Clinical suite. At around ten to twelve weeks

Clinical information system West Middlesex UniversityHospital The hospital opened in 1894as the Brentford Workhouse Infirmary. In about 1920 the hospital became theWest Middlesex Hospital. When the original buildings were no longer suitablefor the needs of the hospital, the hospital was redeveloped. Approximately halfof the original site was sold, allowing refurbishment of two remainingbuildings at the east of the site. The new building, constructed between 2001and 2003, was funded by a Private Finance Initiative.             West Middlesex University Hospital (WMUH) is an acute NHShospital in Isleworth, west London, operated by Chelsea and WestminsterHospital NHS Foundation Trust. It is a teaching hospital of Imperial CollegeSchool of Medicine and a designated academic health science partner with ImperialCollege Academic Health Sciences Partnership.

This hospital serves patients inthe London Boroughs of Hounslow, Richmond upon Thames and Ealing. The hospitalhas over 400 beds and provides a full range of clinical services includingAccident and Emergency, Acute Medicine, Care of the Elderly, Surgery andMaternity. In December 2011, WestMiddlesex University Hospital was awarded full accreditation by UNICEF as aBaby Friendly hospital, the first London hospital to achieve this award. TheBaby Friendly Initiative accredits maternity and community facilities whichadopt internationally recognised standards of best practice. This can discussyour choices for where and how to give birth which could include at home, inthe birth centre or in the main delivery suite. At around ten to twelve weeksthe team midwife will meet the patient to plan antenatal care includingscreening and ultrasound options.

They also have a highly experienced andcompassionate team that are on hand to provide the support, care and advicethat patient need throughout pregnancy. They also recommend the Baby Buddy Appwhich is free and full of useful information about pregnancy, birth andpatient’s new baby. For screening options, patient will be ready for yourultrasound scan between 12 and 14 weeks, and at this time patient will also beoffered a combined screening test for Downs Syndrome.

In week 14, patient maybe offered the Quadruple test which can also screen for spina bifida. In week20 to 22, patient will then be offered an additional scan to look for any fetalanomalies.  There is many section thatinvolve in this department which is obstetric medicine clinic (OMC), Endocrineclinic, the preterm clinic (PTC) and Prepregnancy Clinic. The OMC is a specialclinic run by the highly experienced high risk team (known as the ‘H team’) forwomen who have conditions such as epilepsy, high blood pressure, blood clottingor bleeding tendencies, mental health problems and autoimmune issues. Theendocrine clinic is for women with pre-existing diabetes or gestationaldiabetes.

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The clinic facilitates a ‘joined-up’ approach to helping pregnantwomen have a healthy pregnancy. The Preterm Clinic PTC started in 2010 andruns every Thursday at West Middlesex University Hospital within the ObstetricMedicine Clinic. It aims to offer specialised and friendly advice to women whohave previously experienced a preterm birth or late pregnancy loss, or who areat increased risk of preterm birth. It is run by the H team of doctors andmidwives led by consultant obstetricians Miss Joanna Girling and Miss LouisePage.

For pre-pregnancy clinic, they done it twice a month for women who areconsidering pregnancy and fall into one or more of the following categorieswhich having existing health problems which may impact on the pregnancy  or present a risk to the future health of themother, having a child or family member with a health problem which may affecta future baby, including their likelihood of developing the same condition andthe options around this, and had a previous difficult pregnancy or experienceda health condition that could recur, so a discussion is needed to plan the typeof care that might be required In September 2012 the Trustconcluded that it was not viable for it to apply for NHS Foundation Truststatus and decided to seek a potential partner. As of 1 September 2015, WestMiddlesex University Hospital is part of Chelsea and Westminster Hospital NHSFoundation Trust. Under the North West London strategy, shaping a healthierfuture, the Trust was designated as a major hospital in 2013.       The Hospital InformationSystemOperating system that areused in this hospital are Window 7, the server is Window 2008. there are 1400desktop that are used in this organisation. The brands they are using are HP64.

This hospital has 155 virtual servers and using VMWare as the server virtualisationsoftware. As for the service desk support, desktop support and network support,this hospital had made a contract with Systems Powering Healthcare Ltd. Theannual average spends over 3 or 5 years. The contract has been started only in2015 so that the requested information can only be available in future.Duration of the contract with extension periods 5 years and the contractexpired date 2020 and the review date at 2020.

