University Hospitals of Morecambe Bay NHS Foundation Trust (UHMB) has a requirement to procure a provider of an electronic document management system on either a fully managed service basis or via an internal scanning Solution supported by existing Trust staff.
Trust profile.
University Hospitals of Morecambe Bay NHS Foundation Trust is a large acute hospital organisation serving the population of South Cumbria and North Lancashire. The Trust operates from three main hospital sites, Royal Lancaster Infirmary (RLI) in Lancaster, Furness General Hospital (FGH) in Barrow and Westmorland General Hospital (WGH) in Kendal serving a population of circa 363 000 spread across an area of over 1 000 square miles.
Each hospital has a range of ‘General Hospital’ services, with full accident and emergency departments, critical / coronary care units and consultant led beds at Barrow and Lancaster plus a Primary Care Assessment Service with GP led inpatient beds in Kendal. All 3 sites provide a range of planned care, including outpatients, diagnostics, therapies, day case and inpatient surgery. In addition a range of local outreach services and diagnostics are provided from a number of community facilities.
The Trust employs approximately 5 000 staff (4 300 WTE’s) and had a total income in 2010/11 of approximately 254 000 000 GBP.
Activity 2010/11.
Inpatient visits 77 000.
Outpatients visits 400 000.
A&E attendances 90 000.
The Strategic context.
The Trust has recognised that medical records management is an area for improvement. It has already taken short-term actions following the external review of medical records.
At present University Hospitals of Morecambe Bay NHS Foundation Trust is faced with an expanding requirement to manage medical records. There are specific problems of space to store records, timeliness of delivery and availability of records across multiple sites.
There is a pressing need to improve the service to clinicians so that they can be sure that they have access to essential patient information when they need to, where they need to, in a secure and reliable way. This in turn will improve services to patients ensuring that those associated with their care have up-to-date and timely information available throughout the hospital.
The strategic case for this investment is therefore very strong. It addresses an immediate clinical and operational requirement, improves services to the patient, supports the Trusts Informatics strategy and improves the security and confidentiality of patient records.
The prime drivers for this initiative directly address these recommendations with respect to the health and safety of Trust staff and equally importantly the care and safety of patients to whom the Trust serves. Clinical care and therefore decision making, is only as good as the information it is informed by. The solutions offered via this procurement must remove the Trusts reliance on the physical case note and at the same time improve information coverage, accuracy and clarity delivered at the point of clinical care.
Scope.
The Trusts Health Records Service (the Service) is currently facing unsustainable pressures, manifested most visibly in its libraries, which are packed beyond capacity. The trust has invested in some short term interim additional storage that will provide adequate case note storage capacity up to August 2013. This procurement has the fundamental objective of providing a long term case note management solution through the use of electronic document management systems capability that will integrate tightly with the Trusts electronic patient record system (Lorenzo). Lorenzo ePR phase one deployment went live October 2008 with phase 2, replacement patient administration capability live in June 2010. The system is being delivered to UHMB using the national programme for information technology (NPfIT) local service provider (LSP) contracts, computer science corporation alliance (CSCA) are responsible for the Lorenzo deployment project at the Trust. The Lorenzo system is being deployed within University Hospitals of Morecambe Bay NHS Foundation Trust as a true clinical portal, providing a one stop shop for clinicians to access or input any patient information they require through a single secure log on. Any resultant systems capability offered through this procurement must adhere to this principle.
This procurement aims to reinforce compliance with the Trusts own medical records policy objectives by providing:
— Better quality of clinical records - improved patient care,
— Better storage and retrieval of clinical records,
— Improved control of clinical records,
— Compliance with legislation and standards,
— Improved disposal of clinical records and
— Reduced costs.
The Trust requires a significant improvement in the percentage of notes available at all patient facing events, typically the Trust achieves only on average 90 %-95 %. The Trust requires 100 % as a result of this project.
The prime driver for this procurement is the improvement of patient care in terms of both efficiencies and safety.
The 2 lots described in this OJUE notice aim to give suppliers flexibility in how they construct a service able to satisfy the Trusts objective, however the Trust expects to contract with a single prime contractor who will deliver the full capability required.
The supplier and solution should be compliant with and preferably certified to the following standards:
— ISO 9001:2008 quality management,
— ISO 27001 information security management,
— ISO 14001:2004 environmental management.
The Trust requires a complete successful deployment of this service by August 2013.
Key business drivers.
There is a significant organisation devoted to ensuring that the paper record is kept up to date and is available to those who need to use it. This includes over 98.7 WTE staff in the medical records and outpatients department, a proportion of these staff have a dual responsibility for both the case note management and the outpatient appointment / reception processes.
This current situation has led to a multitude of problems:
— Existing paper patient notes are often unavailable, difficult to find, in a poor state or incomplete,
— There can be multiple sets of notes for a patient e.g. main file, maternity file, physiotherapy file - and some patients even have multiple main files,
— Staff – including nurses - are duplicating effort (and records) in an effort to compensate for the problems. This also adds risk as there is no single ‘version of the truth’,
— It is extremely difficult for anybody to find all information about a patient with information held on multiple clinical systems,
— Paper notes can only be seen by the person holding them, requiring notes to be copied for MDTs,
— The end result is a complexity that also contributes to poor data quality with no ownership,
— The direct cost of managing and administering the paper record is high.
An EDMS solution will enable the Trust to convert paper health records to an electronic scanned image and then provide networked PC based access to the information contained in these records across the hospital.
In summary the key business drivers are:
— Poor security of paper health record,
— Cost of maintaining paper files – filing, retrieving, delivering, culling and destroying,
— Paper files susceptible to fire and flood,
— Storage facilities over-loaded leading to handling problems,
— Pressure on storage space,
— Cost of transporting paper files between sites,
— Duplication and fragmentation of files in several locations,
— Lost and missing files - unavailability of Health Record for appointments,
— Need to access to stored files when needed - time delays in accessing paper file,
— Inability to share information over different sites or for multiple clinic appointments,
— ePR alignment and strategic fit.