Time To Plug Every Paper-Created Care Pathway Gap








SynApps’s Mark Winstone looks at how NHS CCIOs and CIOs can make a smart move to new ways of paperless working in a crucial part of hospital workflow – Care Pathways

“We are a long way to getting to our paperless targets – but we are still working to remove paper out of our medical records work.”

The quote is from David Walliker, CIO at the Liverpool Women’s NHS Foundation Trust – and I am sure his is a reality many NHS teams can relate to.

In fact, even as we are moving to a paperless NHS by 2020, many hospitals are still shuffling a lot of paper around. This is happening even though a fair number have adopted leading-edge EPR (electronic patient record) suites that are making a lot of their processes fully digital.

Why is that a problem? There is one serious problem with paper still filling up the hospital –and another that’s absolutely critical. Actually, they are inter-related, as we’ll see.

The first one is simple efficiency. When you start a Care Pathway, such as when a patient comes into A&E, if your staff are having to transcribe details onto paper or on and off terminals, that’s simply time wasted – and time they should be using to help the patient directly.

Don’t let Never Events happen because of the paper chase

The second critical issue is that a complicated, disjointed system that’s paper here and digital there means there are gaps – gaps into which patients can fall. And, tragically, they do, resulting in what NHS England classes as the unforgivable Never Events – “serious incidents that are wholly preventable as guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and should have been implemented by all healthcare providers”.

We know of at least one Never Event caused by such a disjointed process: a Trust that has paper at a crucial part of its emergency admissions – and some paper got lost, and a patient ended up with double the dose they should have received.

Minimising the chance of Never Events is one of the principal drivers of the whole move to paperless. But not everyone has an EPR: not all Trusts have turned on all the modules; not all systems have been joined up.

That means there are gaps, often at crucial steps in a Care Pathway, that don’t have any support for a better, more digital way of inputting data and keeping it safely in a central repository. That’s now possible, however, via some great new technology that’s being brought on to the marketplace by our key Enterprise Content Management (ECM) partner Alfresco in the shape of something called Activiti, a functionally rich Business Process Management (BPM) solution.

What Trusts can do is automate some parts of their care Pathways with Activiti, which is a simple but powerful way to build easy to use e-forms that can plug these gaps – and help stop these Never Events ever happening.

‘Significant efficiency gains’

One Trust that’s already finding out just how useful paperless support for Care Pathways is, is Liverpool Women’s NHS Foundation Trust. Let’s find out a bit more about just how.

One of only two hospitals in the UK dedicated to the care and treatment of women and their families, Liverpool Women’s is also the largest women’s hospital of its kind in Europe. And as part of its commitment to a paperless NHS, the Trust recently made the move to an EPR it thinks will completely transform the delivery of its patient-facing services, enabling better, more informed patient care at the point of care while streamlining working practices between clinical teams. The project will generate significant efficiency gains alongside major operational cost savings for the organisation.

A great way to make sure you don’t miss your RTT target

But interestingly, says CIO David Walliker, management soon realised as the EPR project progressed that the non-clinical workforce could similarly benefit from an enterprise content management solution. “It was time to initiate a more efficient paper-less ‘next generation’ working approach that was better aligned with how business users need to operate today,” he says. “Implementing Alfresco will improve staff access to documents and, in due course, support remote access to our resources by mobile workers and remote workforce personnel.

In specific terms, that’s going to include advances like automated electronic document management processing, task management and powerful workflows that he thinks will maximise workforce performance and internal collaboration capabilities, he predicts.

So what’s his view on Activiti? Very positive. “It’s been very quick to develop and get up and running,” he has recently stated. “We’re replacing our paper forms with e-forms this way, starting with emergency staff.” Team members are very enthused by how easy this way of working is, he says, especially how connection with that back-end EPR means many fields in a Care Pathway can be automatically populated by the system itself.

Efficiency is also helping patients, as better record taking and information inputting has started to cut down the need for pregnant mums to come in, he adds.

So there seems to be real basis for optimism here: Activiti does seem to be a way to build more digital NHS workflows. And it’s worth bearing in mind that when you start a Care Pathway of any kind, the clock starts ticking for your RTT (Referral to Treatment) waiting times – another reason to ensure a streamlined, safe way of Care Pathway building.

We really think there’s value in this approach, and I encourage any NHS IT team to explore how it might help.


Mark is joint Chief Executive and head of all Sales activities at SynApps Solutions

You can see a short video about how Liverpool Women’s NHS Foundation Trust is benefiting from Activiti on YouTube here, while a fuller case study can be found online at our partner Alfresco’s site here.

Plus, if you’re interested in finding out more about e-forms and an automated approach to get to paperless Care Pathways, you may want to go to one of these upcoming roadshows. In them, you can hear more about the Activiti technology and about Trust experiences.

The events are supported by NHS England, and are being run in London on June 22 and Liverpool on June 23: please go here for full details, including how to secure your free place if you are a qualified NHS professional.

Hope to see you there!