Hinchingbrooke Health Care NHS Trust ("Hinchingbrooke") required an IT system that could service the needs of patients and clinicians from arrival to discharge. Ascribe has installed a comprehensive electronic patient record for all of its patients. The result is that Hospital clinicians and patients' GPs can track hospital admission, diagnostic test data and discharge information online and in real time. The system's resource management tools help the Treatment Centre ("TC") to maximise their operating efficiency and bed management.

The Trust has added several new IT systems from Ascribe. These all integrate with the Ascribe EPR system:

• Order Communications
• Bed Management
• Theatre Scheduling
• Radiology Imaging
• Web-based clinical viewer
• Electronic Discharge
• Digital Dictation
• Diabetic Review
• Obstetrics
• Endoscopy

To download a Case-Study for Electronic Patient Records, please click here 

Emergency Care:

Southern Health is the largest metropolitan health service in Victoria, providing emergency care services at three locations in the southern Melbourne region and treating over 128 000 patient attendances per year. Southern Health is a major research and training organisation, comprised of Monash Medical Centre at Clayton, Dandenong Hospital and Casey Hospital at Berwick.

Symphony is currently being implemented at Southern Health, replacing three disparate systems with a single database to provide a clinical information solution across the three locations. The Emergency Departments of Casey Hospital, Dandenong Hospital and Monash Medical Centre will take Symphony live in late 2008 and early 2009.

Professor George Braitberg, Director of Emergency Services for Southern Health: "We chose Symphony to help manage our emergency departments for it's specialised ED functionality, high degree of confi gurability and because it is very user friendly. It will be quite easy for the clinicians and staff to integrate it into their patient care workflow. It will deliver a networked profile of the three Emergency Departments that will provide real time views of departmental workload and operational performance allowing us to manage load distribution across the three campuses. Symphony will be our total patient management tool. The degree of end user configurability provides easy construction of clinical and management reports, as well as statutory requirements of Government."

The Emergency Department at The Royal Melbourne Hospital treat the highest acuity emergency patients in Victoria, with 56,000 patient attendances annually, including more than 600 major trauma cases and 18,000 ambulances cases. A $56.3 million redevelopment began in 2005 on the RMH Emergency Department. The project, to be completed in 2009, will expand the ED to 106 beds to cater for an anticipated 65 000 attendances per year.

State of the art information technology is an integral component of the redevelopment, with the goal of becoming a paperless department well on the way to being realized.

To facilitate this plan, the Symphony emergency medicine clinical information system has been implemented throughout the department. The Symphony system will be fully integrated with the hospital patient administration system, pathology, radiology and communications systems, the clinical results portal and the Victorian Ambulance information system.

Dr Keith Joe, Emergency Physician and clinical lead for the ED redevelopment: "We chose Symphony as the ED clinical information management system for several reasons. We were impressed with the ease of access to, and clarity of important clinical and patient tracking information. The ability for us to easily customise screens and format printed matter means Symphony has the potential to be highly configurable to meet the needs and demands of our practice locally. The open architecture of Symphony will also allow us the opportunity to readily integrate the many functions included (such as electronic prescribing, pathology & radiology orders, and clinical documentation) with other ED software, automating many tasks currently performed manually. Our intention is to use Symphony as our core application in optimising streamlined patient care coupled with relevant electronic clinical information at the RMH". 

Barwon Health - Six months later...

Barwon Health provides comprehensive emergency services to the greater Geelong region, with over 45 000 patient attendances annually. The Emergency Department has undergone a major redevelopment, with phase one opened in July 2008 and phase two due to open in 2009. An integral component of the redevelopment was the implementation of the Symphony emergency medicine clinical information system.

Ascribe's Emergency Care system, Symphony, has been live at Barwon Health since March 2008. The first six months following the project go-live have been very smooth, with rapid acceptance of the system among the clinicians. The department is now planning phase two of the project to take all medical and nursing staff paperless over the next six months. This includes electronic prescribing and documentation of medication administration, online nurses notes and emergency care nursing observations records and integration with the hospital Digital Medical Record for Symphony data to be fed to the hospital wide online record for access by staff outside the ED.

