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Exec Summary Electronic Discharge

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Electronic Discharge Summary
EXECUTIVE SUMMARY
Electronic Discharge Summary
EXECUTIVE SUMMARY

S. CHANDE, C. CHAHAL, N. GANDHI, A. HUSSEIN, K. MANOHARON. N. NURU
S. CHANDE, C. CHAHAL, N. GANDHI, A. HUSSEIN, K. MANOHARON. N. NURU

THE PROPOSAL
There were 15 million discharge summaries produced for admissions into hospital last year. A staggering 80% of these were found to be inaccurate or incomplete and another 70% of these were reported as being severely delayed on a regular basis. This compromise to clinical care and patient safety is simply unacceptable.

Our empirical market research has found that the majority of junior doctors, the principal users of discharge forms, were unhappy with the current systems in place. It has also been reported that on average junior doctors spend more time carrying out admin duties than in formal training and teaching sessions. There are electronic discharge systems present however, these have been described as insufficient as they lack comprehensive coding and in some circumstances have actually lengthened the process.

The current problems with discharge summaries have resulted in extended patient stays with consequent unnecessary bed blocks.

The national programme for IT had a vision for standardising electronic information systems across the country. This ambitious goal ultimately failed to deliver on its promises. This was largely due to the top down approach undertaken by the UK government. A push towards a more bottom up, local approach has since been adopted.

This provides a perfect platform for ‘OUR COMPANY’ to exploit this market space and provide customised information systems solutions to hospitals and GP practices. Our product, SED (Smart electronic discharge), automatically prepopulates the electronic discharge form using existing electronic patient information, vastly reducing the time taken to produce a discharge summary and increasing efficiency and cost savings.

Of the 1000 hospitals in the UK, around 80% of these meet the perquisite requirements for the functionality of our software. Other software firms (Beacon and Medisec) have already entered this market, however there offerings do not incorporate our soon to be patented ‘smart technology’.
We aim to obtain a grant from the health innovation challenge fund to develop our software package. We are also in the early negotiation stages with several hospitals who have expressed interest in our product and we plan to use the money from the grant to implement it in one of these hospitals.

PRODUCT
SED (smart electronic discharge) is a unique system that aims to replace the current methods of producing discharge summaries. The ‘smart’ software is able to automatically extract the appropriate data from the electronic patient and prescribing records and input it into the relevant fields of the online, standardised discharge form. In addition to the automatically validated fields, there are also drop-down lists and date selectors to improve the efficiency of the discharge production process thus saving valuable clinician time whilst producing a comprehensive summary. An option to link the system with local GP surgeries will also be in place.
This section is automatically inputted by SED
This section is automatically inputted by SED
Additional information written by the clinician
Additional information written by the clinician
Medications are checked by the ward pharmacist and the clinician in charge of proof reading the form
Medications are checked by the ward pharmacist and the clinician in charge of proof reading the form
This section is automatically inputted by SED
This section is automatically inputted by SED
This section is automatically inputted by SED
This section is automatically inputted by SED

The benefits of our configurable, easy-to-use and secure system include a reduction in discharge times with accurate clinical information reaching the GP on the same day. This will remove mail handling for primary and secondary care. In addition, the software has a number of checkpoints to ensure compliance with drug dispensing requirements, avoiding fatal prescribing errors whilst simultaneously providing an improved audit trail. Our solution offers a streamlined, efficient and consistent system that saves hospitals time and money. This has been demonstrated by a prospective case control study investigating the time delay in the production of a discharge summary, with the main findings shown below.

Current methods of producing a discharge summary include handwritten and electronic formats. The main problem with handwritten summaries is the illegibility of handwriting, with the resulting form also having to be posted to GP’s or scanned and emailed. This essentially adds a further step to the process. Existing electronic formats still need manual input of the data, meaning they are still prone to errors and can often be more time consuming than handwritten forms. A step further from this is forms containing drop down boxes. This often results in problems due to the limited options and has not been shown to increase efficiency.
Although a number of solutions are already in the market, no system has the ability to automatically prepopulate the discharge form with existing electronic patient information. Our integration engine also handles messaging of completed summaries to the relevant primary care physicians. We believe this will provide us with a significant competitive advantage to gain a foothold within the UK market.
The initial cost of the software will cover the cost of the system, the training of doctors and maintenance of the system. The software will include free updates and maintenance in the first 2 years. Thereafter, software updates will be available at a reasonable cost in order to speed up the systems with benefits of added features.
Facilitating faster data collection, if any fields are missing/incorrect on inspection, contact details of those responsible can be flagged up ensuring rapid delivery of accurate e-Discharge summaries to GPs.
Built-in user interface allowing feedback and two-way communication between primary and secondary care in order to resolve queries as efficiently as possible.

Risks and opportunities
Opportunities
We have identified a gap in health information technology market. We aim to patent our technology, making the barriers to entry high. Additionally, we can aim to form a strategic alliance or a joint venture with the software providers of EPR in order in to increase uptake of our system.
Risks
There a number of risks associated with the smart software due to the technical nature of our proposed product. Firstly, we anticipate some initial resistance from clinicians in adopting the software following the issues with the NPfIT programme. We endeavour to involve all end users from an early stage in the implementation process, as has been illustrated by our initial market research amongst junior doctors in shaping the software. Secondly, the variability in hospital systems currently in place may pose compatibility issues, however SED is a configurable and easy-to-use system. Furthermore, we will dedicate additional time during installation to address any problems regarding compatibility as maintenance and training are included in the cost of the software. Thirdly, the software is subject to imitation by competitors however ‘first-mover’ advantage will enable us to implement the software in a number of hospitals before similar products are released. Additionally, future plans include forming a strategic alliance with the developers of electronic patient record; this provides those hospitals that have yet to go paperless the opportunity to go digital in one go to enable a comprehensive and integrated solution for their information system needs. The strategic alliance will provide us a distinct competitive advantage over potential imitators.

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