Posted on April 13, 2022

With support from the West of England AHSN, Bath and North East Somerset, Swindon and Wiltshire (BSW) CCG built on a recent trial using an early ‘mobile’ version of TPP’s SystmOne electronic health record, by introducing a new care home module across a small number of care homes.

Early feedback is indicating demonstrable benefits in improved communication between care homes and primary care, as well as efficiencies around access to patient clinical records.

In October 2020 BSW CCG successfully bid for NHS England funding, aimed at projects supporting accelerated use of digital technologies during the Covid-19 pandemic to enable the ‘virtual’ care of patients across primary, community and acute care settings. This allowed the project to extend its scope, with the aim of spreading the use of SystmOne into 20 care homes during 2021.

“Our team at BSW CCG have thoroughly enjoyed working with our colleagues at the West of England AHSN, who played a crucial role in securing regional funding from NHS England to scale up our work programme. They also helped us to shape our approach to the planning and delivery of the project, which has made a real difference in releasing clinical time to care for patients within the care homes who have adopted the new system.”

Jason Young, Assistant Director of Digital Transformation at BSW CCG

The challenge

Prior to using SystmOne in care homes, the registration of a new care home resident could take on average three to four hours, as information to complete paperwork needs to be pulled from multiple sources. It can be difficult to obtain a full medical history for individuals new to a care home, particularly when coming from another care setting or if they have few family members.

Care home staff also spent significant time contacting local GPs to discuss resident health problems, reorder prescriptions, arrange consultations – or just seek advice. The Covid-19 pandemic increased pressure on these services and demonstrated the relevance for potential online consultations.

The approach

The West of England AHSN provided programme management support to the BSW CCG team, as well as local experience of delivering digital transformation projects.

The AHSN also part-funded an external technical specialist to assist implementation and was also instrumental in securing additional funding from NHS England as part of the Covid-19 response.

The project team approached 67 care homes to establish their interest in having access to SystmOne.

Where there was a positive response from a care home, the team also engaged with the local GP practice and provided a product demonstration to both.

This formed stage one of the four-phase approach:

  1. Engagement and demonstration of SystmOne.
  2. Information governance training, covering the Data Protection Security Toolkit (DSPT)
  3. Technical implementation and system training for SystmOne
  4. Transformation – design of processes and procedures between the care home and local GP practice.

Later, an additional stage was included to make contact with the care home two to four weeks after implementation to check progress and offer additional support where needed. This provided a useful opportunity for an informal conversation to start to understand the initial impacts being experienced, and whether these matched the original hypothesised benefits.

As of 30 November 2021, 18 of the projected 20 homes had fully implemented SystmOne, with a total capacity of 738 beds. Further care homes are now interested in the technology.

“SystmOne has saved us time and having access to information allows us to feel less of a hinderance to the GP, where we would otherwise have to call the surgery.”

“Getting to know a resident and their medical history much faster, this includes all open referrals to other services. Easier to plan the future care for residents, used to wait one to two weeks for GP summary, but now have immediate access.”

Feedback from care home staff

The impact

Data on the usage of SystmOne for the eight months to 31 October 2021, when 17 care homes were using the technology, reveals varying use of the system. Two homes had been using it significantly and consistently for several months, while another six are considered regular users.

Further analysis suggests usage levels may reflect uptake by specific members of staff in particular homes, with a number of users ‘dropping off’ the data, possibly reflecting the transient nature of the workforce in the care home sector.

Overall, 50 different staff members across 14 of the 17 care homes were using SystmOne in this eight-month period, viewing 4,085 patient records in the period.

It is estimated that up to 2,820 hours of time was saved during registration of new patients into care homes. This is based on it previously taking an average of three to four hours to register a new resident, pulling the information needed to complete paperwork from multiple sources. Whilst these numbers are not validated, a former care home manager confirmed, “the documentation when registering someone new in a care home is immense.”

Further feedback captured:

  • All the participating care homes say they believe they are delivering better care by using SystmOne.
  • The access to GP notes and medicines history via SystmOne are seen as particularly helpful.
  • The care homes report clinical time saving due to improved communication channels with GPs (less telephone queueing for example).
  • They get quicker responses from GPs – less ‘telephone tag’.
  • Significant time saving is being reported in registering new residents, due to accessing patient records more quickly, giving the ability to plan for care immediately, rather than having to wait for paper records to arrive.
  • Some reports of quicker access to test results (bloods, pathology/radiology, etc), with a couple of examples of this leading to earlier prescribing and receipt of medication for a resident – reducing pain.
  • Care homes using SystmOne report quicker and more confident clinical decision making – leading to better care.
  • Three care homes say they have avoided ambulance call outs or ED visits as a result of using SystmOne.
  • Three care homes are using the GP tasking facility.
  • Four care homes are keen to record information into patient records (such as test results) – involving a potential upgrade of service.
  • Care homes are keen to use the medicines ordering facility once a planned enhancement is released later this year by TPP.

Whilst from a relatively small selection of care homes, the feedback gained to date supports the original aims to improve to patient care and create internal efficiencies through implementation of the TPP Systm One solution.

“Overall SystmOne has helped our residents.’’

“We are finding it really useful, especially if we have queries about GP consultations, allergies, lists of meds and medical history and resus status for new people.”

“We avoided having to send a resident to hospital where they may have continued to suffer by being resuscitated/treated against their will.’’

Feedback from care home staff

Key learnings

Care homes were at the forefront of the challenges encountered during the Covid-19 pandemic, which meant engagement was difficult as staff had different priorities to contend with. These were exacerbated by:

  • Outbreaks of Covid-19
  • Covid vaccination programme
  • Restricted visiting for relatives.

Additionally, agile project delivery was negatively impacted by:

  • Relatively high turnover of staff
  • Low digital literacy levels
  • Limited Wi-Fi capacity
  • Care homes’ IT incompatibility with SystmOne.

It is important to understand that staff in care homes work under very different pressures to many staff in the NHS and other industries. Homes range in size and in the services they offer. Many are small, family-owned business, whilst others are chains within larger corporate organisations. But each has its own culture, systems and processes that need to be accommodated when collaborating with the care home teams to implement new ways of working – particularly when introducing a new technology.

The majority of homes contacted, regardless of their structure, didn’t have capacity to see implementation through to fully embed the use of SystmOne. Those that had the perseverance to be able to do so are now seeing efficiency benefits, but the capacity to engage and transform should be a consideration for any future care home projects.

Next steps

The project has now transitioned to ‘business as usual’ for BSW CCG, so more homes can benefit from the implementation of TPP SystmOne.

BSW CCG have also shared their approach and learnings with Gloucestershire CCG who are ‘fast following’ with some early successes.

Find out more

Find out more about the West of England AHSN’s digitial transformation work or email dave.evans5@nhs.net.

 

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