The Southmead Story, ACIS - Advanced Clinical Information System

Thursday 25 November 1999

The Board Room, Moorfields Eye Hospital, City Road, London, EC1V 2CD


Dr Anthony Madden, Consultant Anaesthetist & acting ACIS Programme Director, Southmead Hospital, North Bristol NHS Trust

The presentation built upon the short talk given by Tony in the LMSG session at HC'99 as reported in the May edition of LMSG News, and expands upon some of the issues identified in the LMSG meeting of January 1999, reported in the March 1999 edition. His talk was organised as follows:

  • The Clinical Problem
  • The Strategic Context - 1999
  • The Strategic Context - 1994
  • What is ACIS?
  • ACIS Implementation
  • Benefits
  • Lessons 
  • The Future

The issues facing the Trust were similar to the rest of the NHS but can be illustrated by:
1) The John Glen problem - we can send a 70 year old into orbit but we cannot retrieve the notes for our patients.

2) Airline fatalities run at 0.27/million departures, but hospital admissions carry a 3.7% risk of iatrogenic injury, & 13.6% of injuries are fatal.

3) Dr Madden introduced quotes from Lawrence Weed:
Paper-based systems 'can not assist the human brain’s limited capacity to recall and process large amounts of data'
'If we managed travel like we manage healthcare then travel agents would book flights on the basis of the flight schedules they could remember'

4) The Audit commission (1995) noted that Paper clinical notes are 'poorly legible, ill-structured, bulky and untidy'

With key resources of money, the estate, people, & information, a strategy was set out by the Trust which would achieve Evidence Based practice, Integrated care paths, multi-disciplinary clinical teams & use of the existing ACIS system.

This was in 1995 & they reviewed possible suppliers, but the existing supplier (EDS) was judged the best solution. Following user involvement in getting the business case approved an agreement with EDS was set out in a 9 year contract, with clear objectives : to achieve value for money, secure the lifetime of the legacy systems & to outsource the IT.

ACIS comprises the information & functions that support effective patient care, i.e. from one workstation a carer has access to legacy hospital systems, to EPR (which contains GUI, rules, OCS), intranet & internet, email & basic office functions. Implementation has been staged within each clinical department.

In year 1 the following are introduced: Clinical repository + presentation of data, Order communications, Electronic prescribing - orders, Embedded guidelines (Order Sets), Basic decision support, Knowledge bases (Internet, Medline).

In Year 2 order communications are expanded to include MAR (Medicine administration recording), patient documentation, integrated care pathways & sophisticated decision support.

Clinical departments have been categorised into 3 groups, those that are well contained (cardiology, general surgery), the diffuse (general medicine, urology, gynaecology) & those that are very mixed in their interactions (A&E, Orthopaedics & trauma, renal, obstetrics). The first category have been equipped but it is taking more effort for the latter groups.

Benefits so far -

Structured clinical records - patient centred, with a place for everything & everything in its place, Patient lists are now accurate & complete, Summary clinical histories are available, Order status tracking can be carried out, Results can be displayed by order /day /graph. There is no duplicate data entry.

Improved work environment, with on-line guidance & remote 24 hr x 7 day access, estimated saving of 30 min/day/doctor, & reduces the mileage covered by doctors in chasing information.

For the Trust, there is now analysable data, the system has been a factor in pushing through ward re-organisation, ADT processes are better, and specimen collection is more controlled.

Reduced Length of stay is suggested by the data though the correlation is not strong.

Expected benefits soon are improved standards of care, improved clinical audit, access to eBNF, multi-professional care paths.

The session concluded with questions and answers annd some general discussion.