Elective care conference: theory of Patient Administration System Implementation
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The document summarizes the challenges of implementing a new patient administration system (PAS) at an acute NHS Trust. It discusses the implementation process, system functionality requirements, and lessons learned from replacing the PAS system at Derby Teaching Hospitals NHS Foundation Trust. Key challenges included extensive data migration, rewriting numerous interfaces, training large numbers of staff, and addressing significant post go-live issues around data quality, reporting accuracy, and operational pressures on staff. Careful planning and testing of processes, as well as dedicated post go-live support, are emphasized as important to successfully replacing a critical PAS system.
Elective care conference: theory of Patient Administration System Implementation
- 1. Patient Administration System Implementation- The Theory Mark Norwood, Associate Director of IM&T, Derby Teaching Hospitals NHS Foundation Trust Peter Hyland, Intensive Support Manager, NHS Improvement 20th April 2016
- 2. Content of the Session IST Session (10 minutes) • Implementation Process • System Functionality • Reporting Requirements Derby Teaching Hospitals NHS Foundation Trust Session (30 minutes) • The joy of replacing a PAS system in an acute Trust- The challenges and lessons learnt Questions and Answers Session (10 minutes)
- 3. Implementation Process • History transfer- More history to be transferred for elective care the better • Access to the old system if needed- Typically as read only • Supplier support at go-live- Needs to be on-site dedicated support to address issues in real time for a suitable length of time • Supplier support post go-live- Significant support for the supplier post go-live required and fast track through helpdesk with dedicated support • Training – How near go-live are staff trained on the new PAS – Who are all staff included within training – Integrated training for RTT • Validation- How is the validation requirement managed
- 4. System Functionality • Issue Escalation- A dedicated PAS supplier resource is needed to support issue resolution – Dedicated helpdesk for the Trust – Standards in place around issue escalation with a feedback loop on issues – Formal process for escalation of issues • Interfaces- Two way is better than one but can be uncommon
- 5. The joy of replacing a PAS system in an acute Trust The challenges and lessons learned
- 6. What Are We Doing?
- 7. What Does PAS Do? It drives/ supports the activity of the Trust! • Managing the administration of patient pathways (Outpatient/ Daycase /Elective waiting lists) • Providing patient demographic and attendance details via interfaces to other systems : iCM / PACS/ Infoflex / ORMIS/ LABS / EDIS / CRIS / Cardiobase etc • Extracted information enables us to bill for services develop and plan our services in response to health care trends and patterns in relation to the needs of our population • Information recorded helps us to evaluate the quality of care and monitoring waiting times, cancelled operations etc
- 8. Why Is replacing PAS So Difficult? EPRs tend to work very differently Data migration typically forces system to work like old PAS! Upwards of 50 distinct process change requirements need testing / signing off Typically upwards of 30 Interfaces need rewriting / testing All PAS extracts into data warehouse need rewriting, validating Millions of records to migrate, 1000s of validation rules to be applied 1000s of staff to train in (typically) 6 Weeks Significant downtime required to cutover Migrated data rarely behaves like native data Change in interface paradigm!
- 9. Why Is It So Difficult? 2 • Its Big Bang! • We don’t do this often • We’re expected to carry on as usual • It shines a light!
- 10. Pre go-live concerns Poorly defined, inconsistent, organically grown processes = extensive process errors = significant data quality issues The gap between the new and the old system – first time move! Data is ‘corrected’ using two methods: – Algorithmic rule based system scripts which evolve over time= black box – Costly and time consuming manual validation and correction Reactive correction is the norm = reliance on validation + correction Too much reliance on temporary staff in project team Trust / staff already under pressure operationally Focus on the clinical not the administrative
- 11. Post Go-live Issues Operational Staff struggling to keep up, can’t remember the training, hate the new system Staff tired after the cutover period Can’t do a day’s work in a day…. Phones not answered – DNA’s increase, patient cancellations down… Clinics not filled Data quality issues Weaknesses being exposed Reporting Loss of reporting operationally during go-live – up to 5 days Data catch-up may impact on reporting temporarily and can persist– days work in a day Reconciliation of reports/ data submissions on two systems Anomalies / differences on two systems Data quality issues typically missing stops, extra referrals (PTL growth)
- 12. What happened to my Elective Care reporting? Step change in at go-live – PTL/ Referrals and Inability to explain step change or evidence which position is correct Hidden long-waiting patients discovered on PTLs post-go-live due to increased focus, too much noise on the lists! Data correction procedures not tested Impact of migrated data is not fully understood Worsening RTT position post-go-live due to staff use of incorrect process (particularly where algorithmic solutions have been in use) Worsening RTT position due to increased time to perform operational tasks post-go-live Information department constrained by resource, over-whelmed by PTL diagnostics Inadequate planning for post-go-live stabilisation and containment – resulting in reactive attempts to manage snowballing DQ issues
- 13. • Data Migration - understanding how the data would behave/ Clean existing data completely • Phase down activity • More / better supported super users – helps overcome the training deficit • Focus on getting a few things right at a time • Have systems to monitor processes – track errors, backlogs, areas under pressure • Have a stabilisation team – assume you will have issues • Ensure all processes have standardised tested SOPs including corrections What we could be done better!
- 14. Later/ Emerging issues Expertise walks out – temporary staff/ contractors leave Data quality issues significantly impact on reporting – most notably RTT – patients appearing on lists/ hidden waits Income impact / changes Impact on planning / forecasting – dq, backlogs, change in counting/ process/ codes Spiral out of control…..... Data quality problems overwhelm correction work Information department overwhelmed by PTL diagnostics / fixes Where is the Issue? More noise on lists = greater errors made by admin staff Impacts on actual activity, performance,income Unable to submit