Neil Pound ISUG 2012. Plan How we transferred from Isoft to TPP (And a little bit about why) How we...
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Transcript of Neil Pound ISUG 2012. Plan How we transferred from Isoft to TPP (And a little bit about why) How we...
![Page 1: Neil Pound ISUG 2012. Plan How we transferred from Isoft to TPP (And a little bit about why) How we switched What went right & wrong What to ask the suppliers.](https://reader035.fdocuments.us/reader035/viewer/2022062516/56649e365503460f94b266e1/html5/thumbnails/1.jpg)
Neil PoundISUG 2012
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Plan• How we transferred from Isoft to TPP
(And a little bit about why)
• How we switched• What went right & wrong• What to ask the suppliers at the demos• Where we are now• What I wish I had known 12 months ago
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This isn’t going to be…
• Advice on which system to choose• A plug for TPP (but we do like it now)
• A model example of best practice
But it will be warts and all truthful!
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Background
• Woodlands Medical Practice, PMS PFI 10yrs ago• Sutton in Ashfield, deprived• 9200 pts, increasing• 5.2wte doctors, 4wte nurses (NP)• F2 training• 4 reception, 2 nurse admin, 2 script admin, 2
data quality, low staff turnover• Host nursing home coordinator service
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Background: IT• Isoft Premiere 10+ yrs (Microdoc)• Apollo SQL/Apolloscan (8 yrs)• Frontdesk/Contract+• Easylabeller• Cardiosoft ECG• Welch Allyn ABPM• GPintranet
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Background: Organizational
• Paper-light• Nurse Clinical coder (QOF)• Touch screen check in / Jayex• On line appointments / script ordering• Pathlinks (one local provider)• Data “cleansed” (IM&T DES)• No dedicated IT person
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Me• Ex nurse/IT trainer/programmer/systems
analyst• GP (9.5 clinical sessions)• Federation chair• QOF/IT lead• No links to Isoft/TPP• My views are my own!
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Why did we change?• Isolation• Functionality• Disastrous trials ETP/C&B• Lack of support (local / Isoft)• Complexity of integration• Lack of robust hosted solution• Future uncertainty
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Choosing a system (Avon IM&T)
• Practice (clinical benefits / strategy / impact)• Strategic fit (local / national)• System (status / roadmap / functionality)• Financial implications (practice / PCT)• Management considerations (practice / PCT)
• Decide priorities • NO SYSTEM MEETS ALL REQUIREMENTS
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What to look for• Don’t just consider the clinical consultation• Functionality: gains vs losses• Where do you want/need to be in the future• Commissioning• Add-ons (current/integration/necessary)• QOF (updates)• Reporting• Current software & developments
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What to look for: data sharing
• Locality teams (DN, palliative, MH, sec care, HV)• Templates• Formularies• Organisation• Messaging• ? Problems / access / “ownership”
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What to look for at the demo
• Sales reps will have an orchestrated demonstration: break it up, use real time demo if poss, ask Q’s ‘show me’
• Beware airware• Involve as many staff as practical and at least one
reception/admin/nurse• Arrange a second demonstration• Examples (eg set up template / search / recall
communication)
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Important questions for new provider (1)
• What data loss during the transfer?• Reference sites (local)• Is data in other systems (eg Frontdesk) part of
the clinical record & will this transfer?• What happens to data fields not mappable?
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Important questions for new provider (2)
• How is potential data loss (Premiere) handled?
• Does deleted data transfer?• Will recalls be directly transferred?• Will prescription history & reauthorizations
transfer?• How about pts not currently registered
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Important questions for current supplier
• How long will your database be accessible?• What happens if we need access to the data
after this period (costs & how long)?• Will you provide a named contact for data
queries (for the transfer)?• Do you need info from any other systems
(FDW)?
