University College London Hospitals
Hyland helps one of the largest NHS Foundation Trusts implement an integrated content management platform with its EPR.
University College London Hospitals (UCLH), an NHS Foundation Trust based in London, is one of the largest academic health centres in the United Kingdom. UCLH comprises 10 distinct hospitals and works in close collaboration with its academic partner, University College London, part of the University of London.
The challenge
UCLH had made good progress in planning the implementation of an electronic patient record (EPR) system and was considering incorporating imaging technology into the project. Initially, there was reticence about expanding the project scope. Key users couldn’t understand why, if the hospital was acquiring a state-of-the-art EPR, it was also necessary to expend resources on the acquisition of an enterprise content services platform.
However, it became clear that the ability to capture document images was a necessary addition to the overall EPR system. Although very powerful, the EPR wouldn’t provide a solution for several important aspects of healthcare information management. For example, UCLH identified three broad categories of information not readily managed by the EPR:
- Legacy unstructured data
- Pre-hospital information (such as referral letters and notes from other providers collated before the patient's admission to UCLH)
- Various document types and images generated in the hospital (e.g., 12-lead ECGs, consent forms, property forms, drawings and photographs — both professional medical photography and photos taken by the patient)
10
Hospitals
12,000
Staff members
1 million+
Patients served per year
The solution
A document management application was already in use in various departments at UCLH, as was a PACS system that was managed by medical physicists. The team realized that the best solution would be to bring the projects together to create an enterprise-wide solution and complete source of patient information within the EPR.
Upon review of Hyland’s offerings, as well as enterprise content service solutions from other vendors, UCLH decided that Hyland’s OnBase provided the functionality and proven integration with its Epic EPR that was necessary for the project.
The EPR team believed that the joint implementation of the enterprise content services platform and EPR provided the perfect opportunity to change and optimize workflows. The project was ambitious. The team tried to pack as much into that moment in the hospital’s development as possible.
A massive effort went into clinician engagement for the overall EPR program, with over 500 people heavily involved, plus the training of an “army of superusers.” This also meant deciding which specific information would be handled by the EPR system or OnBase. The key questions formulated to guide these decisions included:
- Where does the data come from?
- Is structured data important?
- Should the data drive workflows?
- Is it research data?
- Is complex form design needed?
- How do users interact with the data?
“However, no matter how hard you try, you will never think of everything before go-live,” said Dr. Stephen Cone, chief clinical Information officer and consultant anesthetist at UCLH. “In addition to the other benefits that OnBase brings, it also allows us to quickly add document-based workflows to the system as they arise.”
One of the most important technical capabilities of the Hyland solution when implemented alongside the EPR is that the documents managed within OnBase can be accessed and viewed, in context of the patient record, from within the core clinical system.
The integration is so effective that the EPR team believes the vast majority of hospital staff don’t realize they are using OnBase. Instead, they think scanned images of documents are simply part of the EPR. The user experience had to be seamless, and simplicity was key.
This was especially important in the hospital’s outpatient departments.
“We have always relied on good clinic letters in outpatient departments to communicate back to the primary care doctors and to facilitate communication among doctors in the clinic,” Dr. Cone said. “We have always relied on good clinic letters in outpatient departments to communicate back to the primary care doctors and to facilitate communication among doctors in the clinic,” Dr. Cone said. “We really emphasize this to junior staff, and so we teach them how to create effective letters. We brought most of the letters over into the new system, so we did not need to back-scan paper records. The clinic letters contain what we need, and we have now ceased to pull paper records for clinics. As a result, we clinicians no longer have to wait for information or to make decisions without the benefit of the full clinical history.”
If your mission is a full medical record, with everything viewable in one place, you need to integrate enterprise PACS and content services into your EPR solution.
— Dr. Stephen Cone, Chief Clinical Information Officer, UCLH
The difference
An integrated EPR: Patients and staff have felt the system’s benefits. Patients have noticed that doctors never seem to be missing important information during their clinic visits.
“Gastroenterology loves the integrated EPR. So does dermatology,” Dr. Cone said. “We use images as a key part of our wound management service, and OnBase allows us to quickly capture these images and make them accessible to clinicians via the EPR. Patients are also able to submit, using their phone camera at home, images of the state of a wound so we can monitor progress and healing without the patient needing to travel to the hospital.”
Business continuity: Another key benefit OnBase offers is its role in business continuity planning. Every department has paper-based systems in place that can quickly enable normal activities to continue in the event of an EPR system failure. Recovering from such incidents can be time-consuming if large-scale data entry is required. OnBase makes that unnecessary.
Strengthened partnership: UCLH deepened its partnership with Hyland by adopting Hyland’s enterprise imaging SaaS solution. The solution consolidates multiple image repositories and provides a holistic view of all medical imaging content and information. UCLH is now relieved of the burden of application software and hardware management, and expects the solution to increase image collaboration and reduce costs.