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 Clinical information system

West Middlesex University
Hospital

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The hospital opened in 1894
as the Brentford Workhouse Infirmary. In about 1920 the hospital became the
West Middlesex Hospital. When the original buildings were no longer suitable
for the needs of the hospital, the hospital was redeveloped. Approximately half
of the original site was sold, allowing refurbishment of two remaining
buildings at the east of the site. The new building, constructed between 2001
and 2003, was funded by a Private Finance Initiative.

 

            West Middlesex University Hospital (WMUH) is an acute NHS
hospital in Isleworth, west London, operated by Chelsea and Westminster
Hospital NHS Foundation Trust. It is a teaching hospital of Imperial College
School of Medicine and a designated academic health science partner with Imperial
College Academic Health Sciences Partnership. This hospital serves patients in
the London Boroughs of Hounslow, Richmond upon Thames and Ealing. The hospital
has over 400 beds and provides a full range of clinical services including
Accident and Emergency, Acute Medicine, Care of the Elderly, Surgery and
Maternity.

 

In December 2011, West
Middlesex University Hospital was awarded full accreditation by UNICEF as a
Baby Friendly hospital, the first London hospital to achieve this award. The
Baby Friendly Initiative accredits maternity and community facilities which
adopt internationally recognised standards of best practice. This can discuss
your choices for where and how to give birth which could include at home, in
the birth centre or in the main delivery suite. At around ten to twelve weeks
the team midwife will meet the patient to plan antenatal care including
screening and ultrasound options. They also have a highly experienced and
compassionate team that are on hand to provide the support, care and advice
that patient need throughout pregnancy. They also recommend the Baby Buddy App
which is free and full of useful information about pregnancy, birth and
patient’s new baby. For screening options, patient will be ready for your
ultrasound scan between 12 and 14 weeks, and at this time patient will also be
offered a combined screening test for Downs Syndrome. In week 14, patient may
be offered the Quadruple test which can also screen for spina bifida. In week
20 to 22, patient will then be offered an additional scan to look for any fetal
anomalies.

 

There is many section that
involve in this department which is obstetric medicine clinic (OMC), Endocrine
clinic, the preterm clinic (PTC) and Prepregnancy Clinic. The OMC is a special
clinic run by the highly experienced high risk team (known as the ‘H team’) for
women who have conditions such as epilepsy, high blood pressure, blood clotting
or bleeding tendencies, mental health problems and autoimmune issues. The
endocrine clinic is for women with pre-existing diabetes or gestational
diabetes. The clinic facilitates a ‘joined-up’ approach to helping pregnant
women have a healthy pregnancy. The Preterm Clinic PTC started in 2010 and
runs every Thursday at West Middlesex University Hospital within the Obstetric
Medicine Clinic. It aims to offer specialised and friendly advice to women who
have previously experienced a preterm birth or late pregnancy loss, or who are
at increased risk of preterm birth. It is run by the H team of doctors and
midwives led by consultant obstetricians Miss Joanna Girling and Miss Louise
Page. For pre-pregnancy clinic, they done it twice a month for women who are
considering pregnancy and fall into one or more of the following categories
which having existing health problems which may impact on the pregnancy  or present a risk to the future health of the
mother, having a child or family member with a health problem which may affect
a future baby, including their likelihood of developing the same condition and
the options around this, and had a previous difficult pregnancy or experienced
a health condition that could recur, so a discussion is needed to plan the type
of care that might be required

 

In September 2012 the Trust
concluded that it was not viable for it to apply for NHS Foundation Trust
status and decided to seek a potential partner. As of 1 September 2015, West
Middlesex University Hospital is part of Chelsea and Westminster Hospital NHS
Foundation Trust. Under the North West London strategy, shaping a healthier
future, the Trust was designated as a major hospital in 2013.

 

 

 

 

 

 

 

The Hospital Information
System

Operating system that are
used in this hospital are Window 7, the server is Window 2008. there are 1400
desktop that are used in this organisation. The brands they are using are HP
64. This hospital has 155 virtual servers and using VMWare as the server virtualisation
software. As for the service desk support, desktop support and network support,
this hospital had made a contract with Systems Powering Healthcare Ltd. The
annual average spends over 3 or 5 years. The contract has been started only in
2015 so that the requested information can only be available in future.
Duration of the contract with extension periods 5 years and the contract
expired date 2020 and the review date at 2020. The language that are used in
this hospital systems are HL7 and DICOM

 

Order Communication system

Sunquest Information Systems

Sunquest’s laboratory
information system automates and drives the entire workflow of the clinical lab
for organizations across the world. It streamlines lab processes to decrease
specimen handling time, increase productivity and improve turnaround time.  With more than 2,000 application interfaces
and 11,000 instrument interfaces, it is designed to work seamlessly with any
system to create a powerful integrated solution that supports laboratory
medicine and promotes quality patient care.

