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PEARL Implementation Update

Sunday 13 November 2022: Bermuda Hospitals Board today provided an update on its progress with the implementation of its first BHB-wide electronic medical record system, called PEARL (Patient Electronic & Administrative Records Log).

Chief Executive Officer & President Dr Michael Richmond noted that the first two weeks had not been without their challenges, but that activity was beginning to return to normal.

He said: “The success of the implementation has been carried by our staff, external physicians and our partners, who prepared all they could, then have worked through the early expected issues that a major system implementation experiences. It has been a true team effort, as PEARL connects all parts of the hospital from pharmacy, diagnostics, finance and support areas to emergency, acute and critical care at all campuses.

“The good news is that we are on track and, after two weeks of having a slow down in our planned and outpatient activity, services will be running at normal capacity from Monday, including the number of elective surgeries. These are still early days, but issues have been managed, staff are mastering the new system, and we wanted the community to be fully informed about our progress.”

Despite a planned slow down in planned and outpatient activity, over the first two weeks after go-live there were still 3,267 encounters in ambulatory care (outpatient clinics and diagnostics), 150 surgeries (elective and emergency) and 20 babies born. In areas where activity could not be controlled, the normal activity levels were experienced. There were 1,011 people who attended the Emergency Department and Lamb Foggo Urgent Care Centre, and 142 admissions to an inpatient ward. This reflects KEMH and MWI wards.

In the Emergency Department, the average length of time between arrival and discharge did increase in line with expectations in the first week, but has gradually decreased since then (see data below).

Dr Richmond added: “I would like to extend my appreciation to the community for their understanding. We know it has been a challenge at times for patients in Emergency with longer average stays than normal, and elective procedures were reduced in the first two weeks. But the great promise of PEARL is to that as we work through this period we will be able to improve our care, smooth transitions, and use the system to help us deliver a better, safer care experience.”

PEARL went live in the early hours of Saturday 29 October, when information was transferred and then validated. Staff in different departments started using the system from the early afternoon.

The following is the ED length of stay (from arrival to discharge) for each day following go-live. The average length of stay up to 29 October in ED was 198 minutes (3 hours and 18 minutes).

Emergency average length of stay per day (midnight to midnight) in minutes

  • Saturday 29 October (partial day): 294
  • Sunday 30 October: 405
  • Monday 31 October: 442
  • Tuesday 1 November: 358
  • Wednesday 2 November: 485
  • Thursday 3 November: 366
  • Friday 4 November: 285
  • Saturday 5 November: 289
  • Sunday 6 November: 239
  • Monday 7 November: 289
  • Tuesday 8 November: 190
  • Wednesday 9 November: 160

 

13 November 2022 Home Page, News

BHB prepares for PEARL’s implementation

Thursday 27 October 2022: Bermuda Hospitals Board (BHB) today provided an update to the community about its first BHB-wide electronic medical record system, which goes live in the early morning of Saturday 29 October. The system has been called PEARL (Patient Electronic & Administrative Records Log) by staff.

Nurse on an acute care ward with a ‘workstation on wheels’ that can be used in patient rooms

PEARL is an electronic medical record system that makes patient information, from medical history to the latest physician notes and test results, immediately available to those who are involved in a patient’s care. This information will no longer be on paper or limited to fragmented systems. This means BHB staff caring for patients won’t have to wait for paper records to be delivered, check multiple systems for key information and results, or wait for information that might not have been filed yet. PEARL makes it easier to avoid duplications and delays because everything a clinician needs is immediately available in one place, and always up to date.

CEO & President Michael Richmond notes: “We are preparing for an exciting and significant transition in how we work. A big thank you must go to our staff across BHB for their hard work. PEARL’s implementation rests on the shoulders of hundreds of staff involved in designing, building and testing the system since the project started in April 2021, and over 1,400 staff who
are attending training, even as they meet their duties as care providers.

