Leeds Teaching Hospitals NHS Trust ensures excellence in oncology care through its Regional Master Patient Index

Leeds Teaching Hospitals NHS Trust ensures excellence in oncology care through its Regional Master Patient Index with InterSystems HealthShare®

The UK’s National Health Service (NHS) has established a “Putting Patients First” mandate to improve the patient experience. Each patient has a unique identifier so that

Trusts across the UK can integrate care records and patient indices to improve data sharing and efficiency. Leeds Teaching Hospitals NHS Trust (LTHT), as one of the largest Trusts in the UK, is a good example.

As the centre for many specialist services in West Yorkshire, Leeds Teaching Hospitals is home to the Leeds Cancer Centre, one of the largest integrated cancer centres in the UK providing some of the most advanced treatment and care for patients with cancer anywhere in the world, LTHT has a well-established reputation for excellence in healthcare informatics. Over a decade of development has gone into the building of its bespoke in-house solution, called PPM, for managing oncology records. This system is used as the basis for shared patient records for seven Trusts in the Yorkshire Cancer Network. However, to improve the patient experience in oncology care, LTHT realised it should connect PPM to other systems. An integrated and interoperable electronic patient record (EPR) was introduced to allow it to manage the large quantities of data fed through LTHT’s seven local hospital sites every day.

Deputy Director Eileen Jessop knew that LTHT needed a robust and reliable technology platform that could work across the region. “Our existing electronic patient record solution had been developed by our oncology team to provide highly advanced data sets and to allow the creation of cancer treatment pathways overlaying patient data. It was built to work across the 15 systems used within our Trust, and had been shared with other Trusts in the region. As we are committed to the provision of the highest standards of care, it became apparent that we needed a more scalable solution that would allow a greater integration of information to join up records across the region.”

Jessop added, “It was important to find a solution that could work with the platforms that operate across our Trust and that could grow to meet our needs and the broader regional needs as we work towards achieving our strategic vision.”

Expanding the role of the electronic patient record

“As a centre for specialist care, particularly in oncology, we hold data on nearly 1.5 million cancer patients. Many of these patients interact with our services in different care settings on a regular basis. Therefore, it is critical that their clinicians are able to access accurate, up-to-date information to ensure the quality of care they receive,” Jessop noted.

“Across our seven hospitals, we have 2,000 in-patients beds plus critical care and day beds, with more than 15,000 dedicated staff,” Jessop explains. “Furthermore, oncology services from across West Yorkshire send samples for testing and other patient data to us. So our master patient index needs to reflect the complete picture of cancer care from the Yorkshire Cancer Network.”

Since 2012 the informatics focus for LTHT has been its EPR, with oncology’s PPM solution used as an example of the approach they should follow. However, LTHT found that to scale the EPR to address the broader needs within the Trust and throughout the region, it would need a new platform on which to build it.

The Trust identified the greatest challenges it faced in the development of the solution:

– Ensuring the solution could manage as many as 9,000 users
– Managing patient identity matching across an entire region
– Combining information from multiple data sources.

“We knew that we needed a platform that could pull all of this information together for our patients across the disparate informatics systems used in the region. We needed a solution that provided market-leading interoperability.”

Taking a lead on interoperability

For a number of years, LTHT has used InterSystems Ensemble® as its rapid integration engine, and the InterSystems Caché® fast and scalable database to support its patient administration system (PAS). LTHT has now decided to implement InterSystems HealthShare®, a health informatics platform that enables strategic interoperability and analytics for action. HealthShare will support the development of a regional master patient index (RMPI) to power an integrated digital care record (IDCR).

“We evaluated the interoperability capability we already had internally, and we found that the InterSystems solution provided the greatest flexibility,” says Jessop. “Our internal informatics team have been able to configure HealthShare to ensure that it delivers exactly what we need on the IDCR, with the support of InterSystems.”

The IDCR in Leeds currently holds the demographic records of 1.3 million patients, which is supported by HealthShare’s Patient Index capability to uniquely identify all its patients across the region. This enables the Trust to continuously improve the quality of patient data and governance of care processes across its estate of connected systems, including in specialist care settings such as oncology.

Some of the advantages that HealthShare is delivering for LTHT include:

– Checking the accuracy of oncology patient data
– Highlighting and facilitating the removal of duplicate patient records
– Ensuring that the Trust’s PAS is up-to-date and contains the correct details
– Feeding patient data back to the RMPI so clinicians across the region can access it.

