The Dermatology Department at Selly Oak Hospital was suffering a secretarial crisis due to a combination of a legacy IT letter system that was no longer maintainable, staff illness and maternity leave and as a result had a 6 month backlog of letters. In addition there were a number of separate IT systems that were already available to clinicians, but were underused because of multiple login passwords and poorly presented data. They also had a requirement to capture images and coded diagnoses.

This presented Bluewire with wide ranging challenges which were managed by a staged release of software beginning in 2001. Experience and feedback from this site resulted in the emergence of the company that Bluewire has become. The University Hospital, Birmingham (UHB) became Bluewire's first development partner and installed user site.

Objectives

• Provide a clinical portal maximizing the value of existing systems
• Provide a replacement for the defunct existing letter systems
• Provide a system for the management of workload of the Medical Secretaries
• Provide a system for monitoring the output of the Medical Secretaries
• Provide ICD-10 and specialist dermatology clinical coding functionality
• Provide an option to outsourced transcription services
• Provide comprehensive audit and reporting tools
• Reduce the turnaround time for clinical letters

The solution - making use of existing systems

The first version of the system focussed on making best use of existing systems. An interface was written to a legacy IRC PAS system which was underused because of its outdated "green screen" / DOS based technology. This was combined with data from an existing eNotes case note tracking system. This immediately increased the effective use of this data.

The second version following on 1 month later added an interface to a laboratory results and radiology report database. Presentation of the data was considerably improved, with highlighting of abnormal results, the ability to view multiple test reports on one page, and the addition of 'grid' and charting views to track results over time and identify trends.

Replacing the existing letters system

A critical requirement of any replacement system was the ability to import 60,000 existing letters. Unfortunately the old system was unsupported and had no software API to facilitate exporting its data. Bluewire were able to write custom code to analyze the letters and look for matches in the hospital PAS system along with dates.

As the Epro replacement had a much more powerful template system, the secretaries were delighted with the ability to create their own templates, and the fact that the demographic data was imported automatically from the PAS system. Managers too, were pleased with the fact that the problems of sending letters to the wrong GPs was solved as all letters were now sent to the current registered GP from the PAS system.

ICD10 diagnoses

One of the original objectives was to form a database of dermatology patients by ICD diagnosis. In the early days, there was simply a free text field in which clinicians could enter a brief clinical synopsis of the patient. This proved to be enormously valuable, and it was decided it was essential to retain it. However, an ICD10 diagnosis module and also an IDDC (specialist dermatology) module was added along with features such as a configurable common diagnoses tool, and a reporting engine for retrieval of the information. This tool, integral to the solution, provided busy healthcare staff with the ability to search for documents relating to particular patients, diagnoses or clinical terms in just seconds.

External transcription

Although considerable time savings had been realized with the original solution, by 2006 the trust had become interested in external transcription services. Bluewire wrote an interface to a third party solution so that the completed transcriptions could be automatically imported into the Epro system, allowing the users to continue to use their existing templates and retain the other benefits of Epro which they had become use to.

Today

The epro product has now been used successfully in the Dermatology Department since 2001. The partnership nature of Bluewire's relationship with the team at UHB continues, as they assist with beta testing of new version releases and serve as an extremely valuable, user reference site..