Staff involved in integrated testing earlier this year

“Our focus now is ensuring BHB maintains services safely throughout the go-live. There will likely be a couple of weeks where staff will be getting used to new processes, and we will run slightly slower than normal, but our ability to use PEARL will quickly become more sure and faster each day. Once we are used to using the system, the opportunities for improvements are going to help us soar.

“Going live with PEARL is just the beginning. PEARL is a tool our staff will use to deliver what they strive to do each day – the best possible levels of care and the best patient outcomes, something of which Bermuda can be truly proud.”

Key information about how BHB is managing PEARL’s go-live:

  • PEARL will be used across all BHB services – at King Edward VII Memorial Hospital, Mid-Atlantic Wellness Institute, Lamb Foggo Urgent Care Centre, and across all BHB group homes
  • All BHB services will continue throughout the go-live process, but it will initially take staff a bit longer to complete tasks as they put their training into practice
  • Elective activity (for example, non-urgent surgeries and outpatient appointments) will continue throughout, but there will be a phased reduction in work – at 50% of normal level in the first week after go-live and 75% of normal level in the second week after go-live. This will give staff some breathing room as they get used to using PEARL, minimising any potential patient safety or care risks. This is a best practice for implementing this kind of system, and follows advice from other hospitals and Cerner on how to successfully manage the transition
  • Emergency services will be open, but patients with minor conditions may experience longer waits. People are advised to see their GP if they have minor issues or need help managing their chronic illnesses
  • Additional Cerner employees and BHB staff who are PEARL super users will be positioned in departments, supporting staff ‘at the elbow’ in the first two weeks after go-live
  • A multi-level command centre structure is in place for the first two weeks in case there are issues that can’t be resolved at the department level, but need quick and effective resolution
  • After 10 November, we anticipate normal levels of elective activity will be restored, including surgeries

Chief of Staff Wesley Miller explains: “I am very proud to work with our staff as we prepare for this implementation. PEARL is going to transform what is possible in delivering the very best in safe, quality care across BHB. A system implementation of this size and complexity isn’t easy, but the reward of working through it will be in the enhanced ability to improve patient care and outcomes, which is at the heart of all we do.”

Chief Hospital Information Officer Keltie Jamieson adds: “Our focus over the next few weeks is on maintaining safe services as staff adjust. There will be a lot of on-the-ground support in departments as well as escalation processes for issues as our hard-working staff get used to something new. Patients and visitors in the first two weeks will see additional people in bright t-shirts who are the in-department support. We have done all we can to test and test PEARL again, but issues are normal in any major system implementation. The key is having robust structures to escalate and resolve them, which we have.

“There is so much to look forward to once we are through this implementation period, but step one is a successful implementation. That will give us the strong foundation we need to use PEARL as a tool of constant improvement in our pursuit of excellence.”

Click here for more information about PEARL

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Editor’s Notes – PEARL’s development to date:

  • PEARL will replace multiple BHB systems, and was necessary as BHB’s main clinical system was old and no longer going to be supported by the vendor
  • Cerner was selected via a competitive process involving about 100 BHB staff starting in 2018, with final approval in 2019 from the Board
  • The project was due to start early in 2020, but was postponed for a year due to the pandemic
  • The electronic medical record project started on 1 April 2021
  • The system was designed and built by the vendor, Cerner, in partnership with over 350 BHB staff
  • There have been two extensive rounds of integrated testing, involving BHB staff who ran patient scenarios to test all parts of the system
  • Although the project was undertaken because BHB’s main clinical system is being retired by the vendor, electronic medical records are the international standard of care. With all information in one place and clinicians across BHB able to share real-time orders and notes, care processes – such as a patient visiting emergency and being triaged, tested, diagnosed and admitted to an inpatient ward – can take place more efficiently
27 October 2022 Home Page, News

Lamb Foggo Urgent Care Centre services to open weekends only for a month

Wednesday 19 October 2022: Bermuda Hospitals Board (BHB) today notes that the Lamb Foggo Urgent Care Centre (UCC) will close on weekdays from Wednesday 19 October, for at least a month. The UCC will remain open during its usual hours on weekends from 9am to 9pm. This only relates to urgent care services, and does not impact the weekly Integrated Healthcare Clinic that runs on Wednesdays.

