actually delivered but this is not bad at all! It works, is capturing rich information and has essentially got rid of paper notes – except at present for medication charts.

What is now in place is clearly a key part of the nervous system of the Hospital.

Once the more advance information management issues are solved there is the basis of a really useful and important system here that will in all likelihood make a very positive difference to care. This is all much better than I dared hope!

Well done to all those involved in getting to this point!

David.