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Questions for IT• Will current hardware suffice (full survey)• Costs?• Branch surgeries• Extras (new equipment)• N3 link issues / reliability
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Timescales• August-Sep 2010 demonstrations providers• Sep-Oct shortlisting, further demo & technical
queries• October 2010 decision to change• March 2011 project initiation• September 1st data cut & verification• October 26th 2011 TPP go live
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Planning (6+ months)• Pick a go live date and fix it• Try and have all GPs present• Consider absences, QOF, holidays• Arrange locum support in advance• Backfill for ALL staff• Training needs assessment (differences)
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Planning (months)• Form project team in practice (?PM)• Monthly meetings in house• Supplier/training/IT meetings • IT survey (hardware)• Backup verification• Smart cards
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Planning (weeks)
• On schedule?• Data cuts (verification/validation for
migration)• Test system available?• Detailed training schedule• Backfill/locum• Tell patients• Rota (less ? no routine)• Repeat prescriptions• Operational/business procedures (with
trainers)• Training (system administration)
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Planning (days)
• Trainers on site (process review)
• Training in test environment
• Prepare (some) data for live site (templates, formularies, staff, configuration)
• Hardware installation & configuration
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Planning (D-2)
• Last data cut• No scanning/pathlinks (manual systems)• Consultations ? Paper ? Old system• Shared list appointments (any practitioner)• No QOF, no “routine” work• Training• Heaven!
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Planning (D-1)
• Technical go live• Hardware testing (IT on site)• (check data)• Training• Set up staff rotas• Transfer to live system
(staff/templates/formularies)
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Go-live day• IT & multiple trainers on site ? in room if nec
• Longer appointments with breaks
• Review lunch & end of afternoon
• “Emergencies” only: no routine work
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Post go-live (days)• More training (scanning/pathlinks/letters)• Catch up (scanning/pathlinks)• Template modification• Consolidation training • Back to usual appointment system• Routine work resumes
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Post go-live (weeks)• Templates modifying (still)• Recalls updating• Repeat prescriptions restarting• Scanning/pathlinks catch up • Data re-entry from system downtime• Reports - reestablishing• QOF resuming
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What went well• Data transfer • Negotiation with migration team• IT hardware (touchscreen, Jayex, printers)• Well planned project management• Patient appointments & scripts• Manual procedures pathlinks/documents• Electronic pathlinks & documents
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What went a bit wrong• Communications & messages• Patient reminders• Templates• Scanning & document management• Configuration users & screens• QOF catchup
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What went horribly wrong
• Training (inconsistent, inflexible)• Post go-live workload underestimated• Repeat script catch up• Scanning/pathlinks catch up• Christmas & the flu season (weather?)• Holidays• Recalls not serviceable• Appointments (searching)
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What did we do?
• Panic• Review, discuss & change (daily team &
monthly practice meetings)• Looked at other practice’s use of system• Tried not to change too much too quickly
(process) • Extra work (me)
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Overall Review
• Training: quality, duration, consistency • Business process management: don’t change
it if you don’t have to• Time bombshell• 3 months to be up to any speed• 6 months to be back where we were• 9+ months to be ahead of this
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Costs?• Very difficult to quantify
• Main cost to practice is lost time & productivity
• Backfill & locum costs
• Extra time to configure system (me)
• QOF / complaints / stress
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Regrets?• Lack training environment early• Didn’t realise poor quality training & little
understanding how GP’s (us) work • Didn’t recognise trainers misconception that
all practices work to same IT level• Didn’t look at how other practices use their
system early enough• Complacent (go live), lost overview
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Currently• 11 months on• Functionality better (templates/macros)• Data sharing (safeguarding)• Prompt letters• ICE ordering & access to pathology• Reliable• Working remotely
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What do I like?• Functionality better: Templates & macros• Formularies (Read/drugs)• Reporting (fast, easy)• Alerts• Customized views & configurability• Data sharing (safeguarding)• Prompt letters, ICE & access to pathology• Reliable• Working remotely
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What do I miss?• Frontdesk• Upto date reporting• Error messages• Upgrades & multilex updates• ISUG conference
• ? control
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Finally• Good luck: you will cope• GP’s flexible & resilient: cope with change• But timescales, so many changes, complexity…• It will be difficult but plan ahead• Think disaster recovery,
what if scenarios• Ask for help (SNUG)
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Useful links
• http://www.gp.aimtc.nhs.uk/GPSoC_Change.asp• http://www.gpchoice.org/gp-choice/decision-to-
change-systems.aspx• http://www.connectingforhealth.nhs.uk/systems
andservices/gpsupport/gpsocce.org/gp-choice.aspx