Customer Solution Case Study
/ NHS Trust Delivers Better Patient Care Through Integrated Data Warehouse Solution
Overview
Country/Region: United Kingdom
Industry: Healthcare
Customer Profile
The Central and North West London Mental Health National Health Service (NHS) Trust provides mental health services to four boroughs in London.
Business Situation
To achieve a three-star rating the NHS Trust needed to integrate its disparate patient administration systems (PAS). Clinicians needed to have simplified, around-the-clock access to patient care plans.
Solution
Insource IT Consultancy designed and implemented a Web-based, integrated data warehouse solution based on Insource AcademyTM, Microsoft® SQL ServerTM 2000, Microsoft Windows® 2000 Advanced Server, and the Microsoft .NET Framework.
Benefits
n Around-the-clock access to PAS.
n Single source of data simplifies access to vital information.
n Accommodates future growth and development.
n Delivers a high standard of patient care. / “Previously, our clinicians, had very limited knowledge of patients in the rest of the Trust. Now they can access critical patient data in a uniform manner, regardless of the borough in which the patient initially received treatment.”
Clive Pilcher, Head of Information Management, Central and North West London Mental Health NHS Trust
The Central and North West London Mental Health NHS Trust provides mental health services to the boroughs of Brent, Kensington and Chelsea, Westminster, and Harrow, with additional services provided in Ealing, Hounslow, Hammersmith & Fulham, and Hillingdon. The Trust used one patient administration system (PAS) in Harrow, and another separate PAS for the boroughs of Brent, Kensington and Chelsea, and Westminster. The Trust needed to integrate these disparate systems and provide clinicians with simplified, around-the-clock access to patient care plans. The Trust engaged Insource IT Consultancy to design and implement a Web-based data warehouse solution based on Microsoft® SQL ServerTM 2000, Microsoft Windows® 2000 Advanced Server, Microsoft Internet Information Services (IIS), the Microsoft .NET Framework, Microsoft Visual Studio® .NET, and Insource AcademyTM. Now, clinicians across all four boroughs have all-hours access to patient care plans. The NHS Trust is now better placed to respond quickly to patient needs and deliver a high standard of patient care.
Situation
The Central and North West London Mental Health National Health Service (NHS) Trust in the United Kingdom provides a range of mental health services in eight London boroughs. It operates at around 90 sites to provide a comprehensive range of services for adults, older adults, children, and adolescents, and for substance misuse.
The Trust is continually working to develop and improve its services to ensure that it meets the highest possible standards of patient care. When government performance indicators, or star ratings, were announced in 2003 for all acute NHS Trusts, primary care Trusts, and mental health Trusts in the country, the Central and North West London Mental Health National Health Service Trust was soon awarded a two-star rating from the Commission for Health Improvement.
Its long-term aim is to achieve a three-star rating—the highest rating. This would be a major symbol for the Trust, it would emphasize the Trust’s status with its staff and partner organisations, would allow the Trust a reduction in the degree of external reporting it is required to meet, would enable it to apply for Foundation Trust status, and would give an additional £1million (U.S.$1.8million) capital funding. To do this, the Trust must meet further key targets. One of these targets is to have a single electronic system for its care programme approach (CPA), which is available to all clinicians 24 hours a day, seven days a week. To address its needs for an improved CPA, the Trust decided to look at its existing IT infrastructure.
Clive Pilcher, Head of Information Management, Central and North West London Mental Health NHS Trust, says, “We have two main patient administration systems (PAS). One, called ‘ePEX’, serves the boroughs of Brent, Kensington and Chelsea, and Westminster, and the other, called ‘JADE’, serves the borough of Harrow.
“The ePEX system held master patient index (MPI) details, such as name, age, and ethnic origin, but it did not hold details of patient care plans—they were produced in Microsoft® Word documents. The JADE system held all patient data including care plans for Harrow.
“From a clinician’s point of view, this situation is not ideal. A patient could walk into accident and emergency (A&E) in Harrow for example, and it would be very difficult to establish if they were known to another part of the trust, if they were a current patient, or what kind of medication they might require.”
Solution
The Trust knew that the best solution would be a data warehousing system and approached leading IT services provider and NHS specialists Insource IT Consultancy to help find the right system to meet its exact requirements.
Pilcher says, “We wanted to create a system where any clinician with the appropriate access, anywhere in the trust, could access a care plan on any patient, regardless of whether or not they were in an area covered by the same system.
“To ensure that we were in the running for a three-star rating, we needed the solution to be implemented extremely quickly. Insource was the only company that we approached that was confident that it could meet our demands—and it did. We approached Insource at the end of February 2004, and the data-warehousing solution was in place by the end of March. We were really impressed.”
The solution is based on Microsoft Visual Studio® .NET 2003 development system, Microsoft SQL ServerTM 2000, a part of Microsoft Windows Server SystemTM integrated server software, Microsoft Internet Information Services (IIS), and Microsoft Windows® 2000 Advanced Server operating system. Peter Stevens, Enterprise Architect, Insource, says, “Using Insource AcademyTM in conjunction with the .NET Framework and Microsoft Visual Studio .NET development environments helped us to deliver the new system very quickly.
