Planning for Care Records Service (CRS) integration using InterSystems Ensemble

05 Sep 2007

Barts and The London is one of the largest and most respected teaching hospital trusts in Britain. Its mission is to bring excellence to life – to give patients the best possible care so they can live better, fuller, longer lives. As part of the trust’s commitment to excellence, it is currently commencing a £1 billion PFI (Private Finance Initiative) to build the UK’s largest new hospital over the next eight years.

In parallel with this, the organisation has initiated its “Pathfinder Clinical Strategy” – a programme of clinical process transformation to complement the new hospital, which is predicated on the availability of modernised information systems. As part of the programme, the trust is committed to being an early adopter in London of the NHS Care Records Service (CRS). This will ultimately connect more than 30,000 GPs and 270 Trusts across the UK to national systems that will support appointments, prescribing and access to summary medical records.

However, the programme presents the trust with a very large challenge. It is clear that for an organisation that holds critical information on peoples’ health – and ultimately their lives – it is unfeasible to allow for any down-time while it modernises its systems. This means that it needed to find a solution that will allow its doctors and nurses to continue to have access to patient information while the hospital’s tightly integrated legacy infrastructure is integrated with the third party solutions that will be rolled out over the next few years.

The trust looked at a short list of potential integration solutions, and after a thorough evaluation process it selected the Ensemble rapid application integration platform. Ensemble will play a key role in the management of HL7 (the standard for the exchange, management and integration of electronic healthcare information) based communications and integration links across the trust.

“We chose Ensemble because it is an extremely tightly integrated engine, and is much faster, and easier to use than other products, allowing us to rapidly set the project in motion due to our tight timescales” said Mike Eagles, Head of Software Development at Barts and The London NHS Trust. “It is a strong design environment and doesn’t leave the user to grapple with disparate utilities – everything you need can be found within two tools. This means, for example, that we don’t have to write as much code as before, which gives us a massive jump-start in ensuring we’re in line with CRS.”

The first phase was for the trust to use Ensemble in the deployment of its new Radiology Information System (RIS). Ensemble allows the trust to integrate RIS with its order communications system. RIS went live in July 2006 with the Picture Archiving and Communications System following in November 2006. When finalised, Care Records Service will be completely HL7-based and the trust will be able to extract information from CRS and then ensure that it is usable by its existing decision support and clinical information systems.

The next step in the roll-out of Ensemble will be in the replacement of Barts and The London’s Patient Administration System, by implementing Cerner’s Millennium system in phases adding extra functionality and enhancements over the next five years. Over the past five years, the in-house team at the trust has developed an Electronic Patient Record viewer, which provides doctors and nurses with a portal view into different patient care systems. With the introduction of CRS this system and a number of other departmental and clinical systems in general would have become orphaned. Ensemble has enabled the team to retain the data repositories that existed in the Patient Administration System, design CRS integration layer and remove the old Patient Administration System – all without disturbing the existing systems.

This has a two-fold benefit. From the end-user perspective the existing systems running alongside CRS will look and feel the same as before so doctors and nurses can still access the patient information they need quickly and efficiently. Yet, from an IT perspective the trust has adapted its infrastructure to ensure that it is in line with the requirements of CRS. Therefore, the end users will be able to continue to deliver the highest levels of patient care.

The trust always strives to be a pioneer, which it underpins by ensuring that its IT systems are of the highest standards. This has led the trust to develop and deploy many of its medical information systems using its own in-house ICT department, which after 30 years has grown to more than 60 people and includes 15 software developers.

“The relationship with InterSystems has also proven to be a success for Barts and The London from a support perspective,” Eagles comments. “We have a very effective and productive relationship with InterSystems. The team responds quickly and competently to our questions and requests, and provides a high level of technical support to us when required.”

Duncan Allen, Alliance Manager at InterSystems, said, “We are delighted that Barts and The London are applying Ensemble’s powerful and flexible integration capabilities to get the maximum value out of their existing solutions whilst delivering new local initiatives. At the same time, they will be better prepared to connect to the new regional systems, thus meeting the challenge being faced by the majority of Trusts today.”

Eagles concludes, “Ensemble ensures that Barts and The London is in line with the Connecting for Health programme, and has eased our pathway considerably. Because the in-house team doesn’t have to write as much code any more, we’ve been able to focus on other areas of the business and drive efficiency into the organisation. This enables us to ensure that our Trust remains one of the most technologically advanced in the country and that we can meet the requirements of our “Pathfinder Clinical Strategy.”

Every year Barts and The London cares for over 500,000 people from the City, East London and beyond, from communities with a rich ethnic, religious and cultural diversity. The trust is made up of The Royal London Hospital in Whitechapel, St Bartholomew's Hospital (Barts) in the City of London, and The London Chest Hospital in Bethnal Green.