Great Ormond Street Hospital


The fetal cardiac service at Great Ormond Street Hospital provides a quaternary referral service for the diagnosis, counselling and management of prenatal cardiac disease. The service has a unique role as an interface between the paediatric cardiothoracic services at Great Ormond Street Hospital and obstetric and maternal health units throughout London and across the UK.

The Great Ormond Street Hospital has great clinical expertise in all forms of prenatal cardiac disease and the service dovetails seamlessly with the neonatal cardiac surgical and paediatric cardiac programmes. The hospital is the main provider of this service for the North Thames region and for a wider population base. The diagnosis of fetal heart disease is a very emotive area, so a flexible working practice has been adopted in order to see an urgent referral within 24 hours.

Clinical Issue
Quality improvement is at the heart of patient centred care at GOSH. In order to improve the delivery of care and patient experience it was felt that a dedicated fetal database and digital reporting system would add considerable value. The reporting system in place was a complex system of clinical ledger, medical notes and word/excel spreadsheets. Clinical letters were either dictated and typed immediately, in the case of an abnormality, and faxed to the referring health professional, or in cases of normality, the clinic letters were dictated and then emailed to an overseas transcription service for transcription. These letters were returned within 48hrs and then subsequently posted out to the patient and clinical teams.
Unlike, other fetal medicine specialties, fetal cardiology assessments require obtaining and storing video clips of the moving cardiac structures. Excellent existing video archiving and access solutions were already in-place. It was felt that a fetal digital reporting system, such as ViewPoint, could act as a clinical and research database as well as provide immediate clinical reports.

National Standards
Patient held-notes are the standard practice of care in Obstetrics, and the results of all antenatal scans are given to women at the end of each consultation to place in their notes. This requires the use of a digital reporting system, to generate a comprehensive report in the setting of a busy outpatient clinic. National Guidelines (BCCA 2010) – recommend a fetal digital reporting system as a minimum standard.

Aim
The aim was to improve clinical governance and the delivery of care to all fetal patients by introducing a fetal digital reporting system at Great Ormond Street Hospital.

Solution
Great Ormond Street purchased a new ViewPoint system for their Fetal Cardiac department. The solution connects to their local PAS to push patient demographics to the ViewPoint database automatically. By integrating with PAS users do not have to manually update the patient records with demographic changes or add new patients to the database. The system is connected to the ultrasound machines, so that images and data can be sent from the scanners and then filed against the ViewPoint patient record automatically. The system then dynamically generates reports for both patients and consultants using fields and text that the user has entered during the examination.

Outcome
Dr Shankar Sridharan - Locum Consultant In Fetal & Paediatric Cardiology comments:

“We are now able to efficiently produce a comprehensive fetal cardiac clinic letter from each visit. This report is produced in real-time and generated from the fields in ViewPoint. This report is then given to patients to form an immediate record in the Patient held-notes.

In addition to being compliant with National Standards for delivery of Fetal Cardiac Care (BCCA 2010) there were many key advantages to adopting this necessary clinical system that support the Trust aims and vision. These include Zero Waste (cost savings, avoiding cycle of dictation/letter generation/burden upon secretarial support), Zero Waits (improved patient experience, no delay in the communication of time-sensitive clinical outcomes, improving quality of care delivery) and Zero Harm (putting in safeguards to foster clear communication to both the patient and other medical staff across multiple sites and Trusts). The implementation of this digital reporting system has helped us develop the Fetal Cardiac service further by increasing our visibility from academic and clinical perspectives”

In addition Dr Shankar Sridharan writes about the financial implication:

“The implementation of a fetal digital reporting system, whilst not directly generating revenue in itself, builds integrity into our service and protects us against potential adverse events that may arise due to the delays inherent in our current practice. There are profound potential cost savings in this respect.

Adopting this infrastructure has enabled better planning for fetal patients by giving us the opportunity to ensure there is sufficient capacity to admit all these patients, thereby maximising income potential.
This platform will provide key infrastructure to support the safe running of the recently expanded fetal cardiac service, and allow us to track activity and outcomes from a business perspective”

Commenting about the service he received from HealthNetConnections.
“We met with many vendors that provide reporting systems and databases. It was a clear and easy decision for us to work with HNC. From the first point-of contact, to meetings on-site, installation visits and subsequent system implementation HNC have been a delight to work with.

The company was very sympathetic and understanding in their approach to us. They have worked tirelessly, helping us through all the stages of implementing an IT system in a busy NHS infrastructure. Where problems have arisen, HNC has helped us work through them and provide a clinical system that actually works well, in the real life setting of a busy clinical environment. We were very keen for our system to be modified so that a clinical letter was generated rather than an ‘investigation report’. This required input from the HNC team, in designing complex forms that contained embedded computer ’logic’. This ultimately produced a series of ‘Smart Letters’ where each clinic visit generated a similar, but different letter for the patient, GP and referring clinician. Overall, these ‘Smart Letters” are more personal and human in comparison to a ‘scan’ report. All the fields in these letters are generated from ViewPoint itself.

The process is ongoing and we are getting considerable support from the HNC team. The after-sales aspect has been particularly strong. When an issue arises, the help-desk team at HNC has been able to fix the issue remotely, within a matter of minutes. It is this aspect of the service that we value the most now. We would definitely recommend HNC to all our clinical colleagues across the Fetal Cardiac Network. They are great clinical partners and we are very grateful for their help and support in allowing us to build and develop our service further.”

The new Mittal Children’s Centre at Great Ormond Street will open in 2012 and they are planning to expand the cardiothoracic and Fetal Cardiac programmes. In the financial year 2010/2011 Great Ormond Street performed over 510 cardiac bypass procedures and 650 total cardiac cases and over 100 thoracic operations. The fetal cardiology network will receive greater input. They hope to expand the ViewPoint platform to help with the challenges of strengthening the Fetal Cardiac Network.