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Building digital bridges – adapting EMIS for hospice use

Author: Jack Taylor
18 May 2017

Egton Medical Information Systems (EMIS) is a system that supplies electronic records for patients in primary care. Jack Taylor, Data and Information Systems Development Lead at East Lancashire Hospice, explains how the hospice has adapted the system to its operations.

Picture the scene.  East Lancashire Hospice, April 2016.  A newly assembled team sits down to discuss how to adapt EMIS, “the most widely used primary care clinical system in the UK”, into a bespoke method for recording hospice patient information.  There is seemingly no clear starting point; no one thing above all else that needs to be addressed first.  Now imagine staring at a giant jigsaw puzzle with each individual piece seemingly of the same size, proportion and image.  Where would you start?

The idea was simple on paper…have less things on paper!  Our aim was to move towards the majority of specialist palliative care patient information being recorded and stored electronically, in keeping with local and national drivers for recording end of life assessment, planning and patient preferences. 

This move represented a massive cultural shift for the hospice.  Responses to the proposal ranged from excitement and optimism to anxiety and scepticism, with everything else in between.  It was clear however that we needed to take on this challenge, not only as part of future proofing our services and communicating with the wider healthcare system, but because it actually had the potential to improve patient experience.

EMIS presented us with a system out of the box that had essentially been built for primary care.  It had numerous exciting tools and features but came without clear indication of how they might be used within a hospice setting.  We soon came to the realisation that we would need to adapt and mould the system to fit with our very specific needs.

To say that the first few months were challenging would be an understatement.  We could spend a great deal of time and effort trying to develop an idea or learn an aspect of the system, only to ultimately find that it may not fit with what we were trying to achieve.  We persevered however and the more we probed, the more we learned.  We started to see the potential in the system and the path towards our goals became clearer. 

After much deliberation, we concluded that the simplest approach was best.  Being able to navigate the system in as few clicks as possible became our mantra.  There were times when in order to achieve this it felt like we were cheating the system.  We looked beyond the tools at our disposal and thought about how they might be used in different ways.  Rather than take things at face value we began to manipulate the system to allow for circumnavigation of the more complex features of the user interface.  EMIS started to work for us instead of the other way around.

As time passed, confidence grew.  We took great pride in our growing creativity and being able to respond with a resounding ‘yes’ when asked whether something could be done.  We began to relish the opportunity of working on something that initially looked to be impossible, pushing towards that breakthrough…the eureka moment where the answer suddenly became clear. 

Instead of numerous time out planning and training meetings, the hospice project leads provided a limited number of system overview sessions, followed by on-site discussions with team members for clarity on existing processes.  The hospice leads would then work to replicate these within the system to ease the changes into practice.  People began to see how things would work.  Ideas and inspiration started to come from all directions.  Enthusiasm gathered momentum. 

Three weeks before ‘go-live’ our manual migration commenced.  We started to facilitate practical workshops in small groups and issued our own user guides.  Case summary templates were created on the system to allow staff to ‘practice’ prior to full launch.  Hospice leads were then on hand to provide support as we declared the teams ready to go!

East Lancashire Hospice went live with EMIS on November 30 last year.  Our launch day was quiet, free from crisis, panic and emergencies.  In the weeks following the launch there were numerous kinks to iron out and a range of queries to address.  Just like with any new project the team quickly developed a snag-list of things to address.  With that being said, everyone seemed to embrace the system more quickly than had been anticipated.  Even the most vocal sceptics were willing to give it a go.  We all supported each other and last remnants of trepidation started to fade away.

A few months have passed now and EMIS has been fully integrated into our clinical and administrative culture, allowing for significant streamlining of our processes and increased visibility of patient information.  We are never more than a few clicks away from finding a record that is rich with individual experience relating to the patient’s journey, but that is well laid-out, searchable and built on complex mechanisms that allow us to capture consistent levels of data.

There can be a perception of a divide between the administrative and clinical functions within healthcare settings.  If anyone were looking to dispel that myth we can think of no better example than of how our hospice team worked together to achieve a successful implementation of this system.  We are immensely proud of what we have been able to achieve, with clinical experience, specialist knowledge and technical expertise coming together to create something truly special and tailor-made for our services.

The journey so far has already given us clear indication and appreciation of the benefit of electronic records.  The challenge now is not to rest on our laurels but to build on what we have achieved together, pursuing better outcomes wherever we can find them and allowing the system to reach its maximum potential for our patients. 

For more information visit East Lancashire Hospice

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