The language that are used inthis hospital systems are HL7 and DICOM  Order Communication system Sunquest Information SystemsSunquest’s laboratoryinformation system automates and drives the entire workflow of the clinical labfor organizations across the world. It streamlines lab processes to decreasespecimen handling time, increase productivity and improve turnaround time.  With more than 2,000 application interfacesand 11,000 instrument interfaces, it is designed to work seamlessly with anysystem to create a powerful integrated solution that supports laboratorymedicine and promotes quality patient care. Sunquest ICE offers ascalable solution from a single department to system-wide use.

The system canbe used in departments without existing clinical information systems, acrossentire health networks integrated to other clinical information systems or as astandalone system. Highly configurable features provide safe, efficient andeasy-to-use for general practitioners and clinicians requesting laboratorytests, radiology exams, therapies or any other service.OpenNet – view and sharepatient information quickly and easily with other Trusts or ICE systems. Bysearching and validating on demographics for a patient, OpenNet retrievesresults for display, allowing easy transition between patient reports. ServiceProvider List – available for electronic ordering for any and all departmentswithin the hospital.

Clinical Forms Toolkit – easycreation of electronic clinical forms to enhance your requesting workflows.Ensure completion of clinical assessments to meet CQUIN targets.Discharge (clinicalcorrespondence) – allow clinicians to compile a discharge letter for a patientduring their inpatient stay and send the letter to the GP’s Practice System.Meet UK guidelines for an immediate discharge summary to the doctor within 24 hours.

 Electronic Medical Record orElectronic Patient Record (EPR)In administration, Electronicpatient record (EPR) that are used in this hospital are Carnis ver-23 Lastwordfor inpatient and outpatient. This software is also being used in emergencydepartment for unscheduled patient and communication software in the hospital.The flow of the administration in this hospital then all patient record hasbeen kept in this system.

For example the patient data (demographics, medicalhistory), treatment information (medications, procedures), diagnosticinformation (diagnostic orders and tracking, results, reports), operationalinformation (appointments, waiting lists, patient flow), clinical careinformation (clinical noting, nursing observations, specialist care), clinicalanalytics (graphical presentation of data), information shared betweenproviders (GP and other hospital data, referrals, discharge summaries, contactswith social services), operational analytics (trending and predictive modellingof demand and capacity). An EPR is much more than just an electronic version ofthe patient ‘s record. It combines a complete, integrated source of patientinformation with support for the clinical and operational processes formanaging patient care, generating a complete record of each patient encounterand automating and streamlining clinical and operational workflows.      For patients the EPR andsupporting IT infrastructure will provide secure access to their medicalrecords in an electronic form which, over time, will become more standardisedin terms of the recording and presentation of key clinical information, accessto scheduling systems, offering greater choice in terms appointments and theability for patients to take control of their own bookings, enable patients toupdate their medical record and interact with clinicians in wholly new waysoutside of the standard ‘outpatient clinic’ setting, reduce duplication (e.g.repeating information provided elsewhere in the system, or the re-requesting oftests already completed) and give confidence that the clinical pathway isevidence based, standardised and monitored, make use of fast developingenabling technologies (e.

g. wearable medical devices), and provide proactivehealthcare through modelling, best practice and the use of ‘Big Data’ (i.e.population health) with the aim of early detection of potential health problems(and likely improved outcomes) For the staff the EPR and supporting ITinfrastructure will move away from paper based systems to ‘digital first’, provideaccess to the full patient record on any (approved) device at any locationwhere care may need to be provided and enable colleagues, peers, patients toview and interact with the record at the same time, access to all data enteredinto the system (and data entered in other provider systems) for audit,healthcare informatics and research purposes, offer evidence based,standardised care pathways which are task driven with embedded clinicaldecision support, support predictive modelling of demand and capacity planning.For stakeholders, the EPR and supporting IT infrastructure will share theinformation in digital form across care settings, use digital communication toengage with trust staff to discuss and plan patient care, provide performanceinformation for scrutiny of services and provide information to enabledecisions about where patients should be treated  For patient’s referral, Outpatientreferrals was conducted by Hounslow GPs and Richmond GPs. The ReferralFacilitation Service (RFS) was for the outpatient. As for Hounslow GPs, thereferral need to be send in form.

Forms should be emailed [email protected] or faxed to 0800 756 7754.

