Truly, paperless

It has become an international pioneer in its introduction of paperless digital workflows. It has even been acclaimed as the most advanced digital hospital in Europe.

No, there really isn’t any paper

In just three years, UKE has implemented an integrated electronic patient record, across the entire 1,400 bed hospital.

The system includes clinical workflow and documentation, closed loop medicines management, and order communications; all based on Soarian Clinicals.

It incorporates all patients’ diagnostic imaging, labs results, charts, clinical notes and drug history; and it is available to any clinician working in the hospital.

On a press trip organised by Siemens, a pack of European health IT hacks were shown around the new build hospital, part of a larger medical campus.

Even though the journos did their best to find paper – by peering behind reception desks and behind closed doors – barely a form, folder, or sheet of paper was to be seen, apart from a few notes on notice boards. The new hospital just isn’t designed for paper. Historic records are stored seven kilometres away.

Hospital staff that were interviewed were entirely matter of fact about the system. All said paper really had gone, with the exception of patient consent forms – where the legal status of digital signatures remains an issue.

Otherwise, clinical staff now access and update a single integrated electronic patient record using wireless computers on wheels or one of thousands of PC terminals. Patient records can also be called up on bedside entertainment consoles.

“We’ve tried tablets, but while they are great for viewing information they are not great for entering data, and in a hospital environment you need to be able to enter data,” said Dr Peter Gocke, head of IT at UKE.

From financial crisis to turnaround

UKE’s success in implementing electronic patient records began eight years ago, when the hospital was in a deep financial crisis. In 2004, it was losing money and faced an annual Euro 37m deficit. It urgently needed a turn-around plan.

Chief executive Professor Jorg Debatin said that the hospital had embarked on the EPR project as part of a modernisation programme that centred on the development of a new Euro 340m hospital development.

“We had out of date infrastructure, poor buildings, bad processes and organisation of the hospital. We had no choice but to think how we could do things differently,” he explained.

Productivity has dramatically improved and the financial position has turned around. Clinical workflows have been redesigned to be more efficient, using Soarian’s worklow engine to better organise and schedule the different components of a patient’s care.

Clinical decision support tools are also embedded in its systems. The senior management at UKE said the first step was to think carefully about how the hospital wanted to redesign its processes.

Over two years, an encyclopaedic ‘book of best practice’ was drawn up for every part of the hospital. “IT should follow process,” said Dr Gocke. “It was no longer an IT project but a hospital project.”

Having said that, he added: “In 2004 our IT systems were poorly integrated and out of date. In places the individual systems worked quite well but they were poorly interfaced and didn’t like each other much.”

UKE decided it wanted a system that was: fully integrated; offered a future-proof platform; provided a combined approach to clinical documentation; provided a fully complete workflow engine; and a complete clinical archive.

The system chosen to fit the bill was Siemen’s Soarian. But Dr Gocke joked that because it was such an important decision “everyone was afraid to make a mistake” – resulting in a massive two volume contract.

With just a few problems on the way…

Once Siemens had been selected there was “just nine months” to migrate from its historic systems to Soarian, to be ready for the new hospital opening.

Dr Gocke said that although this was challenging the huge amount of detailed preparation work done in advance meant people knew exactly what they needed to do.

Even so there were still big challenges that had to be tackled in rolling out a new system and ways of working to 4,000 end users.

“Soarian Clinicals had come fresh out of Beta so there were problems,” said Dr Gocke. These included getting the reliability up the levels needed by a paperless hospital, which was “a nightmare” but has been achieved. “They had to close the gap between what was needed and delivered.”

Other problems included the need to upgrade wireless infrastructure in some parts of the hospital. Some of the computers of wheels didn’t work as expected. And for a while “it took up to seven minutes to log in to the system, now down to a couple of seconds,” said Dr Gocke.

To fix performance problems after go-live, a “task force” was set up that was led by the chief executive and included high quality clinical champions. “Departments typically send people whose absence on the wards is not missed. In the task force they sent better people.”

Safer and more flexible

As well as eliminating paper patient records, clinical data warehouses are now in use to analyse patterns of clinical data to improve quality of care and patient safety.

Professor Debatin said that UKE is now a safer place to be treated “as data doesn’t get lost in hand-overs or when being transcribed from paper”. But, he stresses, these patient safety improvement are not down to Soarian: “they are down to use now having safer processes.”

He also said that the system gives the hospital considerable flexibility to change and respond to events. This was put to the test last June, when UKE was a medical hub for the deadly E.Coli cucumber outbreak in northern Germany, which killed 18 and injured many more.

UKE had to shift into full emergency mode, screening thousands of patients. “During the E.Coli outbreak the use of Soarian meant we were able to operate at 210% capacity. It really gives huge flexibility,” said the chief executive.

And should a technical or civil emergency ever mean that the Soarian system became unavailable, or that the hospital had to be evacuated, UKE has a contingency.

An evacuation print room has been built, with battery back-ups, with nine high speed printers that within 90 minutes can print off a four-page EPR summary of every patient currently being treated by the hospital.