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The Royal Cornwall Hospitals NHS Trust

"Sybase has helped us develop an extremely innovative health care information system to achieve all our aims in a very efficient and cost-effective way."

Andrew Forrest
Head of the Electronic Health Records Program
Cornwall NHS IT Services

The Royal Cornwall Hospitals NHS Trust needed a solution that integrated information from its wide range of special services, including community medicine, care of the elderly, mental health, midwifery and district nursing. Using Sybase technology, it developed the Electronic Health Records system, improving patient service delivery and the quality of information available to clinicians.

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Integrating Outdated Systems
For patients to have confidence in their health care providers, it is absolutely essential that a high standard of communication be maintained among all practitioners and agencies. Patient records therefore need to be as up-to-date and as accurate as possible, but this is particularly difficult to achieve when health services are spread over different geographical areas.

"With so many different information sources it was hard to maintain the accuracy and currency of patient records," said Andrew Forrest, head of the Electronic Health Records Program at Cornwall NHS IT Services. "Information was exchanged mainly by phone calls and letters rather than by being recorded in a systematic way. It became apparent that clinicians needed a more efficient means of exchanging this crucial data."

A project was launched to establish an Electronic Health Records (EHR) system that would require the integration of more then 15 different health care systems. These included many "green screen" legacy systems due for replacement in 2002. "This was an ambitious undertaking requiring considerable expertise, and so we were meticulous in our evaluation of solution providers," Forrest said.

They selected Sybase Professional Services and IMS Maxims, an Irish health care software specialist. Sybase was chosen for the flexibility of its product range. "Flexibility was essential," Forrest said. "The Health Service now needs to be accountable for the quality of its service provision. It needs to be able to adapt quickly and efficiently to changing requirements and its systems need to reflect this. We were confident that Sybase could deliver the appropriate integration of legacy systems in order to retain the existing infrastructure and reduce costs."

As well as providing the capability to integrate disparate legacy systems, the solution ensured that data was replicated so that up-to-date information was maintained across all platforms and made accessible to more users.

The Changing Face of UK Health Care
In the next few years, the system will consist of dozens of different modules combining both administrative and clinical information on patients for access by all of Cornwall's health care services.

"Sybase has provided the integration architecture to unlock all the data from all the different legacy systems so that we can build up a single picture of each patient," Forrest said.

This means that all administrative records, lab results such as blood tests, pathology and x-ray results, as well as all clinical information, will be easily accessible. It will provide a full history and timetable of every aspect of the patient's care and treatment. It will also be possible to store existing paper records as scanned images.

The new system delivers a holistic view of each patient, regardless of how many specialists are involved. A diabetic patient, for example, may have blood sugar tests and see a podiatrist and an eye specialist, as well as their own GP and other clinicians. If they have an operation, the surgeon might want just a few headline facts to check on their general state of health.

New modules will also be added for in-depth recording of clinical information in particular areas such as diabetes, urology, breast care and mental health. The data will be input by the clinicians themselves, a hands-on approach that will minimize the chance for error and reduce duplication of inputted data.

"We want to record the information once but enable it to be displayed in many different areas," Forrest said. "The modularity of the system lets us create specialist clinical views of the information with the right level of detail. It is a clear example of excellence in health care information systems." 

Planning Patient Care
"Sybase has helped us develop an extremely innovative health care information system to achieve all our aims in a very efficient and cost-effective way," Forrest said.

The benefits of the EHR system are considerable. Enhanced access to more accurate and timely information results in a much higher standard of patient care. "Clinicians can see all the past data from the old database systems and enter new data within a single environment," he said. "This has significantly enhanced the decision-making process and allowed the medical teams to plan patient care much more effectively."

The Cornwall health community is delighted with its new EHR system. "Sybase Professional Services has been excellent; we have worked with some very bright people," Forrest said. "We have been kept informed at every stage of the project's progress and now we are seeing the vision come to life. With the Sybase solution in place, we now have a reliable starting point from which to develop further services."

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