Paul Wilder (Interim lead for Technology Enhanced Learning at Frimley Health NHS Foundation Trust)
The Electronic Patient Record has changed dramatically over the last 20 years as NHS Trusts start embracing computer systems to record details about the patient’s medical journey (nursing/medical notes, radiology, clinical observations on NEWS 2, prescribing, etc). As simulation technologists and educators our challenge is to incorporate a representation of these systems effectively and smoothly into our scenarios.
In part one of this article I covered what I believed the main options a simulation service has in this regard, and then in part two I discussed some different approaches to creating an in-house simulated EPR system – most of which were Microsoft Excel based. In this third and final part I wish to look at how you can approach this subject if you have the funds available to put towards a commercial solution, and what are the advantages of doing this, such as how they might be superior at dealing with the various challenges raised by running in an educational setting.
Currently as this is such an evolving new aspect of simulation based education, I’m only aware of two main commercial approaches; the first is to pay a programmer to create a bespoke system or app based on your exact specifications and the second is to pay for an annual subscription to the UK web based SIMEPR system.
Although you gain the advantage of having a bespoke system, the issue with the first approach is that your organization is having to pay all the costs to create a full system to your specifications, which means you have to get those correct up front. In addition, there are ramifications to consider about what happens as time goes on. I heard from one trust that had gone down this route who now had a basic simulated EPR system, but it didn’t meet their evolving specifications, nor did it quite do what they wanted, but they could no longer find any more money to pay the programmer, especially because the original one was no longer available, so they would need to find someone new willing to understand and work with it.
The second approach of subscribing to SIMEPR has the immediate obvious disadvantage of you not owning the system, so your budget must factor in a not inconsiderable sum of money every year. In addition, if you have put a lot of work into creating your own scenarios in its Cloud system and then you decide to not pay anymore, you would lose all that effort – although as well as the ability to edit scenarios created by others to save time writing them from scratch (more of that below), there is also in development a link between the commercial IRIS scenario sharing platform and SIMEPR.
I feel well placed to briefly discuss this second approach, as I led from our trust (as one of six) in using and evaluating SIMEPR, originally for our Foundation Doctor programme as part of an HEE funded project. For example I know that although being cloud based means you do not need to install any software, you do need internet access to it on two devices (candidate and facilitator), and we were not the only trust to have IT firewall issues – indeed we now use our patient guest Wi-Fi for our access. However that also has the advantage that developing, modifying and even controlling scenarios can be done from any internet enabled device, including when off site, and that the system is easily upgradable with new features that involve nothing more from our end than logging out and back in again.
I don’t wish to turn this article into a sales pitch (I have no connection to the company, other than being a customer), so will only briefly outline a few of the other advantages I feel the system has, but we have overwhelming positive feedback from our candidates that points to its value, hence our trust continuing to pay for it every year.
I briefly mentioned scenario sharing above, and I am proud that thanks to many months of hard work in our trust (primarily by our Education Fellows), that we have roughly thirty fully detailed multidisciplinary / FY scenarios, including ten-page standardised templated Word documents linked to our Sharepoint from SIMEPR. We also have other scenarios such as for Physio On Call and Preceptorship Deteriorating Patients, and inside of SIMEPR all of these are accessible, downloadable and easily editable by any other organisation for their own simulation use.
The company is one person and he is exceptionally responsive to suggestions and is constantly updating the product – for example we now wish to use it with our ODPs and Anaesthetists, so requested theatre paperwork such as the WHO Surgical Checklist be added for use by candidates. Indeed the sharing scenarios function was due to the request made near the start of the original HEE funded project, as all six trusts involved wanted a collaborative approach. Another feature I believe was developed after feedback, was that universities requested it better reflect how they run simulation, so a ward based mode was introduced that allows multiple candidates to deal with multiple patients.
The product itself is exceptionally simple to use – indeed we’ve had both candidates and facilitators use it without any training whatsoever, although that’s not a recommended course of action, but shows just how easy it is to choose a patient, view their history, review and write NEWS scores, prescribe medication and so on. Indeed our brief introduction to SIMEPR for candidates before the start of a scenario is now often given by a simtech and not a facilitator / clinician.
One of my favourite features is how the facilitators can monitor (e.g. on an iPad) what the candidates are doing on SimEPR and when they request an investigation (such as an ABG or chest x-ray), the facilitator can, at the time of their choosing, send back either a prepared programmed result or just create / download one for the candidates to review. This has totally negated the laminated results cards that I used to hide around the simsuite under trays and the like, and having to tell the candidates where they were when we wanted them to see the relevant results.
In the same manner we used to have to tell candidates to always write on the NEWS sheet and Drug Charts etc in pencil, and then after every scenario we would have to rub them out – now the scenario automatically resets itself back to its initial programmed state, and it keeps track of relative timings too – so the patient always stays the same age (on paper we once accidently had one of our very old paediatric scenario patients no longer be a child – opps!) and (for example) the patient on SIMEPR can always have had their last observations taken exactly ten minutes before the scenario started.
So in conclusion I believe that if you can afford it then SIMEPR is by far the best way to go currently, however events are moving fast and there are conversations already taking place around a free open source solution that multiple organisations could modify themselves if they desired. This can only benefit all of us in the long term, as along with all the other home-grown solutions out there, it provides us with choice and hopefully also applies pressure on the subscription cost of SIMEPR.
I hope you found my three part article useful (or at least interesting!), because it’s been very rare in my experience that we have had such a radical change in how we support and run our simulation based education, to more closely model what happens in real healthcare settings. I’m always happy to talk about this subject so if you have any comments, feedback or other questions please email me or catch me at a simulation conference / meeting.
Thank you for reading.
paul.wilder@nhs.net