NHS LONG TERM PLAN


providing multidisciplinary teams with instant access to patient medical history, whenever there is patient interaction. Implemented in 2014, Hicom’s paediatric diabetes management system, Twinkle, links with the hospital’s PAS and pathology system to provide nurses, clinicians and dieticians with the ability to quickly access up to date patient data, appointments and test results. Twinkle also delivers a single view of all medical notes and as a result has improved operational efficiencies and interoperability, which has led to considerable time savings for staff and better care for patients within the hospital’s three clinics and in their homes.


Efficiency


The system enables nurses to review vital patient data such as what insulin regimen a patient is on, previous appointment notes, historical HbA1c in graphical form and any ongoing issues that need to be evaluated. They can also view any alerts that are on patient records that indicate additional tests are required. Dr Parakkal Raffeeq, consultant paediatrician at University Hospitals of North Midlands, said: “The process of planning each day of appointments has not only become less time intensive with using Twinkle but we’ve also been able to better manage resources. “Previously, data was just being stored,


however Twinkle is more than a database, it’s a live clinical information system. For example, if a nurse in the community visits a patient in the morning and a note is added to the system to state additional insulin was given, both us and our patients have the reassurance that a nurse on call later that evening will have access to up to date and accurate information and will know the next course of care needed to be given to the patient.


“This has led to the team feeling more prepared heading into an appointment and they know what the outcome of the appointment needs to be.”


Auditability


With the requirement to regularly submit information for the National Paediatric Diabetes Audit (NPDA), one of the initial main drivers for the Trust to use Twinkle was having the use of data indicators that immediately identify any gaps in information. Similarly, when reporting for the Best Practice Tariff (BPT), clinicians are able to click on individual patients and see how they are performing, how many appointments they have left in the fiscal year and whether they are likely to meet targets that have been set. These features are key to enabling clinicians to proactively manage long term care planning and ensure accuracy of data as part of their day to day patient interactions. Dr Raffeeq continued: “The functionality of being able to access individual patient data, whether recent or historic, and at any time, is proving to be extremely useful for when we review patient care and for the NPDA.”


Paperless-approach


In support of the Government target for the NHS to become paperless by 2024, the Trust is committed to moving away from paper-based records and migrating to a digital working environment. Dr Raffeeq, noted: “Working with paper records has been challenging. If notes don’t arrive at the clinics in time or are misplaced, it can have an immediate knock on effect to not only our team but also our patients. Now, if a note is added to a patient record, regardless of when it was added or if it was added in a clinic or at the patient’s home, we are all able to view what


care is needed on any given day. “Additionally, we are delighted that


having Twinkle and digitising our processes has meant that the aim to achieving paperless records throughout the entire Trust is well and truly in sight.” The implementation of Twinkle has proved to be an invaluable data resource for the diabetes team at UHNM and the day to day operation of the hospital. It is enabling staff to input changes to patient records in real time and giving them access to accurate and up to date information, whilst cutting down the amount of time spent on administrative tasks. Additionally, it is helping them to better prepare for and manage appointments and has freed them up to spend more time with patients. Ultimately, the combination of all the benefits being seen from using the technology has led to the diabetes team being able to make better informed decisions about the care they provide to each of their patients.


Looking to the future


There is already a great deal of progress being made by the NHS and its providers and it is vital that this good work continues. Integration must be a primary consideration when selecting and implementing new digital solutions, not an afterthought. The investment at an early stage of projects will deliver considerable rewards in terms of data accuracy, clinical time saving, patient satisfaction with how they are treated and ultimately better outcomes in the long term. This will allow targeting variation in the achievement of diabetes management, treatment and care processes, in line with the Long Term Plan commitments.


References


1 “Operational productivity and performance in English NHS acute hospitals: Unwarranted variations.” Accessible at https://www.medica- tradefair.com/en/Press/Press_Material/Trend_ Reports/MEDICA_becomes_number_one_trade_ fair_for_health_start-ups_too


2 The NHS IT Strategy. Accessible at https://www.england.nhs.uk/blog/the-nhs-it-strategy/


3 Enhancing the Quality of Life for People Living with Long Term Conditions. Accessible at https://www.england.nhs.uk/wp- content/uploads/2014/09/ltc-infographic.pdf


4 https://www.england.nhs.uk/diabetes/treatment-care/ 5 https://www.diabetes.org.uk/about_us/news/ diabetes-prevalence-statistics


6 https://pharmafield.co.uk/healthcare/what-is- diabetes-symptoms-policy-and-treatment/


7 Diabetes in adults. Accessible at https://www.nice.org.uk/guidance/qs6/chapter/List- of-quality-statements


8 Type 2 diabetes in adults: management. Accessible at https://www.nice.org.uk/guidance/ng28


9 Paediatric Diabetes Best Practice Tariff Criteria – for paediatric diabetes units in England A brief guide Updated November 2017 V2. Accessible at http://www.cypdiabetesnetwork.nhs.uk/files/7015/1 238/6565/Updated_Guide_for_Paediatric_Diabetes _Best_Practice_Tariff_Criteria_V2_2.pdf


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