A complete picture of oncology care in West Yorkshire

The Leeds Cancer Centre at Leeds Teaching Hospitals is the central point for data from multiple sources. The existing PPM solution combined information from each patient’s cancer record, the Trust’s EPR on a patient, as well as the Leeds Care Record. As a result, the new solution had to be able to manage data from all of these sources, and combine this information within one index. It also needed to ensure that patient information was consistently available in all locations where it might be accessed by the authorised clinical teams.

“InterSystems HealthShare enables us to link patient data together correctly and highlight records where we might need more information. With oncology services across the region feeding their data in to the Trust, this capability is hugely important to support the work of our clinical staff who require access to complete medical records to deliver the high standard of care our patients expect.”

The Trust is using HealthShare to employ new identifiers to connect patient records together. With the data of four to five million patients across the region involved, the solution had over 10 million different identities that need to be connected together. These were from multiple data sources that are not linked to the patient administration system at Leeds Teaching Hospital.

HealthShare’s probabilistic linking engine uses statistical analysis to suggest potentially associated records where inconsistencies may present. For example, the spelling of a name usually spelt with a non- Roman alphabet may have previously left records incomplete and unconnected. HealthShare helps manage data quality by highlighting partial completes and duplicate records from multiple data sources.

“HealthShare’s patient indexing probability matching capability has identified that there are over 100,000 patients where the patient record has been missed, duplicated or is incomplete. This has meant that we have been able to generate a working list of records that fall into this unclear grey area. It would not have been possible to identify these errors with our previous solution, and we’re now much closer to having a 100% match on patient information.”

LTHT now has better control over its own data, enabling the Data Quality team to work through a clear list of queries. Additionally, LTHT has realised an improvement in data quality in its PAS which impacts upon the data feeding into all Trust systems and into the wider region.

Patients are also benefitting as they now only need to enter their information once, saving time and avoiding errors while reducing potential for adverse medical events. Letters are now dispatched to the correct address, resulting in the more people attending outpatient appointments.

“To deliver a high standard of care, we need to be able to identify the patient quickly when they visit one of our care sites, and all of this information needs to be in the right patient record at the right time. HealthShare’s solution for a regional master patient index, which can power a region-wide integrated digital care record, ensures that we’re able to deliver on this,” Jessop said.

Leeds Teaching Hospitals NHS Trust is offering its RMPI to other Trusts in the region who request access. This is improving the quality of care across the region by ensuring patient information is current and accurate across different care settings. It is also helping to broaden out the applications for the patient index; for example, the Trust is currently looking at how the patient index can help improve the region’s pharmacy services.

Looking to the future

Following the success of HealthShare with its oncology services, LTHT is now assessing which other specialist services could benefit from a more integrated system.

“We have worked closely with the clinical teams to deliver this specialist care project. With our internal informatics team able to do most of the implementation work themselves, we’ve been able to ensure that HealthShare responds to the precise needs of our oncology specialists in a way that can be expanded upon as needed in future or replicated easily in other projects. HealthShare is having a transformative effect on our patient databases, enabling us to offer a much better experience for those for whom we care. ”

“InterSystems’ partnership approach means that we can combine the requirements and know-how of our clinical team with advanced technology solutions that go beyond our internal development capabilities. The ease with which we’ve been able to deploy HealthShare means we can clearly see how it can support our informatics vision. InterSystems will be central to maintaining the hospitals’ reputation for having some of the most advanced technology and best patient survival rates in the UK.”

About InterSystems

InterSystems develops advanced software technologies that enable breakthroughs. With a passion for excellence and a focus on client success, InterSystems provides data management, strategic interoperability, and analytics platforms used in healthcare, financial services, government, and other industries. In selected countries, InterSystems also offers unified healthcare applications, based on its platforms that deliver on the promise of connected healthcare. Founded in 1978, InterSystems is a privately held company headquartered in Cambridge, Massachusetts, USA. For more information, visit InterSystems.co.uk.

About Leeds Teaching Hospital NHS Trust

Leeds Teaching Hospitals is one of the largest teaching hospital trust in Europe. It offers a range of high quality hospital services for the people of Leeds and is one of the largest providers of specialist services, with more than 100 different specialties, for patients from across the country. It has an enviable international reputation for excellence in specialist care, research, and academic training. The Trust covers a large area of Yorkshire, and beyond, and comprises of approximately 2,000 inpatient beds together with critical care and day-case beds. It has more than 15,000 dedicated staff across seven hospitals who treat around 1.5 million patients a year. The Trust’s annual budget is £1 billion.

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