Royal Papworth Hospital NHS Foundation Trust and Cambridge University Hospitals NHS Foundation Trust have achieved a first-of-type in the UK by interfacing their electronic patient record (EPR) systems – Lorenzo at Royal Papworth and Epic at Cambridge University Hospitals – to speed up lab ordering and results. The interface means blood test orders and results can be shared electronically between the two organisations, delivering significant time and safety benefits for lab staff and clinicians and putting the trusts at the forefront of NHS IT interoperability.
Royal Papworth Hospital has just moved into a state-of-the-art building on the Cambridge Biomedical Campus, alongside Cambridge University Hospitals (Addenbrooke’s Hospital and The Rosie Hospital). The two trusts share a pathology service, so ahead of the move a complex piece of IT integration work was undertaken to enable timely sharing of blood tests for patients at Royal Papworth. The work included a first-of-kind integration development between the DXC Lorenzo EPR system used by Royal Papworth, and the Epic EPR used by Cambridge University Hospitals NHS Foundation Trust.
Andrew Raynes, Director of Digital and Chief Information Officer at Royal Papworth Hospital NHS Foundation Trust, describes this as “a huge feat.” “In total, we needed to integrate five systems, but the major challenge was the interface between Epic and Lorenzo,” he says. “There was no reference anywhere else in the country for doing that, but, with Cambridge University Hospitals, we collaboratively achieved a bi-directional interface and we did it in just seven months.”
Dr Afzal Chaudhry, Renal Consultant and Chief Clinical Information Officer at Cambridge University Hospitals, added: “Being able to share laboratory results in a digital way with our neighbouring hospital supports our clinical colleagues in providing more effective and quicker care for our shared patients, which improves patient outcomes.”
Replacing laborious processes
The link has eliminated many of the time-consuming processes. Chris Johnson, the Chief Medical Information Officer at Royal Papworth, explains; “Prior to the integration, we would order a test using our order communications system,” he says. “If the test was going to be done at Addenbrooke’s Hospital, we would print out the request, marry it up with the blood bottle, and send it over to the labs at Addenbrooke’s, where it would be transcribed into the Epic EPR.
“When the test was completed, the result would be automatically emailed back as a pdf due to the lack of integration between the trust’s systems. Administrative staff at Royal Papworth would have to open-up the pdf, rename it, add some patient identifiers, and save it into a file-drop so it could be sucked up into our document management system. “Or, if it was numerical data, our qualified lab staff would have to sit down at a computer and transcribe the details from these pdfs into our lab system, so it could display the result to clinicians. It was an extremely laborious process, prone to error, prone to delay. With the electronic patient record integration, all of that work has now gone away.”
Faster, safer results
This has delivered significant benefits. Most obviously, turnaround times have improved dramatically. “Thanks to this collaboration, we are now receiving results digitally within 48 hours, which means that clinical decision making can happen far more quickly.” Patient safety has also improved, because there are fewer points at which complex results must be copied from one form or system to another.
Eamonn Gorman, the Chief Nursing Information Officer at Royal Papworth, says that although there were checks in place at each stage, he is pleased that this transcription has been largely eliminated.
“As a nurse, you are always worried about patient safety, he says. “I now have much more confidence in the safety of the results. I definitely sleep better at night knowing that transcription is no longer an issue.”
The integration has also enabled some improvements to be made to the front-end of the Lorenzo system at Royal Papworth through which clinicians pick-up results. Instead of being faced with a long list, clinicians can use an ‘in-tray’ to pick up the results that are most important for their patients and acknowledge results electronically. “If the result is normal, it sits in the Lorenzo electronic patient record, but if it is abnormal, then it is flagged up,” Gorman explains. “So, there might be 50 results in the Lorenzo EPR and five in the in-tray; and that’s great because they’re the ones that you need to know about.”
Complex integration requires trust collaboration and clinical engagement
The integration project involved some complex technical work involving both trusts and a lot of clinical engagement to make sure that clinicians, lab staff and IT systems were all speaking the same language when it came to what tests are being ordered and what the results mean. In total, five IT systems were involved. The pathology and radiology systems at Royal Papworth can both be used to request tests and order results, so they both had to be integrated with the Trust’s Lorenzo system. The major integration was between Lorenzo and Cambridge University Hospitals’ Epic EPR lab module. At the Royal Papworth side, this was achieved using the hospital’s Viaduct integration engine, another DXC product. Viaduct manages all of the HL7 messaging between systems at Royal Papworth and communicates directly with the Ensemble integration engine at Cambridge University Hospitals. Where appropriate, Viaduct sends test requests to Addenbrooke’s for its labs to process. On return, the test results are directed to the appropriate system – Lorenzo, if patients are on a hospital ward, or the system in use on the critical care unit – so that they are easily available to the attending clinicians.
“One of the big challenges was making sure that our charts aligned with the lab’s charts,” says project manager Marie Hills. “For example, we had to make sure that what we called a ‘full blood test’ matched what the lab called a ‘full blood test’ and then we had to test to make sure that all the systems understood that in the same way. “Then we had to make sure that what was displayed in Lorenzo could be clearly understood by clinicians, and that no changes had been made to the results in their transmission.” This involved extensive collaboration with colleagues at Cambridge University Hospitals and everybody involved in the project stresses that clinical engagement was key to getting this right. “You need everybody at the table, and you need to make sure that risks have been identified and mitigated before you press go.” Raynes says.
Ahead of the interoperability curve
The integration has delivered benefits over and above faster turnaround times and improved patient safety. Fewer repeat tests are being ordered because the results come back quicker in a digital way and are easier to share with clinical teams.
Raynes says the project has national significance, because it shows that hospitals don’t have to be using the same electronic patient record system to exchange information with each other, and that interoperability works. “There has been an idea, since the days of the former National Programme for IT, that we all need to be on the same system,” he says. “That has been challenged by the Wachter Review [a report ordered by former Secretary of State for Health and Social Care, Jeremy Hunt, on the state of NHS IT] and the tech vision [a more recent vision published by Hunt’s successor, Matt Hancock].
“They say that interoperability is the way forward, and we have shown that this is right. What matters is that systems use open standards and open application interfaces (APIs), so they can talk to each other. Now, we are ahead of the curve. We have put policy about interoperability into practice, and we have done it collaboratively with our neighbouring trust”.
“This is an exceptional programme of work involving the commitment and dedication of both technical and clinical teams at both trusts” said Chaudhry. “This collaboration is a natural extension of our hospitals’ partnership and another key achievement in providing joined-up healthcare between a patient’s care settings using digital technology.”