“Prebuilt templates and code libraries within our .NET Academy tool set meant that our developers spent less time on coding and were able to achieve a technically complex, yet simple-to-use system, within the very tight time frame. We also have extensive NHS domain knowledge and this was fundamental in delivering the solution on time.”
The new system imports data with IIS to the SQL Server–based data warehouse from the two systems on a nightly basis. Insource devised a naming convention for the Word documents, so that they could also be imported to the data warehouse. SQL Server merges the data from the two systems into a common data set.
The data warehouse has a Web front end so that any user with a Web connection can log on to the application. There is a very simple search stream, similar to the search stream in use on the Trust’s existing applications.
Stevens says, “Now, a user just types in a patient name and a list of matching patients appears on the screen. At the touch of a button, that user can see all of the patient’s details and, if necessary, their care plan. The new system is available 24 hours a day, seven days a week to more than 650 clinicians and administrators across the trust.”
Benefits
All-hours Access to PAS Builds Clinician Confidence
It is essential for the Trust to provide an around-the-clock service to all of its patients, not just so that it can meet its targets for a three-star rating, but also so that clinicians feel adequately equipped to deal with a mental health emergency at any time.
Pilcher says, “It’s all very well having people to talk to nine to five, Monday to Friday, but what happens when, as is often the case in mental health, a patient has an unexpected crisis and needs immediate help in the middle of the night. The systems need to be in place to support the clinicians in providing the right treatment for each patient no matter what the time is. The new solution gives us that support.”
Single Source of Data Simplifies Access to Vital Information
Every clinician must be confident that they have access to a reliable system that tells them exactly what the care plan is for any current patient. Pilcher says, “When a patient walks into A&E for example, it is vital that a clinician can identify whether this is a current patient, where they’re in treatment, and who’s treating them.
“The details of the care plan will also help the clinician establish what the diagnosis is on the patient and what particular issues there might be, and whether they are on any medication.
“Previously, our clinicians, particularly in the borough of Harrow, had very limited knowledge of patients in the rest of the Trust. Now they can access critical patient data in a uniform manner, regardless of the borough in which the patient initially received treatment. That means that our staff are better equipped to deal with patient emergencies and can ultimately deliver better patient care.”
Easy to Use and Accessible to All
The new solution was built with ease of use in mind. The Web-based system has a similar look and feel to the Trust’s existing systems so staff needed little training to get started. Pilcher says, “Familiar tools and layout made the whole transition very smooth. We did train people to start with but it was so easy to use that we produced a training guide which staff can use without having to go on a course.
“It’s simply a case of a few clicks and you’re in, and a few more clicks and you’ve got the information you need. Even staff with limited computer skills can use the system without needing to worry. We know that people find it easy to use—it’s doing the job that we wanted it to do and you can’t really ask much more of a system.”
A Solution That Can Accommodate Future Growth and Development
Because the solution was built using Microsoft software and based on the .NET Framework, it will easily scale to meet the Trust’s future needs. Stevens says, “In particular, the object-oriented programming model of the .NET Framework ensures that new applications can be easily integrated in the future with no need for complex architecture redesign or recoding.”
Pilcher says, “We can enhance the system without affecting the simplicity of the system. The Insource team chose a suite of technologies that easily integrated with our existing systems. They designed a system that coped with our immediate needs but could also be adapted to incorporate additional requirements like reporting.”
Delivering a Higher Standard of Patient Care
Before the project began, the Trust outlined six key areas in which it planned to make strategic improvements. In 2003, Dr Peter Carter, Chief Executive, Central and North West London Mental Health NHS Trust, said, “There are six areas that we need to address. These are Care Planning Approach (CPA), suicide rate, missed outpatient appointments, child and adolescent mental health services (CAMHS) service mapping, data quality, and junior doctor hours. The Executive Team has devised a specific strategy to deal with these areas over the coming year.”
Having met government targets for CPA, the Trust is now closer to gaining its three-star rating. Pilcher says, “We are now much better placed to gain that all-important three-star rating. But more importantly, with improved patient administration, our clinicians have the support they need to provide their patients with a much higher quality of patient care across the trust.”
Microsoft Windows Server System
Microsoft Windows Server System is a comprehensive, integrated, and interoperable server infrastructure that helps reduce the complexity and costs of building, deploying, connecting, and operating agile business solutions. Windows Server System helps customers create new value for their business through the strategic use of their IT assets. With the Microsoft Windows ServerTM operating system as its foundation, Windows Server System delivers dependable infrastructure for data management and analysis; enterprise integration; customer, partner, and employee portals; business process automation; communications and collaboration; and core IT operations including security, deployment, and systems management. For more information about Windows Server System, go to: www.microsoft.com/windowsserversystem