 

Sunquest ICE offers a
scalable solution from a single department to system-wide use. The system can
be used in departments without existing clinical information systems, across
entire health networks integrated to other clinical information systems or as a
standalone system. Highly configurable features provide safe, efficient and
easy-to-use for general practitioners and clinicians requesting laboratory
tests, radiology exams, therapies or any other service.

OpenNet – view and share
patient information quickly and easily with other Trusts or ICE systems. By
searching and validating on demographics for a patient, OpenNet retrieves
results for display, allowing easy transition between patient reports. Service
Provider List – available for electronic ordering for any and all departments
within the hospital.

Clinical Forms Toolkit – easy
creation of electronic clinical forms to enhance your requesting workflows.
Ensure completion of clinical assessments to meet CQUIN targets.

Discharge (clinical
correspondence) – allow clinicians to compile a discharge letter for a patient
during their inpatient stay and send the letter to the GP’s Practice System.
Meet UK guidelines for an immediate discharge summary to the doctor within 24 hours.

 

Electronic Medical Record or
Electronic Patient Record (EPR)

In administration, Electronic
patient record (EPR) that are used in this hospital are Carnis ver-23 Lastword
for inpatient and outpatient. This software is also being used in emergency
department for unscheduled patient and communication software in the hospital.
The flow of the administration in this hospital then all patient record has
been kept in this system. For example the patient data (demographics, medical
history), treatment information (medications, procedures), diagnostic
information (diagnostic orders and tracking, results, reports), operational
information (appointments, waiting lists, patient flow), clinical care
information (clinical noting, nursing observations, specialist care), clinical
analytics (graphical presentation of data), information shared between
providers (GP and other hospital data, referrals, discharge summaries, contacts
with social services), operational analytics (trending and predictive modelling
of demand and capacity). An EPR is much more than just an electronic version of
the patient ‘s record. It combines a complete, integrated source of patient
information with support for the clinical and operational processes for
managing patient care, generating a complete record of each patient encounter
and automating and streamlining clinical and operational workflows.

 

 

 

 

 

 

For patients the EPR and
supporting IT infrastructure will provide secure access to their medical
records in an electronic form which, over time, will become more standardised
in terms of the recording and presentation of key clinical information, access
to scheduling systems, offering greater choice in terms appointments and the
ability for patients to take control of their own bookings, enable patients to
update their medical record and interact with clinicians in wholly new ways
outside of the standard ‘outpatient clinic’ setting, reduce duplication (e.g.
repeating information provided elsewhere in the system, or the re-requesting of
tests already completed) and give confidence that the clinical pathway is
evidence based, standardised and monitored, make use of fast developing
enabling technologies (e.g. wearable medical devices), and provide proactive
healthcare through modelling, best practice and the use of ‘Big Data’ (i.e.
population health) with the aim of early detection of potential health problems
(and likely improved outcomes) For the staff the EPR and supporting IT
infrastructure will move away from paper based systems to ‘digital first’, provide
access to the full patient record on any (approved) device at any location
where care may need to be provided and enable colleagues, peers, patients to
view and interact with the record at the same time, access to all data entered
into the system (and data entered in other provider systems) for audit,
healthcare informatics and research purposes, offer evidence based,
standardised care pathways which are task driven with embedded clinical
decision support, support predictive modelling of demand and capacity planning.
For stakeholders, the EPR and supporting IT infrastructure will share the
information in digital form across care settings, use digital communication to
engage with trust staff to discuss and plan patient care, provide performance
information for scrutiny of services and provide information to enable
decisions about where patients should be treated

 

 

For patient’s referral, Outpatient
referrals was conducted by Hounslow GPs and Richmond GPs. The Referral
Facilitation Service (RFS) was for the outpatient. As for Hounslow GPs, the
referral need to be send in form. Forms should be emailed via
[email protected] or faxed to 0800 756 7754. Practice enquiries: Tel 05511
434910. It is obliged to send any paper referrals received at the hospital back
to the Referral Facilitation Service before booking an appointment. as
for Richmond GPs, the referral should be referring either via the Richmond
Clinical Assessment Service (RCAS), or directly through eReferrals. Where
services are unavailable on eReferrals, email a paper referral to [email protected] For general referral
information, eReferrals system is used for all referral where possible, most
outpatient used this system. It required two week wait rule. The services that
offered this system are Antenatal clinical assessment service, Gynaecology, TIA
(Transient Ischemic Attack), Early Pregnancy Assessment Unit (EPAU), Pre-operative
Assessment Department, Acute Assessment Unit (AAU), Subfertility clinic

