Blueberry In-Patient Management System - Overview
BIMS integrates with hospital Trusts’ Patient Administration Systems (PAS) to automatically enter patients into BIMS and to the Trust’s Active Directory login system to provide a simple login method for users. A flexible permissions system limits access according to the users’ role, whilst a reporting sub-system allows comprehensive monitoring of performance against a variety of targets.
The length of time patients have to wait in Accident & Emergency is one of the key issues for the health service and much effort has been put into improving these by hospital trusts. In line with recommendations made in the Government’s NHS Plan for England, a ‘see and treat’ incentive scheme has been in place since 2004 aimed at reducing A&E waiting times:
“No patient should spend more than 4 hours waiting in A&E departments – from arrival to admission, transfer or discharge – other than in exceptional circumstances.”
The BIMS ED interface builds on the successful KLOK system produced by Blueberry Consultants and has the following key features:
- A “Desktop” display showing all the patients in ED along with details such as name, time arrived, doctor etc. A colour coded ‘traffic-light’ display is used so that staff can quickly identify how long each patient has been waiting and if a 4 hour breach is likely.
- A “Patient Record” display which is used to edit patient details and to transfer patients between bays in ED and to request a ward admission.
- A “Medical Records” feature which is used to automate the requests for patients’ medical details.
- Administration screens which are used to define system parameters such as doctors’ names, department names, bay names etc
- A reports area which allows a user to generate reports on the number of patients who exceeded the 4 hour wait time and a means to review and annotate those breaches.
If a patient is discharged from ED after treatment then a discharge letter can easily be written and immediately printed.
Electronic delivery of discharge letters to the patient’s GP is also possible. Alternatively if a patient is to be admitted then a bed request can be made directly from the patient details screen. The ED Desktop display shows a summary of bed requests and allocations in a clear manner.
Bed Request and Management
The bed management screens show the current outstanding bed requests, split into a number of different categories, e.g. urgent, repats, ward movers. When allocating a bed the current bed occupancies for each ward are shown, with accompanying statistics on sex of patient and other requirements. Estimates of bed free times can be added by the ward staff which assists the bed managers in allocating suitable beds.
Patients can be allocated to free beds or queued to currently occupied beds.
The ward screens are similar to those in ED but with more emphasis on capturing information about the patient’s condition and on the status of the beds on the ward. There are two ways of viewing the ward status:
This shows a summary of the patients’ details in a table view. The table is colour-coded to indicate how close a patient is to the Estimated Departure Date ( EDD ). Additional parts of the table show patients that are pending arrival, including those who have actually arrived but not transferred to the bed and those patients that are expected but not yet arrived. Patients who have been discharged but whose discharge letters have not been completed are also shown.
The bed view shows a diagrammatic view of the beds on the ward, grouped into bays and sections. Summary details of the patient in each bed are provided and beds that are currently empty but are allocated to patients are also indicated.
By using Microsoft’s Silverlight development platform the bed view provides a user-friendly interface where, for example, patients can be transferred between beds on the ward simply by dragging and dropping.
In both views clicking on a patient will bring up the patient details screen for that patient.
One of the aims of the BIMS system is to capture enough patient treatment data during the patient’s stay to allow discharge letters to be completed automatically. Letters can then be given to the patient on discharge rather than being completed at a later date. Copies of patient letters to GPs and notes copies are generated automatically and additional copies, e.g. for child protection agencies, can easily be specified.
Electronic delivery of letters is also possible provided the target e-mail addresses are within the NHS.net domain.
Two letter templates are provided – one for ED patients and one for in-patients. Letters are stored with the patient details and can be viewed or re-printed at a future date.
Controlled drugs can be prescribed using an electronic TTO system in adherence and compliance with legislation. Complete dose information can be entered on the system, including quantity, route, frequency, duration and notes. A method for pharmacy approval for prescriptions is built in to BIMS.
Integration with Other Systems
To avoid duplicate data entry or manually copying of data from other systems, BIMS can integrate with a number of different data sources:
- PAS – patient records are transferred from PAS via a HL7 link and automatically entered into BIMS.
- GP address data – PAS supplies a GP reference ID which is used to obtain GP address details from a database within the Trust.
- User login information – BIMS uses the user’s Windows login to authenticate and determine the user’s access permissions. A method of regularly updating the BIMS users from the Trust’s personnel database is available.
- Drugs database – the available drugs list for writing prescriptions is imported from a different database within the Trust. This list is automatically updated on a daily basis.
“Now that the patient management system has been operational for some time at the Lister and QEII hospitals, the benefits are really starting to emerge. In fact, the staff who originally resisted the system now threaten death if it goes offline!" Teri-ann Grange I.T. Projects Manager East and North Hertfordshire NHS Trust