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Situation

East Grinstead’s Queen Victoria Hospital NHS Foundation Trust (QVH) is one of the world’s leading specialist centres for reconstructive surgery, and expert therapy and rehabilitation services. It serves people across the South of England who have experienced damage or disfigurement as a result of disease, trauma, burns, major surgery or a congenital condition.

Burn victims and patients who could have been treated at their local hospital were often sent to QVH for review. In such cases treatment could be delayed by several hours, and patients would be involved in unnecessary travel (particularly if QVH’s services were not suitable for the patient). QVH consultants and specialists could also be diverted from other urgent cases that were more suited to QVH’s highly specialised capabilities. In 2012, QVH recognised that this was a situation which could be solved with adoption of the latest technologies.

Solution

Ballard Chalmers is a Microsoft Gold Partner, and greatly experienced in developing custom software for public sector organisations.

Initially, Ballard Chalmers’ consultants were brought in to work closely with QVH to scope out the design and objectives of a new application that would allow their specialists to review cases online, ensuring that patients would be transferred to the appropriate hospital, thus treated as quickly as possible. Following intensive evaluations, QVH contracted Ballard Chalmers for the design, development and implementation of the new solution – Telemedicine Referral Images Portal System (TRIPS).

TRIPS was built within a SharePoint 2010 environment using .NET custom development, running on SharePoint 2010 Server using Standard CAL licenses. It has now been implemented at QVH, providing a secure (encrypted) transfer of digital images of injuries, which enables hospitals to directly link review and consult with QVH clinicians on patient injuries at any time of day or night, regardless of where in the region the patient is located.

Outcome

QVH’s partnership with Ballard Chalmers has been highly successful. The TRIPS platform has streamlined the way in which QVH clinicians interact with other hospitals, averting unsuitable patients from making the unnecessary journey, saving time and ensuring that the hospital is ready to receive and treat patients efficiently and effectively. Most importantly TRIPS has helped to save lives and undue suffering.

Nasir Rafiq, IT Manager at Queen Victoria Hospital said, “We appreciate all of the project input from Ballard Chalmers, who not only developed the system rapidly and without disruption, but suggested enhancements to our original concept. The system is creating opportunities for even better patient care than envisaged at the start of the project.

The roll out of TRIPS was further accelerated by the involvement of the London and South East of England Burn Network (LSEBN), who recognised that it contributed substantially to its own objectives. The LSEBN was established in 2008 to take forward the recommendations of the National Burn Care Review Committee Report, which found that there was an “urgent need for a coherent national burn care strategy with clear standards”. The LSEBN provides the framework for a coordinated approach to burn care in London and the South East and the decision was taken to implement TRIPS in other hospitals.

Clinicians across London and the South East are now using TRIPS to expedite patient care. Patients can be immediately referred to one of five hospitals in the south east of England: QVH, Broomfield Hospital (Chelmsford), Chelsea and Westminster Hospital, St Georges Hospital (Tooting), and Stoke Mandeville Hospital (Aylesbury) and specialised clinicians within each of these five hubs are able to interact with approximately 200 hospital emergency departments and over 7 million potential patients.

This NHS Consultant in Emergency Medicine said "...the TRIPS system is great because it allows the picture to be worth a thousand words, especially when you can talk to a coordinator or clinician with the photos in front of you. It allows you - as the referring clinician - to have confidence in the diagnostic support, because the support can see the injury and also it allows you to be exact when discussing concerns or specific questions regarding particular injuries and management."

The current system is hosted within the QVH domain but in future, hubs and other hospitals could have their own deployment of the system. Potentially each one could be hosted on a separate SharePoint farm at the individual hospital, or alternatively they could be hosted on the SharePoint farm at QVH in a separate site collection and database. As well as providing scalability and resilience, the system is easy to maintain and requires little additional investment in IT.

Currently, the TRIPS website receives over 18,000 referrals per year. Images are received from over 200 fixed locations in A&E, Urgent Care centres, walk-in centres and minor injuries units across the region. In addition, paramedic practitioner teams provided by South East Coast Ambulance Service are able to send images and receive clinical advice from the scene of an incident.

Ballard Chalmers’ CTO, Geoff Ballard said, “Prior to working with QVH we had a proven history of designing, developing and implementing advanced medical solutions for the NHS. QVH recognised that we had the skills to make TRIPS a success.

He added, “As a result of the partnership, TRIPS transformed the way QVH’s medical specialists interact with other hospitals and potential patients. It’s a solution greatly benefiting patients, where speedy action is critical to the outcome of recovery. From what I understand, TRIPS has also significantly improved the quality of advice that burn professionals can provide and has reduced the number of patients who are inappropriately transferred to a burn service.

In January 2013 Ballard Chalmers’ development of TRIPS was recognised by Microsoft as their Partner Solution of the Week. The recognition stated that the system “eases communication, is scalable, easy to maintain and maximises utilisation of the hospital's vital resources”.

In April 2016 the implementation of TRIPS by LSEBN was shortlisted by the Health Service Journal Value in Healthcare Awards in the Telehealth category. These awards recognise and reward outstanding efficiency and improvement by the NHS. 

About

Ballard Chalmers is one of the UK’s leading enterprise software engineering companies, specialising in development for the Microsoft Enterprise Application Platform. We are principally dedicated to software development and integration for the Microsoft Cloud, as well as on-premises and hybrid systems. Our expertise is in Microsoft .NET, SQL Server, BizTalk Server and SharePoint Server.

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