 

 

 

 

 

 

 

Clinical Information System   

 

 

Radiology Information System (RIS)

This hospital using Asteral
as a telemedicine in the RIS. Asteral Ltd. provides strategic equipment
management and maintenance services to the acute healthcare sector in the
United Kingdom. The company was founded in 2001 and is based in Reading, United
Kingdom with additional offices throughout the United Kingdom. Asteral Ltd.
formerly operated as a subsidiary of Brook Henderson Group Limited. As of August
2014, Asteral Ltd. operates as a subsidiary of MESA, Sagl. The company also
offers multiLIFE, a managed service that enables NHS Trusts to improve
strategic planning and transfer related financial and technological risks.

The clinical flowchart for
this systems are that the solutions include Equipment-as-a-Service that enables
hospitals to pass responsibility for equipment planning, procurement, and
management to a vendor-independent service provider. The order from the surgeon
or any department are send to this department. Then, oneLIFE is an application
that provides access to the diagnostic imaging equipment, such as cath labs,
MRI, CT, X-ray, PET/CT, radiotherapy, nuclear medicine, mammography,
radiosurgery, and interventional imaging equipment from various manufacturers.
The machines that are used to captured the image and the result in this
department are Toshiba CX 128, Toshiba Aquiion 64 for CT and Phillips 1 Tesla
for MRI. The multiLIFE that allows replacement or upgrade of equipment at any
time throughout the contract term. In addition, it provides equipment audit service
for hospital, analyse and design, and remarketing solutions. The result then
are send to EPR by the OCS as the communication system in this hospital

 

 

 

 

Laboratory Information System
(LIS)

In this department, they are
using the Sunquest as the information system. Extend the power of Sunquest with
a range of integrated modules. The Sunquest Clinical solution promotes safety
for both patients and providers and allows your organization to focus on what
matters: quality care.

As for the clinical workflow, Automates
microbiology clinical validation, it need to meets the NHS number requirement.
It also includes the Acute Kidney Injury (AKI) algorithm. It is also includes
integrated, method-specific LOINC capability for resulting, reporting and
filing LOINC inpatient records. There are Blood bank, specimen collection
manager, transfusion manager, microbiology testing and resulting, electronic
specimen management routing and tracking in the LIS  the anatomical and clinical pathology are been
taken from the patients either in the lab or even bedside. The clinician will
scan the code of the patients, the graphic information of the patients will
appear in the devices. The clinician use at least two identifies when providing
care, treatment and services such as patients number and id to ensure there is
no mistake happen. After the identifiers done, the clinician need to choose the
specimen that are taken from the patients and the devices will print the label.
The clinician need to place the label to the specimen and the specimen than was
send to the LIS will be examine. In the laboratory, the result is identified
and analyse accurately and it will be record. The result then are send to the
EPR by the OCS system to be check by the surgeon, doctor and other clinician
for the plan treatment.

 

 

 

 

Pharmacy Information System (PIS)

In pharmacy, this hospital
used JAC as the telemedicine of the department. JAC was acquired in May 1996 by
Mediware Inc and continues to operate as a wholly owned subsidiary. The
acquisition by Mediware Inc created the world’s largest specialist vendor of
medicines management and pharmaceutical care software for hospitals. Mediware
Inc. is a publicly quoted company on NASDAQ (code MEDW). Mediware is a
specialist provider of clinical information systems focused on complex areas of
healthcare. Through our more than 25 years of experience, our focus has evolved
from departmental systems residing in pharmacies and blood banks to broader
clinical solutions that encapsulate the workflows of medication and blood
management to deliver a ‘closed loop’ of information and process support from
the clinical professionals to the patient’s bedside. Today, around half of the
NHS uses JAC as their primary pharmacy management system and more than a dozen
hospitals have chosen to implement JAC’s e-prescribing and medicines
administration system. The integrated nature of JAC’s closed-loop medicines
management solution make scenarios like this possible and brings patients and
clinicians together at the centre of care.

