Cerner’s baby gets a Royal welcome (E-Health Insider)

17 February 2011

Cerner’s baby gets a Royal welcome

Winchester has become the first site in the UK to use Cerner PowerChart Maternity. Lyn Whitfield sees the trust’s latest extension of Millennium in action.

In the delivery ward at the Royal Hampshire County Hospital, a large flat-screen monitor shows the midwives which patients are occupying the different beds and what is happening to them.

“We used to have a whiteboard,” says Lorraine Edwards, a midwife seconded to a project to extend the use of Cerner’s Millennium system to maternity at the Winchester hospital. “It took up the whole of this wall.”

Midwives would jot notes in marker pen on the board to try and keep everybody up to speed with what was happening, while keeping different sets of clinical paper notes. Nobody seems to regret the move to the new IT system; except, perhaps, for one little thing.

“I don’t know if it’s just a Winchester thing, but we used to put a smiley face on the board when somebody had given birth,” says Morwenna Biss, another midwife involved in the project.

Somehow, the green tick that Cerner PowerChart Maternity uses to record this ‘event’ doesn’t quite do the job in the same way. The midwives would like a new icon.

Cerner deployments then and now

Winchester and Eastleigh Healthcare NHS Trust is one of the oldest and most extensive users of Cerner Millennium in the UK. It deployed a foundation release back in February 2007, when Fujitsu was still the local service provider for the South of England.

The deployment suffered various delays, although he trust insisted at the time that these helped to make it “more fit for purpose and more robust.”

Now, Greig Benson, the programme manager for a major upgrade to the ‘London’ version of Millennium that took place in December, says the trust has benefited from a new approach instituted by BT when it took over the ‘live’ sites following Fujitsu’s exit from the National Programme for IT in the NHS.

“Everybody talks about an upgrade, but it was a lot more than that,” he says. “The old Fujitsu model was very much ‘one size fits all.’ Whereas the move to the LC1 solution was an opportunity to look again at our workflows and to see what Cerner could offer to support them.

“We took SurgiNet [Cerner’s theatre system], which meant that our theatres went from paper-based working to IT for the first time. We also looked at care notes tracking, using barcodes, which is very popular with staff, as it allows them to look in Cerner and see where notes have been tracked to.”

Go maternity

Plus it became the first trust in the UK to deploy Cerner PowerChart Maternity. Helen Owen, IT lead for maternity, explains that Winchester and Eastleigh had already been looking at maternity because it needed to make a decision on whether to upgrade or replace its existing maternity system.

The trust seconded an obstetrician and two midwives [one whole time equivalent] to look at “all aspects of maternity.”

Once a decision was made to go with Cerner, they also travelled up to the company’s offices in London to test the system and help to anglicise it; changing the way it displays some observations, such as blood pressure, developing new ‘event’ icons, and building in some UK procedures.

“What is really good is that this system is both a patient administration system and a clinical system, so it is single entry,” Owen says. Previously, maternity staff had to complete three or four sets of paper notes, depending on the procedures that they needed to schedule.

In addition – and despite the old whiteboard - “it could take time to bring everybody up to speed.” Whereas the Tracking Board – which powers the monitor in the delivery ward – is updated from the system every 30 seconds.

Biss says the introduction of modern IT has enabled the midwives to spend more time with patients. “We have PCs in every ward room, so we can update the notes without coming out of the room to do it,” she says.

Biss also feels it has improved safety. As an example, she says that when the midwives worked on paper, they had to fill in their own Modified Early Obstetric Warning Score charts and then calculate the MEOWS score, which indicates a mother’s risk of sepsis. Now, the Cerner system works the score out for them.

More to come

Some trusts might have been reluctant to include maternity within a big IT upgrade, given that maternity is often seen as resistant to change of any kind, much less change driven by technology.

Rebecca Lester, Winchester and Eastleigh’s deputy director of IT, says the involvement of the clinical staff, regular communications, and active support for staff whose IT skills were not particularly good at the start of the project were critical to its success.

The next step is to get community midwives using the system. Most have seen it on visits to the hospital, but Benson says there are some technical obstacles to overcome before they can use it day to day.

“Infrastructure is the real issue,” he says. “3G coverage is not the best in leafy Winchester, so we are looking at what products Cerner can help us with.”

Winchester and Eastleigh NHS Trust is facing some uncertainty. It may have to merge with Basingstoke and North Hampshire NHS Foundation Trust to meet the latest deadline for all trusts to become foundations set by health secretary Andrew Lansley.

While it’s not likely to be the first thing on the minds of the two boards, the trusts use different IT systems. Basingstoke was meant to be a Cerner Millennium site, but recently announced it was looking to an IBM portal to improve staff access to data, order communications and correspondence.

On the IT front, it’s also unclear what will happen to the Southern Programme for IT or to the BT contract when it runs out in 2015. For the moment, though, the IT department is looking to see what else it can get out of Millennium.

Benson reiterates: “Under the implementation model with BT we have a lot more freedom in terms of what we can deploy and develop than we had under Fujitsu.

“It’s also a completely different way of working. For the whole of the upgrade project, we worked very closely with Cerner, with BT in the background to call on if they were needed. It really helped in understanding what the product could do for Winchester.”