SystmOne's biggest palliative deployment:
St Barnabas Hospice in Lincolnshire
St Barnabas Hospice cares for people who are living with a life-threatening illness across Lincolnshire, from an eleven-bed in-patient unit and five day-hospices. The day-hospices provide services including daycare, hospice at home, physiotherapy, occupational therapy, complementary therapy, welfare support, a lymphoedema clinic, and bereavement services. In the past 18 months, 70 users across all of the sites have gone live with SystmOne Palliative.
Darren Holmes, ICT Manager, St Barnabas Hospice
Darren Holmes is the ICT Manager for St Barnabas. He is responsible for managing, installing and supporting IT across all the sites. He also chairs the northern cluster of Hospice Connect, a region which covers around 130 hospices. "SystmOne is the preferred solution for Hospice Connect," says Darren, "and my advice to other hospices is that if you can get it, take it! We currently have just over 600 patients, we record around 3,600 contacts a year, and now, that's all on SystmOne. "
This is a significant achievement as Darren explains: "We are a registered charity, a non-NHS organisation, and we operate from eight sites, that makes providing a cost-effective, well supported IT solution quite difficult. Historically, it's been extremely difficult for independent hospices to connect to NHS systems. We don't have a permanent N3 connection or the level of support that other organisations have from the NHS. Our only access to N3 is by using SecurID tokens and our existing broadband infrastructure. That costs £7,500 a year – to the NHS that's peanuts, to us, it's a lot of money."
With 55% of their funding coming from the people of Lincolnshire, value for money was a key factor in selecting a clinical system to support the work clinicians were doing in the hospice. "We were about to sign for another system when we were told about SystmOne. I looked at TPP's website and saw that there was a palliative module. We had demos and saw that it was a better system, and would cost us £33,000 a year less than the one we were about to buy."
For the hospice, sharing data with other clinicians in the region is of paramount importance. Around a third of all GPs in Lincolnshire Teaching PCT are using SystmOne, and the Community module roll-out project includes Community Nursing and Clinical Nurse Specialists. This established SystmOne user base gives St Barnabas Hospice the potential to access a large number of shared records. "We potentially have access to a third of our patients, providing they consent," says Darren. "Very few patients say no to us viewing their record – most believe that it is already being shared. I would say at the moment that about 25% of our records are shared."
Darren continues, "It can be a real help for the clinicians caring for the patients to share their record. It's a fantastic benefit – they can see pathology results, microbiology, so we know if a patient has MRSA or C-Dif before a carer is sent out to them. It's useful clinically but also administratively – Welfare Services can communicate with the GP through the record, they can see that the GP has completed a DS1500 form to enable applications under special rules and the GP can see that the Welfare Service has processed it."
A patient journey for someone suffering from a long-term or terminal illness can be complicated, as Val Shipley, Project Support Officer, explains: "The patient will be referred to the hospice service by a GP, District Nurse, or other carer. Their care can continue for several years, and they can be seen by many different services. For example, from the initial referral, Welfare Services may refer the patient to Hospice At Home, who may refer them to Daycare, who may refer them later on to Physiotherapy or Occupational Therapy, and at some point, they may be referred to the hospice in-patient unit. It's a long journey, and we have a number of services to offer along the way. With SystmOne, the record can now accompany the patient on that journey, being available at each and every step. It's burdensome for a patient to have to keep answering the same question again and again. The fact that the big questions are only asked once and recorded on SystmOne is worth its weight in gold to the patient."
Approximately 50% of patients cared for at St Barnabas Hospice Inpatient Unit are discharged back into the care of the GP. Val says, "When they are discharged, the GP can look at the record and see how to care for the patient. The drugs they have been prescribed may change significantly, so by looking at the record, they can see which are proving the best for the patient. SystmOne is a good tool for taking care of palliative patients, and the fact that all the clinicians have access to each other's records adds to a patient's confidence about their care."
The deployment of SystmOne has assisted the hospice in another pilot that was put in place at the same time. Darren explains: "Enhanced discharges see patients who want to go home to die, discharged from hospital within 24 hours. The Discharge Community Liaison Nurse rings the referral through to the Hospice at Home palliative care team, the patient goes home and it all gets logged on SystmOne."
The rollout of SystmOne across the palliative environment has had other, more unexpected, benefits. "It's enhanced further the working relationship between ourselves and other carers," says Val. "For example, our staff are having more direct contact with other staff. Our nurses can go into a GP practice that uses SystmOne and type up their notes. That not only saves them travelling, it's good for joint working and enhances patient care."
"SystmOne is also improving the business ethos for the hospice," says Darren. "We were run as a local charity, but now with PCTs striving for world class commissioning we need to be businesslike. We're branding ourselves as Specialist Palliative Care in Lincolnshire. All business cases need to be backed up with figures. We have computerised everything so that we have finance, payroll and now a clinical system that can produce the statistics we need to justify and prove ourselves from a business angle."
Val agrees, "With SystmOne, we are able to show exactly what we're doing – how many patients seen, how far the nurses are travelling etcetera. We can produce the evidence that helps us to get funding."
The first phase of the deployment saw the in-patient unit go live in November 2006, and in spring 2008, the community teams at the daycare centres also went live. The level of IT literacy across the hospice at the start was basic. "Hospice staff have a lot of life experience, but are frequently less computer literate than in other areas of the NHS. Some of the nurses had only the computer skills they'd picked up at home," says Darren. Despite this the response to SystmOne has been very good. "We knew it was a good system but have been surprised at how well staff have embraced it. We expected some negativity around business change, but didn't get it. The staff are now getting good at creating records and entering information. And GPs in the area are seeing that it's a benefit to share records with us – they can see a palliative history as each service is recorded."
Val adds, "We have started a user group within the hospice to share information and expertise. We want the users themselves to take some ownership of SystmOne rather than relying on us. Some of our staff were a bit naïve around computers to begin with, but they're getting a lot quicker, and we'd now like to develop some of them into super-users. It's their system now."
Looking towards the future, Darren has big ideas. "We physically can't fit any more PCs in the day hospices, but we would like to get all the Health Care Support Workers on SystmOne. That'd be another 50 users who would need laptops. We would also like to give the nurses the hardware to use out in the field, helping them provide better patient care."
