Our IT policy has been to provide clinical staff with the tools and technology that would enable them to do their job optimally, rather than settling for a universal, but individually-average system
Hospitals face a huge challenge in trying to improve ways of securely, efficiently and cost-effectively accessing patient data. Challenges include an increasing number of clinical applications, massive and ever-expanding volumes of data, a dynamic workforce, the shift to cross-organisational collaborative care, and the increasing scrutiny on high-quality patient care. As such, making the most of clinicians’ valuable time, and providing them with easy, secure access to the right information at the right time, is key.
Salisbury NHS Foundation Trust is one such organisation, which has chosen Caradigm Single Sign-On and Caradigm Context Management software from the Caradigm Identity and Access Management (IAM) suite, to provide its clinicians with improved, rapid access to relevant information, saving time and money – and representing the first stage in its move towards cross-organisational collaboration.
The challenge
Salisbury NHS Foundation Trust operates Salisbury District Hospital, one of only two hospitals in Wiltshire. The trust employs approximately 4,000 staff and provides care to more than 290,000 patients a year across its range of emergency, inpatient and outpatient services.
The trust has always had a policy of selecting ‘best-of-breed’ clinical systems; those which best suited the physicians’ needs. However, over the years this approach has provided the organisation with multiple independent systems. Consequently, the amount of time clinical staff were having to spend switching between different applications was raising concerns over efficiency gains.
Not only was our IT helpdesk receiving a significant number of calls for password resets on a daily basis, but the feedback from clinicians was that we needed a way to make the technology work better for them to support them in providing patient care
Glen Holmes, director of informatics at the trust, explains: “Our IT policy has been to provide clinical staff with the tools and technology that would enable them to do their job optimally, rather than settling for a universal, but individually-average system.
“While this approach has a vast number of clinical benefits for staff, as we have added applications over the years, we ended up with the situation where staff had to remember multiple passwords to log in.
“The supposedly simple act of switching between applications had become arduous and time-consuming. Not only was our IT helpdesk receiving a significant number of calls for password resets on a daily basis, but the feedback from clinicians was that we needed a way to make the technology work better for them to support them in providing patient care.”
In addition, the trust found that, especially in busy departments such as A&E, it lacked an accurate audit trail or documentation reporting which applications individual staff members were using, and which patients were being viewed in these applications.
“What was happening – and this is by no means unique to Salisbury – is that staff were logging on, getting what they needed, and then leaving the machine open for other key members of clinical staff,” said Holmes.
“While this did not present us with any security issues, it did mean that we didn’t have an accurate picture of who was accessing which systems, or performing which tasks at any one time.
“We wanted to find a solution that would firstly save clinicians time by guaranteeing a seamless user switching experience. In addition, we wanted to gain more-meaningful information about what is happening across the trust, and lay the foundation for future collaboration and information sharing.”
The solution
Salisbury identified Caradigm’s Single Sign-On (SSO) and Context Management technology, part of its Identity and Access Management solution suite, as the most-appropriate, and future-proof solution. Caradigm’s SSO allows a clinician to log in once, and then have immediate and secure access to all role-based applications.
The trust has combined SSO with Caradigm’s fast user switching and strong authentication capabilities, which means that staff can quickly and easily unlock/lock the computer terminal’s screen by swiping or tapping their ID badge. When another user logs in, the original user has automatically already been logged out. Furthermore, the original user can log back in on any device within the same workgroup and be logged in and presented with their required application(s) automatically.
The result is that staff now have simple and secure access, with a single set of credentials that can be used for all of their applications.
The benefits
The trust has initially focused on SSO and will enable Context Management once SSO is fully deployed. Salisbury currently has 10 different applications that are SSO enabled, across approximately 180 computers and nearly 1,700 staff around the hospital.
“Our aim is that ultimately two thirds of the computers across the trust will be SSO enabled, while a third will remain private workstations,” Holmes said.
“We have already seen the hugely-positive benefits that the system is having in the areas where computers are shared amongst staff, particularly on inpatient wards. The system is also proving extremely valuable in helping us to manage the in-take and turn-over of our junior doctors; with 80-120 doctors arriving every six months, SSO is really helping them to be as effective as they can be, as quickly as possible, as they have access to the information they need without having to go search for it each time.
There was the impression that the role of IT within the trust was focused on saving costs. Caradigm’s SSO, however, has helped to change this perception in that it has had a tangible effect in making our clinicians’ lives easier and enabling them to spend more time providing quality patient care
“Indeed, we have been told by users that Caradigm SSO has reduced the sign-in time from approximately three-and-a-half minutes, to less than 10 seconds. With the average clinician logging in and out at least 10 times per day, we’re giving clinical staff back approximately two-and-a-half hours a week that they can now use to focus on the patient.”
In addition to the time Caradigm’s Identity and Access Management solution has given back to clinical staff, the technology is providing the trust with a much-more-comprehensive audit trail of activity around the organisation. For clinicians, this functionality provides further professional protection as it allows the trust to track which individual action each clinician took with each patient. The audit facility can also be applied to identify meaningful information around staffing levels and workforce insight, amongst others.
“The engagement and response from the clinical staff has been hugely positive,” said Holmes.
“There was the impression that the role of IT within the trust was focused on saving costs. Caradigm’s SSO, however, has helped to change this perception in that it has had a tangible effect in making our clinicians’ lives easier and enabling them to spend more time providing quality patient care. We’re giving them something that works and that they have wanted.”
The future
Salisbury anticipates that SSO will be fully rolled out across all areas of the trust by June 2015 to coincide with additional, large system upgrades that it is planning in other areas, including the theatres and maternity departments; as well as the implementation of a new EPR. It then intends to roll out Caradigm’s Context Management capabilities, starting with A&E.
Context Management maintains patient context across any relevant applications that are opened on the desktop or a mobile device, reducing the need for the clinician to search for a patient in more than one system. Automatic access to the correct patient record in this setting will save additional time, increase accuracy and reduce the risk of entering data for different patients in different systems. Furthermore, the Context Management functionality is already built in as part of the IAM integrated solution so when Salisbury is ready for the next implementation phase, all it will need to do is extend the workflow for each of the relevant application bridges.
The lessons we have learned from the implementation of SSO have been hugely valuable and will stand us in good stead as we move forward on our path towards integrated care
Commenting on the roll-out to date, Mansoor Khan, consultant plastic surgeon, said: “SSO is a great product. It saves me time when logging in, it’s simple to use and I can get to all my clinical applications quickly. The individual systems within SSO don’t crash or lose connectivity as often, so my clinic runs much more smoothly. Patient Context Management will be the icing on the cake, but SSO in itself is a major improvement to how IT works at Salisbury.”
Holmes added: “The lessons we have learned from the implementation of SSO have been hugely valuable and will stand us in good stead as we move forward on our path towards integrated care. The key is user engagement. We have seen how enthusiastic clinical staff have been when we provide them with a technology solution that enables them to spend more time concentrating on their specialism of patient care. Caradigm has helped bring us together with a shared purpose, and we look forward to the next phase of our relationship.”