Practice enquiries: Tel 05511434910. It is obliged to send any paper referrals received at the hospital backto the Referral Facilitation Service before booking an appointment. asfor Richmond GPs, the referral should be referring either via the RichmondClinical Assessment Service (RCAS), or directly through eReferrals. Whereservices are unavailable on eReferrals, email a paper referral to [email protected] For general referralinformation, eReferrals system is used for all referral where possible, mostoutpatient used this system.

It required two week wait rule. The services thatoffered this system are Antenatal clinical assessment service, Gynaecology, TIA(Transient Ischemic Attack), Early Pregnancy Assessment Unit (EPAU), Pre-operativeAssessment Department, Acute Assessment Unit (AAU), Subfertility clinic       Clinical Information System      Radiology Information System (RIS)This hospital using Asteralas a telemedicine in the RIS. Asteral Ltd.

provides strategic equipmentmanagement and maintenance services to the acute healthcare sector in theUnited Kingdom. The company was founded in 2001 and is based in Reading, UnitedKingdom with additional offices throughout the United Kingdom. Asteral Ltd.

formerly operated as a subsidiary of Brook Henderson Group Limited. As of August2014, Asteral Ltd. operates as a subsidiary of MESA, Sagl. The company alsooffers multiLIFE, a managed service that enables NHS Trusts to improvestrategic planning and transfer related financial and technological risks.

The clinical flowchart forthis systems are that the solutions include Equipment-as-a-Service that enableshospitals to pass responsibility for equipment planning, procurement, andmanagement to a vendor-independent service provider. The order from the surgeonor any department are send to this department. Then, oneLIFE is an applicationthat provides access to the diagnostic imaging equipment, such as cath labs,MRI, CT, X-ray, PET/CT, radiotherapy, nuclear medicine, mammography,radiosurgery, and interventional imaging equipment from various manufacturers.The machines that are used to captured the image and the result in thisdepartment are Toshiba CX 128, Toshiba Aquiion 64 for CT and Phillips 1 Teslafor MRI. The multiLIFE that allows replacement or upgrade of equipment at anytime throughout the contract term. In addition, it provides equipment audit servicefor hospital, analyse and design, and remarketing solutions. The result thenare send to EPR by the OCS as the communication system in this hospital    Laboratory Information System(LIS)In this department, they areusing the Sunquest as the information system. Extend the power of Sunquest witha range of integrated modules.

The Sunquest Clinical solution promotes safetyfor both patients and providers and allows your organization to focus on whatmatters: quality care.As for the clinical workflow, Automatesmicrobiology clinical validation, it need to meets the NHS number requirement.It also includes the Acute Kidney Injury (AKI) algorithm. It is also includesintegrated, method-specific LOINC capability for resulting, reporting andfiling LOINC inpatient records. There are Blood bank, specimen collectionmanager, transfusion manager, microbiology testing and resulting, electronicspecimen management routing and tracking in the LIS  the anatomical and clinical pathology are beentaken from the patients either in the lab or even bedside. The clinician willscan the code of the patients, the graphic information of the patients willappear in the devices. The clinician use at least two identifies when providingcare, treatment and services such as patients number and id to ensure there isno mistake happen.

After the identifiers done, the clinician need to choose thespecimen that are taken from the patients and the devices will print the label.The clinician need to place the label to the specimen and the specimen than wassend to the LIS will be examine. In the laboratory, the result is identifiedand analyse accurately and it will be record. The result then are send to theEPR by the OCS system to be check by the surgeon, doctor and other clinicianfor the plan treatment.     Pharmacy Information System (PIS)In pharmacy, this hospitalused JAC as the telemedicine of the department.

JAC was acquired in May 1996 byMediware Inc and continues to operate as a wholly owned subsidiary. Theacquisition by Mediware Inc created the world’s largest specialist vendor ofmedicines management and pharmaceutical care software for hospitals. MediwareInc. is a publicly quoted company on NASDAQ (code MEDW). Mediware is aspecialist provider of clinical information systems focused on complex areas ofhealthcare. Through our more than 25 years of experience, our focus has evolvedfrom departmental systems residing in pharmacies and blood banks to broaderclinical solutions that encapsulate the workflows of medication and bloodmanagement to deliver a ‘closed loop’ of information and process support fromthe clinical professionals to the patient’s bedside. Today, around half of theNHS uses JAC as their primary pharmacy management system and more than a dozenhospitals have chosen to implement JAC’s e-prescribing and medicinesadministration system.