Dr. David Eddey, Director of Emergency Services, Barwon Health and The Geelong Hospital: "Symphony is now an integral part of our emergency department and the staff are very reliant on it. We were pleasantly surprised with the rapid user uptake and ease of implementation. Feedback from the GP's has been excelle nt, as they now receive a letter with the attendance information every time one of their patients is seen in the department. Our plan now is to progress to Phase Two of the project with electronic prescribing, bring the nurses online and move to a fully paperless department".

King's College Hospital NHS Foundation Trust is one of London's largest and busiest teaching hospitals with the Emergency Department seeing more than 300 patients a day and over 100,000 per year. After 14 years using AEII - Ascribe's former Emergency Department (ED) system, King's College ordered an upgrade to Symphony. Due to the configurability of Symphony and the enthusiasm of the ED staff at King's, many hours were spent planning and discussing how they want to use the system and with the Ascribe staff configuring Symphony to map to their processes.

King's College went live in July 2008 using Symphony in the main Emergency Department and their Clinical Decision Unit.

Symphony interfaces with the Trust's Patient Administration System and the Electronic Patient Record, and it is planned that there will be a seamless link to their ordering system for clinicians to place radiology and pathology requests directly without having to change systems reducing logins/patient selection time. Also it is planned that the Trust's infection control system will send details of patients known to have MRSA and other infectious diseases so that staff in ED are made aware as soon as these patients attend the department.

 Endoscopy Reporting

The Ipswich Hospital NHS Trust is one of the largest acute hospitals in East Anglia and provides healthcare services to nearly half a million people. The Hospital provides a wide range of secondary care and screening services.

A recent audit of the Trust's Endoscopy Department by the Joint Advisory Group on GI Endoscopy (JAG) accreditation visit, led to the establishment of an action plan to enable the Trust to replace their former unsupported Endoscopy Information System. Following a formal tender, Ascribe's Scorpio GI Endoscopy and Bronchoscopy system was selected. In addition to Ascribe's Scorpio system, an HL7 patient demographic interface to the Hospital's patient administration system was also acquired.

This implementation is being delivered in three phases: the reporting system has already gone live, Scheduling (Phase 2) is due in February 2009 and Gastroenterology (with an interface to Pathology) will follow shortly afterwards.

The Hospital is looking forward to using the robust reporting functionality of Scorpio's Endoscopy system to enable them to become authorised as a centre of excellence for National Bowel screening.

Speaking on behalf of the Trust, Maggie Rudduck, a senior implementation specialist said: "Ascribe's Scorpio GI Endoscopy system has proven to be easy to use and popular with clinicians, there is a very short learning curve and we are already seeing benefits that improve the services and care we are able to offer our patients."

Hospital Pharmacy

eMedicines Management - Using ward based Pharmacy staff and IT systems to improve patient safety and departmental efficiency

Web Based Pharmacy Departments with Dispensing Robots

Ascribe successfully installed its web based Pharmacy solution at the Royal Bolton Hospital, part of the Bolton Hospitals NHS Trust, and the site is now completely operational. One unique aspect of this Go Live was that on the same day that the Hospital changed its Pharmacy IT system, they also brought online a Robotic dispensing system; thereby taking a massive leap forward in improving patient care and safety.

The Ascribe web-enabled Pharmacy system is designed by healthcare clinicians to ensure higher patient safety standards: by using a Patient's Medication Record which effectively warns Pharmacy staff automatically by use of it's integrated Decision Support Service if there may be a dangerous drug interaction or allergic reaction, as medications are dispensed.

The Ascribe Pharmacy system was selected by Bolton Hospital NHS Trust because the system extends such a broad range of complementary pharmacy services outside of the Dispensary; the application has been designed to allow ward-based clinical services, such as Medicines Management whereby medicines can be ordered wirelessly from the wards, Electronic Prescribing and Medicine Administration (which records exactly what medication was prescribed, when the medication was administered to the patient, and what reaction was noted). In addition to this, the Ascribe Pharmacy System also provides the Hospital Pharmacy staff with a bi-directional interface from their Pharmacy system to their Rowa Speedcase Robotic Dispensing unit, allowing Pharmacy staff to both issue requests for prescriptions to their robotic system and receive (stock level) updates from their robot.

Brian Smith, Chief Pharmacist at the Royal Bolton Hospital said "The Bolton Hospitals NHS Trust is delighted that Ascribe was able to deliver such a robust and flexible Pharmacy system within a twelve week project cycle. Our staff has welcomed the additional patient safety features that are embedded within the system and we look forward to extending our Pharmacy services beyond the Pharmacy, thereby saving time and providing a higher level of service to our clinicians and patients."

