Moving to an electronic patient record (EPR) is all the rage these days, even in the District General Hospitals (DGHs). When I am not writing these articles I work in one such hospital. At Bolton Foundation Trust we deployed OpenEyes (OE) for cataract surgery in January 2017. Cataract is just the first step of a transition that will conclude in the adoption of OE for all clinical activity in the Bolton eye unit.
Within the last 18 months OE (Moorfield’s homegrown EPR) changed management structure. Prior to the move it was managed by Moorfields Eye Hospital. The move has resulted in OE now being held by an independent, non-profit, charitable trust. Known as the OpenEyes Foundation (OEF openeyes.org.uk), this body works to strengthen the product and aid its deployment into the wider community. Since the move, two NHS Foundation Trusts (Bolton NHS Foundation Trust and East Kent FT) have successfully deployed OE, with more planning to come online in the coming months.
Six months have passed since we deployed OE at Bolton. As the project lead I have received many requests from other trusts to learn more about our experience. This issue’s tech column is therefore dedicated to just that.
EPR options
The requirement to submit cataract surgery outcomes to the UK National Ophthalmic Database (NOD) has shaped the choice of EPR software considerably. If a unit wants to use an EPR to collect and submit data to the NOD there are two appropriately configured software products on the market, Medisoft and OE.
Many trusts have yet to realise that eye care is sufficiently complex to justify a separate EPR. This position is understandable since the provision of software for different medical specialties means they need to talk to each other fluently, which is no small task. At Bolton our trust EPR will be the Allscripts platform, except in the eye unit, where it is OE. We will shortly start work to integrate the two.
Figure 1: OE allows detailed graphical documentation that is converted into text and diagnoses.
How did the deployment go?
Six months have passed since the ‘go live’ and the software is functioning very well. We have not had any reliability issues and we have local administrator functions to configure the software and manage user accounts. Our staff have taken to OE very well. Our supplier (ABEHR Digital) handled our deployment expertly and we would be happy to recommend them.
Has OE achieved the intended outcomes?
The main intended outcome of our first phase was to achieve compliance with the NOD. In this regard the software has surpassed our expectations. We have been able to integrate OE with the software that our community optometrists use to review our post-op cataracts. This integration gives us automated outcome data. It was facilitated by the open nature of the software. For reference, our community optometrists use a platform known as WebStar OptoManager. For trusts without integrated software, OE provides a web page for the outcome data returns.
Is your cataract pathway now paper free?
No, not yet. OE does not yet handle all of our checklists or our pre-surgery patient specific directions (PSDs) for dilating and other drops. Upgrades to the software are already being designed which will address these areas. We are confident that this will become a reality in the not too distant future.
What does your cataract pathway look like?
Bolton and Salford Trusts recently hosted a national health IT conference. The organisers requested a site visit to see OE as part of the event. To support this we made a short video documenting what we had achieved with cataract deployment so far. It is a lighthearted six minute video featuring three of my children as a patient, doctor and nurse (with my wife narrating). If nothing else it shows how the pathway works:
https://youtu.be/FXN1MQVBUD4
What next after cataract surgery?
In Bolton we are about to start using OE for our intravitreal injections. We have also already started using the powerful virtual clinic features to support our glaucoma work. Over the next 12 months, once OE supports PSDs and has rich National Institute of Health & Care Excellence (NICE) glaucoma guideline features, we plan to roll it out into the face to face clinics for those specialities.
Is Bolton able to offer a site visit?
Since February 2017 Bolton FT (with the support of NHS Digital) has hosted two site visit days for six other NHS Trusts interested in OE. More of these days can be organised for trusts wanting to visit a site with a recent OE deployment. Visitors are able to meet our clinical and IT staff in addition to staff from our supplier. East Kent may also be able to offer a similar service for trusts closer to them.
If you would like to attend a site visit please get in touch on the contact details below. Equally, if you would like access to a live online demo site please get in touch.
OpenEyes Foundation
As a consequence of my clinical role and IT experience gained in deploying OE, I have been made one of the Trustees for the OpenEyes Foundation (openeyes.org.uk/openeyes_foundation). As a Trustee I have no financial interest in OE. Indeed, all of our Trustees are volunteers who gain no financial benefit for their contributions.
Regional solutions
Both Bolton and East Kent are exploring the possibility of region wide deployments. It is hoped the ‘Kent Ophthalmology Record’ will result in a Kent wide OE deployment. This would provide OE access to all GPs, optometrists and other eye care providers in the region. In Manchester there is also interest in a Greater Manchester wide deployment of OE to all optometrists and NHS Trusts involved in eye care.
Contacts:
David Haider (Bolton OE project lead)
E: david.haider@boltonft.nhs.uk
Hannah Gowers (OE project manager at East Kent)
E: hgowers@nhs.net
Jason Brown (CEO ABEHR Digital)
E: jason.brown@abehr.com
The author has no proprietary or financial interests in the products discussed.
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