The integrated nature of JAC’s closed-loop medicinesmanagement solution make scenarios like this possible and brings patients andclinicians together at the centre of care. The clinical flowchart forthis telemedicine in this hospital was done by patient discusses her medicationwith the healthcare team on their ward round. The pharmacist team-memberexplains proposed changes to the medication, which the patient will administerherself. The pharmacist also discusses learning points with other team members.

New medication is agreed between members of the clinical team and ordered atthe bedside though a wireless computer linked to an automated dispensary, whererobotic systems pick the new medicines and collates orders. Computer technologyupdates the patient’s record and medication history. The medication that hasbeen issued is simultaneously recorded to update stock records and freshsupplies are ordered. When the new medication is due, the nurse conducting theward-round is presented with clear, complete and verified information. Thenurse is able to record the administration outcome to the clinical electronicpatient record. While the patient is being discharged, a discharge summaryletter is produced and sent electronically to the hospital’s discharge lettersystem and the patient’s GP. After the episode, all information collectedduring the visit is interrogated by the hospital’s management team to identifytrends or anomalies and recommend changes to clinical practise.   Surgical theatresThis hospital used PICIS forsurgical theatres, PICIS Clinical Solutions is a global provider of innovativeinformation solutions that enable rapid and sustained delivery of clinicaldocumentation, financial and operational results in the emergency departments,surgical suites and intensive care units of the hospital.

PICIS ClinicalSolutions offers an advanced suite of integrated products focused on theselife-critical areas of the hospital where the patients are the most vulnerable,the care process is the most complex and an increasing majority of hospitalcosts and potential revenue are concentrated.  The flowchart of this systemare first documents all the information about the patient. Once thedocumentation is readily available and documented appropriately when regulatorysurveyor walks into the room, using this system, it is less complex trackingand don’t need a tissue tracking system you have it all in one place, it ismuch convenience and easy if there are emergency cases involved. In the eventof a recall know that you can easily obtain a list of patients with the giventissue or implant. It also reduces manual labour for patient history tracking.No additional cost needed for tracking the patient’s history.

This system also allowsthem to empower hospital staff to make the software their own by make changeswhen they need/want to without vendor involvement/cost. They can add equipment,meds, allergies, etc. into the system if there any new information from thepatient’s condition. This system also will make sure the doctor has the rightsupplies when he/she steps into the room.

For intuitive and powerful preferencecards, the preference card is selected automatically when the surgeon andprocedure are added to the Surgery Schedule.          Endoscopy, Bronchoscopy andCytoscopy For this department, thesystem that are used as telemedicine are EMIS Health. EMIS Health Endoscopy isa web-based, comprehensive procedure recording and reporting tool that allowsclinicians to accurately record all procedure details. This solution covers allgastro-intestinal (GI) procedures, as well as bronchoscopy and cystoscopy. EMISHealth Maternity monitors and records the full pre and post-natal pathway,ensuring a complete picture of pregnancy is captured. EMIS Health’sgastroenterology solution supports gastroenterology teams in the management ofpatients with long term conditions such as Irritable Bowel Disease (IBD).Clinicians have an overview of full patient details, including diagnosis anddrug outcomes, which can be analysed over time to review effectiveness oftreatment for patients.

By integrating with other clinical systems, such asendoscopy and pathology, clinicians are able to review results and careinformation from within one system.As to clinical flowchart, Itsenable quick and highly detailed capture of clinical data as part of the routineoperation of the department. The clinical reporting is based on national andprofessional dataset standards, providing accurate, fast and comprehensiveinformation, making reports much faster to create and submit for auditing purposes.Then it integrated appointment scheduling means that clinicians have patient appointmentinformation at their fingertips, having pre-selected patient lists at the startof their day, minimising risk.

In gastroenterology (IBD) module linksseamlessly with endoscopy solutions to provide easy access to all procedurereports. The information from the antenatal booking interview is captured alongwith significant events during the antenatal period, the birth (or end ofpregnancy), and up to the discharge home following birth. This solution is usedto support service commissioning, management and planning, risk management andclinical governance; and to support reporting to trust board, clients,commissioners, department of health and other national bodies.Telephone ‘Flare-line’ reviewfunctionality allows quick updating of the patient record, saving subsequenttranscription time. The system can automatically link with both the UK nationalIBD registry and Biologics Audit website to upload all relevant datasets andavoid clinician double entry.

Clinicians can also run remote clinics throughthe Virtual Clinic functionality, which reduces the amount of acute patientvisits. These can be scheduled and prompted when due within the system, withpatient and GP letters being automatically generated.