To download a Case-Study for The Royal Bolton Hospital NHS Foundation Trust please click here 

Mental Health Pharmacy Departments with Packaging Robots

Ascribe has been successfully interfacing to robotic dispensing systems since they were first introduced into the UK. Dispensary robots come in many shapes and sizes, all of them far removed from the public’s perception of a robot. Ascribe supply bi-directional interfaces to these systems: dispensing orders are issued to the robot; it can then either dispense the item(s), or alert the ordering terminal of an issue preventing the item from being dispensed.

Trusts dispense medications to a diverse range of vulnerable patients and clients, including the elderly, who may be incapable of recognising or adhering to a medication routine. It is therefore necessary to provide a simple and clear system for self administration and many dispensaries have opted for a manually dispensed pack that can hold seven days of prescribed tablets.

For a case study comparing the experiences of Nottinghamshire Healthcare NHS Trust and Norfolf and Waveney Mental Health NHS Foundation Trust, please download the pdf using the hyperlink below.

Ascribe Web Pharmacy

Mid Cheshire Hospitals NHS Foundation Trust is the organisation which manages Leighton Hospital, Crewe and Victoria Infirmary, Northwich. The Trust was established as an NHS trust in April 1991 and now employs over 3,000 staff and provides a comprehensive range of acute, maternity, and child health services to a population of 280,000 living in the boroughs of Congleton, Crewe and Nantwich, and Vale Royal.

Mid Cheshire NHS Hospitals Trust selected Ascribe's Web Pharmacy as their departmental IT solution in Leighton Hospital to help deliver improved patient care. The system integrates the Pharmacy's Dispensary, Stores, Finance & Reporting. It will also utilises a software interface to the Hospital's existing Patient Administration System (PAS) to enable a more comprehensive Electronic Patient Record (EPR). Ascribe's Pharmacy solution was selected by Mid Cheshire as the best fit for their clinical and information needs following an open procurement review of competitive bids.

"Our decision to install Ascribe's Pharmacy is based upon the strengths of their clinical systems and the improvements that these bring to patient-care," said Alan Denby, Chief Pharmacist of Leighton Hospital.

Robotic Interfaces to Packaging Robots 

Ascribe has been successfully interfacing to robotic dispensing systems since they were first introduced into the UK.

Robots used to be seen as being solely the domain of larger acute hospitals; stocked from floor to ceiling with boxes and packets of varying shapes & sizes. However robotic systems now come in a variety of shapes and sizes, their design clearly determined by their specific application.

Ascribe supply bi-directional interfaces to dispensing and packaging robotic systems, enabling "two-way" communication between the person requesting an item for dispensing and the robot holding the stock: dispensing orders are issued through the Ascribe interface to the robot; which can then either dispense the item(s), or alert the ordering terminal of a (technical/stock) issue that might be preventing the item from being dispensed in its current form.  

Ascribe has prepared a case study on Robotic packaging systems at two Mental Health Pharmacies with the kind help and suport of Steve Mayers of The Wells Road Centre, Nottinghamshire Mental Health Trust and Steve Bazire of Hellesdon Hospital, Norfolk & Waverney Mental Health NHS Foundation Trust.

At both sites, robotic packaging systems have been applied to repetitive and high-risk tasks; these systems are not subject to the fatigues of monotony and have proven themselves as able to offer considerable benefits to a Pharmacy. As these two sites clearly demonstrate, when correctly used, robots can efficiently undertake time and labour intensive taskes, enabling highly trained pharmacy staff to focus their clinical efforts on dealing with people and providing more care to patients. 

To request a copy of this case study as a pdf document, please email our sales team at salesoffice@ascribe.com. This case study has also been placed in a summary form onto Microsoft's NHS Resource Centre's website - please click here to visit the Microsoft NHS Resource Centre website and read the article

Enterprise 

Electronic Prescribing:  

The Christie NHS Foundation Trust is a specialist hospital, mainly concerned with the treatment of cancer and associated diseases. The Trust is one of the leading cancer centres in Europe offering high-quality diagnosis, treatment and care for cancer patients, world-class research and education in all aspects of cancer. The Trust receives over 12,500 new patients, and treats around 40,000 patients, every year across Greater Manchester, Cheshire and beyond.

