Taunton and Somerset NHS Foundation Trust (TSFT) achieved a significant milestone when it deployed the UK’s first open source electronic patient record (EPR) from IMS MAXIMS.
This pioneering move was part of the reason TSFT was named as a Global Digital Exemplar for the NHS (GDE) in 2016, with two further IMS MAXIMS customers since named as fast followers by Health Secretary Jeremy Hunt in September 2017.
TSFT is working with IMS MAXIMS as its GDE partner, and its two fast followers Wye Valley NHS Trust and Blackpool Teaching Hospitals NHS Foundation Trust, to pursue digital excellence in the NHS. This is about sharing best practice and fast-tracking plans to deliver better, safer patient care at the same time as helping staff achieve greater efficiencies, and enabling better organisational workflows.
As the largest acute hospital in Somerset, the trust and its 4,000 staff serve a population of more than 340,000 people. TSFT wanted to replace its legacy patient administration system implemented as part of the National Programme for IT and looked for new ways of delivering an EPR. It needed a system that would underpin its ambitions for transforming care delivery, reduce costs and provide greater control over software development.
Involving its clinicians in assessing the options, TSFT decided to use the open source version of the IMS MAXIMS EPR; a flexible, cost effective option that provides more local control than a proprietary solution. The trust also recognised future benefit to the NHS overall, being able to develop and share improvements with other NHS trusts, taking advantage of economies of scale.
NHS trusts can use ‘MAXIMS’ and access £45m worth of software development with no licence fees. The open source software has since been developed in close collaboration with clinicians over 30 years, resulting in a proven, safe and flexible clinical information sharing solution.
Eight million records were migrated into the new EPR with minimal disruption to service delivery.
NHS England has been highly supportive, endorsing the trust’s approach. Richard Jefferson, then Head of Programme Commissioning at NHS England, said the project “represents a landmark moment in the use of open software in the NHS and validates the idea that open source can play a significant role alongside proprietary offerings”.
Subsequent national recognition for TSFT as a GDE, and for Wye Valley NHS Trust and Blackpool Teaching Hospitals Foundation Trust as its two fast followers, has highlighted the work at TSFT as a blueprint for NHS digitisation.
Greater clinical engagement
The partnership forged between IMS MAXIMS and TSFT has been key to success, resulting in unprecedented levels of clinical ownership and adoption. One early open day involved clinical staff demonstrating the new EPR to 500 other staff.
The TSFT EPR team, building the system alongside IMS MAXIMS, also explained to clinicians how they would co-create it, right down to drop-down menu configuration, to meet exact workflow needs of each clinical team. This has led to significant usability benefits.
Once 2,500 staff had been trained, the trust was able to use a full replica of the software on the intranet and work through different scenarios. All of these factors meant that nearly every member of staff had seen the software before it went live, resulting in faster and better adoption.
Safer, more effective patient care
Improving the patient experience was an important driver for the project. The trust has been able to make processes for admission, transfer and discharge of patients more efficient and coordinated with the help of real-time bed management and discharge planning.
Financial savings and paperless
The cost of moving to MAXIMS will pay for itself within three years. The EPR will also save the trust £600,000 a year by 2018 and has ensured TSFT is on course to achieve the NHS paperless agenda which supports better care. GDE funding will accelerate the delivery of its technology roadmap including paperless nursing, e-prescribing, clinical decision support, medicines management and integration with GP systems.
The first phase led to some new outpatients activity becoming electronic, such as real-time outcoming of patients instead of completing forms. Clinicians are triaging letters online rather than printing and also making decisions online for referrals.
Providing a real-time electronic document management solution and real-time back-up means correspondence no longer needs to be filed in paper case notes. Printing of correspondence has reduced from 30,000 episodes a month to 2,000.
Primary Care Viewer
Providing access to the primary care record for 95% of the population of Somerset is leading to avoided admissions, more informed drug interactions and reduced administration time for junior doctors.
Real-time sharing of patient alerts, starting with the learning disabilities service, will enhance patient experience and ensure the best possible care is provided.
Benefits in progress
Quicker identification of deteriorating patients (with the added use of mobile apps) – through electronic observations, identifying and escalating deteriorating patients to the appropriate care teams faster.
Paper-light Inpatients – working on a suite of mobile apps that will connect to the back-end database using APIs.
Scalable benefits to the NHS – As the community of MAXIMS users grows, software will advance more rapidly as benefits are shared between the open source community. As a GDE site, TSFT will also be working with IMS MAXIMS to develop a blueprint that can be easily replicated and implemented by other trusts across the NHS
Quote from the Trust
Andrew Forrest, Chief Information Officer:
“IMS MAXIMS is working with the clinicians in the Trust to develop and implement mobile clinical systems that support better patient care, clinical safety and helps efficient working. Using ‘Open standards’ in the applications means that clinicians will be able to use the IMS MAXIMS electronic patient record and link seamlessly to departmental systems for the information they need.’’