Last month Computing was invited behind the scenes to see the National Programme for IT in action at Homerton hospital, one of the most advanced adopters of the scheme. Our guide was Simon Eccles, national clinical lead for NHS Connecting for Health.

Homerton hospital’s accident and emergency department is strikingly different from more traditional models.

At first sight it looks more like an office ­ a central area with 10 or so computers. Around this area are the patient cubicles you would expect in a traditional format. Between the central area and the cubicles are 20 or so “Cows” ­ computers on wheels.

These are laptops used to take patient details and are linked to a central database.
A doctor or nurse will monitor the patient’s heart rate, blood pressure and other diagnostics, and input the results into these computers.

“The idea is to have more Cows than we need ­ I always like to have a few spare sitting around,” said Eccles.

Throughout the department each cubicle has a key feature ­ a screen showing the name and details of the patient inside. This is the electronic version of the whiteboard that we see in Holby City and Casualty, with a crucial difference.

“Previously whoever had the pen was the most powerful person in the department ­ every decision had to go through them,” said Eccles.

Now the whiteboard can be updated from any of the computers in the central area.
The board shows the patients’ cubicle location, name, age,a code for their symptoms or condition, the tests ordered, the length of time they have been in the hospital, and which doctor is dealing with them.

When all the tests have come back, the screen automatically updates to inform the doctor that the results are in and he or she will be able to see the patient armed with all their test results.

“There is probably more information for the clinical staff to input at the start than previously, but it saves time further down the line,” said Eccles.

The hospital uses Cerner’s Millenium patient software package. The computers in the central area all show the same screen as the whiteboard, and a patient record is accessed by clicking on that patient’s name after the member of clinical staff has logged in.

Staff are slowly transferring medical information onto patients’ electronic records.
Eccles said relevant information is much easier to find under the new system.

“Previously I would have to spend ages going through a patient’s record for the right data. I can’t tell you how much easier it is like this,” he said.

A typical patient’s file is about three inches thick, full of handwritten notes and seemingly indecipherable. “This is actually a pretty well-organised one,” said Eccles, holding an example. “Sometimes the handwriting issue can be a nightmare.”

When a patient has been dealt with, the system automatically issues a letter to the relevant people, including the patient’s GP.

Eccles is even more keen on the digital imaging technology.

New networks and imaging systems have enabled a move away from the old-style film techniques for X-rays and CAT scans to digital images.

Rather than being presented with a set of slides, a doctor can now scroll through a sequence of cross sections using the mouse, allowing them to analyse a series of frames more smoothly rather than laboriously moving from one to the other.

They can also click and drag to measure distances accurately.

The images can be sent to specialists elsewhere in about 40 seconds, rather than using a slower and unreliable courier service.

“You would not believe the amount of phone calls which go: ‘I sent it to this department… it’s not here…well I sent it…well it’s not here’. This is infinitely better,” said Eccles.

Given his position, it is perhaps unsurprising Eccles presents such a persuasive case.
But it is clear that the system works and the staff have adapted to it from the efficient way they all go about their business, flitting between patients and PCs.

“It took a bit of getting used to, but it works fine now,” was a typical user comment.
But these are all young, computer-literate staff.

“There are older staff using the system in other parts of the hospital who have got used to it fine,” said Eccles. “Obviously some are more resistant to
it than others, but it is just a matter of getting it working and showing them how beneficial it can be.”