The Trust is a long standing customer of the Ascribe Pharmacy software but has more recently implemented with Ascribe Web-based Integrated Clinical Workstation for Electronic Prescribing and Medicines Administration (ePMA).

The Ascribe ePMA solution provides the Trust with an Enterprise scale solution addressing both the complex needs of specialist oncology and general prescribing and medicines administration in a single software solution. Furthermore, the Ascribe ePMA solution has been delivered as an integrated component of the Trust's clinical / patient administration solution to enable clinicians to access ePMA using a single username and password and the single identification of a patient.

The solution delivered to the Christie has been modelled to reflect their clinical and operational requirements to ensure real tangible benefits can be monitored and any changes to existing working practices are driven by planned improvements.

Substance Misuse Systems (SMS)

Rugby House

The Ascribe Substance Misuse System (SMS) is currently being implemented at Rugby House in London to support the drug and alcohol services provided by the organisation. Rugby House provides services for those who misuse alcohol and drugs, and to enable communities to understand how alcohol and drugs can affect everyday life.

The Ascribe Substance Misuse System is a fully functional database system that supports drug and alcohol services within the provision of DAAT, NHS and non-public organisations. The system supports client management through  are plans. These are an effective tool for clinicians to address and improve a service user's physical and psychological well-being. This is backed up with the in-built production of the core NTA and Home Office datasets (NDTMS, DIP, etc) together with the ability to produce reports for local reporting needs.

The system is based on the successful ePEX Mental Health system that has been developed over the last 20 years to provide support for clinical services and the required national and local downloads. As the system can be tailored to support individual customer requirements, consultancy is underway to ensure the system is set-up correctly to meet the needs of Rugby House. A full implementation and training plan is in place to ensure the successful delivery of the system.

Community Health

ePEX - Rotherham PCT

In March 1993, Rotherham Priority Health Services NHS Trust, an amalgamation of the Community and Mental Health Unit, needed an information solution for their Mental Health, PLD and Community Services. For this solution, the Trust went out to EC Procurement, and, based on its functionality, the MHC software from Protechnic Computers was chosen. Since then both Rotherham and Protechnic have changed their names – Rotherham Priority Health Services becoming Rotherham PCT, and Protechnic Computers becoming a member of the Ascribe plc group of companies. And of course, the original Protechnic software has evolved from MHC, through PHC into the current ePEX.

Originally, the Rotherham system was used for Appointments, Contacts, Inpatient, Mental Health functions (MHA, ECT etc.) and Daycare. At that time the emphasis was very much on administrative functionality, although data input was performed by both IT staff and clinicians. Child Health was brought into the system in 1998, with a merge of the existing child health software into PHC. This not only provided the necessary interactive scheduling for vaccinations, immunisations and surveillance, but also began a longitudinal record of patients from birth into adulthood for all the community services.

Rotherham PCT - Key Deliverables

• The ePEX system enables the Trust to provide information for both local and national requisites:
• National: ePEX provides data for the MHMDS, NWCS, Körner and COVER returns, ePEX interacts with the NSTS and NN4B services.
• Local: ePEX is the main PCT tool used by Commissioners, ePEX is used as a service management tool by the service leads. ePEX is used by field staff for local case management and as an audit tool

Software rollout

The Protechnic software at Rotherham was originally installed at only two sites. Within the first year an additional 20 sites were brought on-line for service provision to District Nurses.  (And all this was achieved with a network procurement which was concurrent with the software rollout.) Today there are over 60 sites and over 600 users on the ePEX system covering Mental Health, Community and Child Health services.

ePEX Services at Rotherham

Since the implementation of the Protechnic software in 1993, Rotherham PCT has expanded the use of ePEX to most of the community services provided by the Trust. This broad use of the system is probably one of the most extensive amongst all ePEX users and demonstrates that ePEX can be used as a single integrated solution taking into account the differing requirements of the following services:

