Luton & Dunstable Hospital NHS Trust

The Luton and Dunstable Hospital NHS Trust is harnessing new technologies to improve care for its patients. In response to the Government’s Information for Health strategy, which pledges a £1 billion investment in IT, and as part of its own information improvement strategy, the Trust has become a leader in the implementation of ground breaking technology.

Luton and Dunstable is committed to excellence in patient care, through improvements in information access, enhanced efficiency and the provision of a better working environment for its staff and patients. The Trust is on track to meet Government targets for EPR implementation and its progress is already being recognised nationally. In September 2001’s ‘NHS performance indicators’, Luton and Dunstable was awarded three stars, the highest possible level of performance.

The strategy
In 2001, Luton and Dunstable Hospital NHS Trust treated over 51,000 inpatients and 200,000 outpatients, 77,000 of whom were first time or new referrals.

The Trust is focusing on modernising the way it delivers patient services to improve the care experience for patients, clinical professionals and staff. As a result, Luton and Dunstable has launched the ‘Changing the Way We Work’ (Change.www) programme. The objectives of the Change.www programme include improving the health of patients, particularly by improving the outcomes of treatment and care, improving access and choice for patients, and improving the utilisation of services.

A key element in the delivery of the Change.www care improvements is the development of an Electronic Patient Record (EPR). The EPR system will, over the lifetime of the project, introduce a fully integrated approach to healthcare, including shared records, order communications (allowing orders to be made and results returned electronically), electronic referrals and on-line appointment booking. In this way, the mass of clinical and patient information generated daily can be captured and made accessible to all those who need it, improving communications and enhancing efficiency. Following a rigorous procurement, Luton and Dunstable Hospital chose information systems supplier iSOFT as its strategic partner to develop an EPR that would deliver many of the Change.www objectives. The contract awarded was a ten-year Private Finance Initiative (PFI) deal which enabled the Trust to focus on service and pass on responsibility for many of the hardware and infrastructure aspects of the project to its partner.

“Our modernisation strategy is focused on improving patient services. Our contract with iSOFT is enabling us to provide innovative integrated information systems that help us to make the service we offer more responsive and modern, while meeting NHS targets to reduce waiting lists. The electronic patient record is a catalyst for providing a complete, patient-centered approach to care. This ambitious modernisation project provides the foundation for links to other record systems such as X-Ray, Pathology, Accident & Emergency and Maternity, so ensuring that information needed for patient care is more quickly and readily available to our medical and administrative staff.”

Stephen Ramsden, Chief Executive of the Luton and Dunstable Hospital NHS Trust

The Electronic Patient Record solution
Change.www focuses on individual topics, addressing change in discrete and manageable sections. The first stage of the EPR implementation was to replace the Trust’s existing Patient Administration System with i.Patient Manager. iSOFT and the Trust worked in partnership to roll out the i.Patient Manager solution to some 2,000 staff throughout the Trust, integrating Radiology, Pathology and A&E.

i.Patient Manager has now centralised information from 600,000 patient records and is available to support work practices throughout in-patients and out-patients. One of the few end-to-end Microsoft® based systems, it can integrate with existing systems so that data can be shared throughout the Trust, rather than being ‘locked’ within one department.

Steps to success
For those just starting out on their EPR project, Luton & Dunstable’s success can be summarised in some key steps.

Key steps:

Agree project plans that concentrate on achieving the Trust’s goals.
Build a highly committed team that is fully dedicated to delivering the project successfully.
Concentrate on training staff and fully communicating the aims and benefits of the project. The users of the system have been trained by a dedicated in-house and supplier-provided team who were fully committed to the achievement of the project plan. The Trust was fully prepared for go-live by an extensive programme of training that covered 750 users in 6 weeks.
Develop an excellent working relationship between the Trust and its supplier. iSOFT and the Trust worked together as one unified team with a common goal, rather than two separate groups. As part of the process of building up a partnership with the Trust, iSOFT donated computers for Luton’s ‘Cyber cafe’. The cafe’ was designed to give staff and patients access to a demonstration version of i.Patient Manager to learn more about the system.
Ensure that the project takes into account all aspects of the roll out, including changes in working practices and briefing out of the changes. It is important to address the ways in which staff tasks will differ as a consequence of the system going live.
Ensure regular reviews are held and that progress is tracked against the plan. Joint action focused meetings should be held by a single joint team which includes the hospital, IT staff and the supplier.
Ensure that the project is high on the corporate agenda and monitored closely in the run up to go-live.

A change for good
The EPR system is delivering real benefits to users, such as access to the patient record wherever it is required throughout the Trust and bed management functionality so that information is centred around the patient, wherever they are.

The system delivers clinical and management information such as waiting lists directly in line with existing NHS waiting list guidelines. Readily available information can be easily analysed to help manage resource allocation and clinical governance. Improved information access for staff also has a direct benefit for the end users: the patients. In his October 2001 Prime Minister's speech on Public Service reform, Tony Blair said, “We have pledged that within four years patients will be able to choose the time and date of their hospital operation, as we move to the booking of 100% of outpatient appointments and planned hospital admissions”. EPR is one of the tools to improve access as part of Luton and Dunstable’s Change.www programme. i.Patient Manager enables the Prime Minister’s pledge to be fulfilled, earlier than the four year timescale identified.

The system offers greater choice for booking appointments while clearly written, smarter appointment letters for patients include full location and parking details. Patients will ultimately be able to book appointments on-line and receive clear, legible computer-generated information in preparation for their visit – in line with NHS targets for booked admissions.

Next steps
The EPR implementation has further continued, with a link to the new maternity system and the go-live of Patient Document Tracking functionality in Christmas 2001. This brings further powerful benefits of unified, consistent information onto the maternity unit. Patient document tracking will enable better management of patient documents across the hospital, thereby improving for example the availability of information to clinical staff when seeing patients, with no delays due to missing or incomplete records. During the project, the Trust has placed a constant emphasis on benefits realisation and review, through a structured partnership with its technology supplier. This supports the underlying principles of achieving better integration of services within the hospital and creating stronger local care partnerships. The single system, integrated approach to healthcare across primary and secondary care will ultimately be facilitated by the use of new technologies such as mobile devices, which will extend the benefits of information access into the community.

At the Trust’s post implementation review, the Department of Health commented, “The way in which the Trust has managed and resolved difficulties is very encouraging for other Trusts who can learn a lot from Luton’s experience. Congratulations to you all for carrying such a complex scheme through to a successful finish.”

Technology overview
The Luton & Dunstable i.Patient Manager implementation is an end-to-end Microsoft solution. It is based on Microsoft Windows 2000 Server and Microsoft SQL Server Enterprise Edition on clustered Compaq Proliant servers in active-passive configuration. This architecture was chosen to deliver up to 99.99% availability and to ensure vital patient systems are on line at all times. Windows 2000 active directory security ensures patient record confidentiality right down to the ward terminal. The further announcement of the Microsoft NHS Enterprise Agreement also provide the latest versions of software licenses for core Microsoft products across all desktops in England's NHS organisations. This will enable Luton & Dunstable to be more efficient and cost-effective in its purchasing decisions and have access to the most up to date technology.

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