 

The clinical flowchart for
this telemedicine in this hospital was done by patient discusses her medication
with the healthcare team on their ward round. The pharmacist team-member
explains proposed changes to the medication, which the patient will administer
herself. The pharmacist also discusses learning points with other team members.
New medication is agreed between members of the clinical team and ordered at
the bedside though a wireless computer linked to an automated dispensary, where
robotic systems pick the new medicines and collates orders. Computer technology
updates the patient’s record and medication history. The medication that has
been issued is simultaneously recorded to update stock records and fresh
supplies are ordered. When the new medication is due, the nurse conducting the
ward-round is presented with clear, complete and verified information. The
nurse is able to record the administration outcome to the clinical electronic
patient record. While the patient is being discharged, a discharge summary
letter is produced and sent electronically to the hospital’s discharge letter
system and the patient’s GP. After the episode, all information collected
during the visit is interrogated by the hospital’s management team to identify
trends or anomalies and recommend changes to clinical practise.

 

 

 

Surgical theatres

This hospital used PICIS for
surgical theatres, PICIS Clinical Solutions is a global provider of innovative
information solutions that enable rapid and sustained delivery of clinical
documentation, financial and operational results in the emergency departments,
surgical suites and intensive care units of the hospital. PICIS Clinical
Solutions offers an advanced suite of integrated products focused on these
life-critical areas of the hospital where the patients are the most vulnerable,
the care process is the most complex and an increasing majority of hospital
costs and potential revenue are concentrated.

 

The flowchart of this system
are first documents all the information about the patient. Once the
documentation is readily available and documented appropriately when regulatory
surveyor walks into the room, using this system, it is less complex tracking
and don’t need a tissue tracking system you have it all in one place, it is
much convenience and easy if there are emergency cases involved. In the event
of a recall know that you can easily obtain a list of patients with the given
tissue or implant. It also reduces manual labour for patient history tracking.
No additional cost needed for tracking the patient’s history. This system also allows
them to empower hospital staff to make the software their own by make changes
when they need/want to without vendor involvement/cost. They can add equipment,
meds, allergies, etc. into the system if there any new information from the
patient’s condition. This system also will make sure the doctor has the right
supplies when he/she steps into the room. For intuitive and powerful preference
cards, the preference card is selected automatically when the surgeon and
procedure are added to the Surgery Schedule.

 

 

 

 

 

 

 

 

 

 

Endoscopy, Bronchoscopy and
Cytoscopy

 

For this department, the
system that are used as telemedicine are EMIS Health. EMIS Health Endoscopy is
a web-based, comprehensive procedure recording and reporting tool that allows
clinicians to accurately record all procedure details. This solution covers all
gastro-intestinal (GI) procedures, as well as bronchoscopy and cystoscopy. EMIS
Health Maternity monitors and records the full pre and post-natal pathway,
ensuring a complete picture of pregnancy is captured. EMIS Health’s
gastroenterology solution supports gastroenterology teams in the management of
patients with long term conditions such as Irritable Bowel Disease (IBD).
Clinicians have an overview of full patient details, including diagnosis and
drug outcomes, which can be analysed over time to review effectiveness of
treatment for patients. By integrating with other clinical systems, such as
endoscopy and pathology, clinicians are able to review results and care
information from within one system.

As to clinical flowchart, Its
enable quick and highly detailed capture of clinical data as part of the routine
operation of the department. The clinical reporting is based on national and
professional dataset standards, providing accurate, fast and comprehensive
information, making reports much faster to create and submit for auditing purposes.
Then it integrated appointment scheduling means that clinicians have patient appointment
information at their fingertips, having pre-selected patient lists at the start
of their day, minimising risk. In gastroenterology (IBD) module links
seamlessly with endoscopy solutions to provide easy access to all procedure
reports. The information from the antenatal booking interview is captured along
with significant events during the antenatal period, the birth (or end of
pregnancy), and up to the discharge home following birth. This solution is used
to support service commissioning, management and planning, risk management and
clinical governance; and to support reporting to trust board, clients,
commissioners, department of health and other national bodies.

Telephone ‘Flare-line’ review
functionality allows quick updating of the patient record, saving subsequent
transcription time. The system can automatically link with both the UK national
IBD registry and Biologics Audit website to upload all relevant datasets and
avoid clinician double entry. Clinicians can also run remote clinics through
the Virtual Clinic functionality, which reduces the amount of acute patient
visits. These can be scheduled and prompted when due within the system, with
patient and GP letters being automatically generated.

 

 

 

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