• Reception Staff at the Family Planning Clinic, Rotherham
• Intensive Home Care Treatment Crisis Intervention
• Family Planning Assertive Outreach
• School Doctors Child Health Services
• STEPS Project Physiotherapy – Paediatrics
• Speech & Language Therapy Physiotherapy – Mental Health
• O.T. - Residential Homes O.T. – Paediatrics
• Physiotherapy – PLD O.T. – PLD
• Community Children’s Nursing Nursery Nursing
• O.T. – Wheelchair Service Mental Health Liaison Service
• Night Nursing Service Health Visiting
• Looked After Children Consultant Paediatrics
• Consultant Psychiatry Consultant PLD
• Dental Services Evening District Nursing Service
• Criminal Justice Liaison Consultant Child & Adolescent Psychiatry
• Chiropody Diabetes Nursing
• Child & Adolescent Psychiatry Community PLD Teams
• Behavioural Nursing Community Physiotherapy
• Alcohol Day Service Clinical Psychology
• Children’s MacMillan Nurse Special Hearing Service

MHMDS Targets

Peter Clarkson – Clinical IT System Support Specialist – believes that, using ePEX, Rotherham were the first Trust in England to produce test data for the MHMDS for March 2003. (Or at least, as Peter says, the first Trust to submit data that identified a problem with the MHMDS Assembler!)

Certainly, Rotherham PCT were one of the very first Trusts to implement the eCPA using ePEX, which enabled them to produce MHMDS more easily. For the past year Rotherham PCT has worked on rolling out eCPA, using the ePEX Care Pathways functionality. This eCPA implementation project has been headed by a clinician, Tom Wyman (CPN), who has utilised the software with impressive end results, which have been the subject of a presentation at the ePEX National User Group.

Flexibility assures acceptance

Peter Clarkson comments that: “ePEX is a good tool for any Trust wishing to use a system that offers a high degree of autonomy to the user in the design of screens and codes. Its flexible approach to the provision of tailored solutions is a great strength in the healthcare market, where adaptability remains a key necessity for healthcare providers”.

Greater Manchester West Mental Health NHS Foundation Trust provides integrated mental health and social care services, to the 700,000 people living in the Bolton, Salford and Trafford local authority boundaries and a range of specialist and secure mental health services across Greater Manchester, the North West and beyond. They employ over 3,600 staff from different professions and disciplines with 400 staff seconded from partner organisations.

• The system has been running and growing efficiently over the last eight years.
• Database availability is at 100% and application server availability is at 99.99% (April 2010)
• Over 30 IT systems replaced with a single application
• Patient data is delivered to an on-screen summary from the server in less than 2 seconds (actual times 0.6 - 1.6 sec)
• Transaction volume: 5.36 million records in April 2010

Mental Health:

JCC - Harrow Unified Mental Health Service

Overview: Harrow introduced a new IT solution to unite and improve health and social services. JCC helps provide coherent responsive patient centred service.

The Organisation

Harrow Unified Mental Health Service (HUMHS), a joint health & social care service, was also a member of The Harrow Partnership, established in 1998, to improve public services and enhance the quality of life for its 220,000 residents and those working or visiting Harrow.
The Partnership targeted four main areas of improvement: health, community care, primary and secondary healthcare, and support for children and families.
In its quest to provide a cost efficient service, supporting carers and effectively treating its clients, Harrow turned to JCC to integrate with a multitude of existing systems across Harrow and add new levels of functionality so that health providers can be much more proactive in their provision of mental health services.

The Business Challenge

HUMHS had a vision. It wanted to use new technology to integrate health and social service systems throughout its borough to create a coherent, responsive and patient-centred service that could also act as a model for the whole of the UK. Underlining its vision was their desire to become a leading e-government organisation operating an ‘Invest to Save' policy.

The organisation believed that more effective communication of important clinical information was necessary to providing a better health system and avoiding the possibility of health care disasters.

With respect to its mental health systems, it wanted to reduce paperwork and duplication, and achieve greater coordination and accuracy of information. The organisation had significant investment in a number of discreet systems and wanted to leverage this investment to give GPs and clinicians at A&E departments instant access to appropriate clinical data on each patient from any location. It also wanted to go beyond this to create sophisticated care plans for patients given diagnosed conditions.

The Solution

‘Harrow Live', created using JCC brings together clinical, therapeutic, diagnostic and administrative information from multiple healthcare and social services sources as a single electronic patient record, without scrapping existing systems.

Acting as a complete picture of the patient's healthcare history and planned future treatment, the record allows clinicians to provide continuity of care across multiple sites and multiple types of service. It integrates systems borough-wide, making valuable clinical information available to all relevant health and social services personnel, regardless of their location. The project did not see its end, Harrow becoming part of the wider CNWL meant that the focus was placed on health with the intention of replacing all of the Trust's current health systems.