Beaumont Hospital Electronic Patient Record
The Business Need
Beaumont Hospital in Dublin began to develop an EPR (Electronic Patient Record) for epilepsy patients more than a decade ago. What started out as a small research project would gradually evolve into a transformational healthcare solution, run by a consortium of clinicians, ICT experts, health service researchers and health policy experts, including Programme Manager Mary Fitzsimons.
“There was a need for continuity of care for epilepsy patients across the whole of Ireland. We wanted a database of patient information that was collected at the point of clinical consultation and then kept up to date and made available in real time,” she said. “As the record built up we would have huge data sets to assess how our services were performing and where to put new resources in the future.”
Ergo became involved around 18 months into the project. First, through its IT Resourcing division, a strategic service focused on placing high-calibre talent in permanent positions within the IT sector. Brendan Dunleavy was contracted through Ergo by Beaumont and would become a critical member of the Beaumont team as Technical Project Lead.
By 2012 the programme was being used by most of the national hospitals that treat epilepsy. Originally supported through research funding, it became part of the National Clinical Care Program run by the HSE, which decided that a managed service provider was required, not only to support and maintain the system but to follow a framework put in place to develop new features and further refine the service. Ergo won the five-year contract and took Brendan Dunleavy on as the head of the new team.
What started life as a small research project has evolved into one of several systems feeding into plans for a national EPR scheme, longregarded as the holy grail of Irish healthcare services. The project highlights how effective partnerships between public service professionals and an IT services company like Ergo can deliver true transformation that can improve the quality of people’s lives.
The core of the solution is about replacing disparate paperwork with a centralised EPR. When a patient follows up a consultation in Cork, for example, with surgery in Beaumont – the only Irish hospital able to carry out such procedures – they would have had to go through the same medical tests and form filling in each hospital. One central EPR would save valuable time for the patient as well as healthcare workers.
The initial development team devised a secure web-based system that would be used in real-time by clinicians during patient consultations.
The Java-based software was built on an Oracle web server and database, and used to capture a broad range of quantitative and qualitative clinical data.
The initial challenge was populating the record with patient data. Having identified the point of clinical consultation as crucial, it was imperative that the electronic record was easy to fill in on a computer. “After
some initial heavy lifting to prepopulate the forms, doctors and nurses can now fill them in as they talk to patients,” explained Brendan Dunleavy. “We had to make it an easy process because there is so little time for them to get it done.”
The collated data now forms the basis of a single EPR that is accessed from multiple points in the healthcare ecosystem via the National Healthlink, a web-based messaging service for the secure transmission of clinical patient information between hospitals and agencies.
There are now 6,000 names in the database, just under half of the patient category that clinicians are looking to capture and collate. “There are around 37,000 epilepsy patients in the country. Two thirds are well controlled with medication – it’s the 13,000-15,000 that have ongoing needs. Our target is make sure all these people get the most appropriate care,” said Mary Fitzsimons.
By the end of the year, all the major epilepsy treatment hospitals will be on the system – Cork, Galway, Limerick, Sligo and Tallaght, St James’s, St Vincent’s and the Mater in Dublin. The next phase will be to enable access for accident and emergency units across the country.
Having built up a decade’s worth of information, Mary Fitzsimons is now looking at new ways of interrogating the data, using business intelligence-type tools to extract more information to drive better patient care. “We want to look deep into the complexity of different patient types, for example, and use predictive analytics to find the best ways to allocate resources,” she said.
The single EPR is already indispensable to doctors and nurses across Ireland, transforming paper-based patient records the size of telephone books into a searchable electronic database. When it came time to move to the next phase, and transition the project to a managed service that would ensure its support and maintenance as well as continual enhancement, the HSE put it out to tender. Ergo was the preferred bidder for a number of reasons including the history it had with the project.
Brendan Dunleavy now works in Ergo, adding new features and services at the behest of the National Epilepsy Programme, which meets annually to plan enhancements and set targets for extending its reach.
One recent upgrade supports a helpline service. If a patient suffers a seizure at home, a nurse on the end of the phone can log in to the EPR, and, if necessary, contact a clinician who can access the same. Between them they can make a recommendation based on the patient’s history. At the end of the call, the nurse updates the EPR with details of the new incident, ensuring it stays current. “Before, it was hard for the nurse to make informed recommendations because they didn’t always have access to the records,” explained Brendan Dunleavy.
An outreach programme has also been introduced under Ergo’s watch. In one instance it supports the 20-30 per cent of epilepsy patients who also suffer from intellectual disability. Outreach clinics can now visit the patients at their residential centres rather than risk upsetting them with hospital visits. Assessments are carried our remotely, accessing the EPR on a laptop.
“The learning from this project and others like it can inform a national EPR solution,” commented Mary Fitzsimons. She also had praise for all the team behind it.
“On a project like this you need to pull people in and keep up the momentum. Ergo have been great,” she said.“We have a very good relationship with them and they get on well with our clinical team. The people involved have a passion for this project, including Brendan, and long may that last.”