Chief of Emergency Dr Chikezie Dean Okereke notes: “The closure on weekdays helps us focus emergency staff at KEMH to manage the pressures being felt in the emergency department. Emergency visits right now are high and bed occupancy within BHB is also under pressure, so we are focusing our nurse and physician resources where the most unwell patients are. This has happened to us before as we move into the colder months. The emergency patient numbers are not related to any one cause. They are multifactorial and include, among others, a generally unwell and increasingly aging population. We expect the UCC will remain closed on weekdays for at least a month, but we will continually review the situation.”

Chief of Staff Dr Wesley Miller adds: “There are ways we each can reduce the need for emergency visits that are better for our quality of life as well as reducing pressure in the hospital. We would urge people to manage their known chronic illnesses and see their GP as needed for advice and treatment, before it requires a hospital visit.

“We are also entering a time when respiratory illnesses are rising. People should do all they can to protect themselves by getting their flu and COVID vaccines, especially if they are older or have pre-existing conditions that make them vulnerable to serious complications. We also want to see people drive more carefully on the roads, avoiding unnecessary and sometimes very serious injuries.

“Finally, we ask that people who are ready for discharge are helped home or to a nursing placement by their loved ones and families. We still experience people staying in hospital longer than they need to be and this causes delays that impact emergency staff as patients wait there longer for an inpatient bed.”

19 October 2022 Home Page, News

Arthur Ebbin appointed as BHB chief financial officer

Friday 14 October 2022: Bermuda Hospitals Board (BHB) today announces that Arthur Ebbin Jr, BBA, CPA, has been appointed as its chief financial officer (CFO), replacing Bill Shields, who is leaving at the beginning of November. The CFO position reports to the CEO & president and the Board of BHB. Mr Ebbin’s appointment is effective Monday 7 November.

As CFO, Mr Ebbin will oversee all fiscal and fiduciary responsibilities for BHB, along with the efficient financial administration of BHB. He will lead the development and implementation of BHB’s financial strategy, with a commitment to uphold ethical and professional standards in all matters relating to BHB’s finances.

CEO & President Michael Richmond comments: “I’m very pleased to welcome Arthur Ebbin to the role of chief financial officer at BHB. This is a critical role, with responsibility for the financial stewardship of the hospitals. Arthur’s history at BHB, and his qualifications and experience in maintaining sound financial management and effective financial strategies made him the ideal candidate.

“We are very grateful to Bill Shields, who is leaving BHB to go home to the UK. Over the last five years, he has undertaken sterling work in managing BHB finances through increasing financial pressures, not least from the pandemic. It is a testament to BHB’s commitment to succession planning and development, however, that we have a well-prepared and qualified Bermudian to take over in what continue to be challenging times.”

Having joined BHB nearly 10 years ago in 2013 as assistant financial controller, Mr Ebbin was promoted to controller of operations in 2016-17, and acted in the role of vice president of finance over the same period. He was appointed as director of business finance in 2017. From 2018, Mr Ebbin was the vice president of business finance at BHB.

Prior to working at BHB, Mr Ebbin held finance positions at various companies in Bermuda, although his very first job was a police constable for the Bermuda Police Service, a post he held from 1979 to 1987. Mr Ebbin achieved a Bachelor of Business Administration from Acadia University in 1991 and went on to gain his chartered professional accountant designation in 1994. He completed certificates in healthcare change management and executive healthcare leadership from Cornell University in 2022.

14 October 2022 Home Page, News

BHB’s electronic medical record to go live in October

 

Tuesday 20 September 2022: Bermuda Hospitals Board (BHB) is pleased to provide an update to the community on its electronic medical record project, which will go live on 29 October 2022.

Since the project started in April 2021, hundreds of BHB staff have been working within dedicated work streams with our vendor, Cerner. Staff have named the new system PEARL (patient electronic & administrative records log).

When PEARL goes live, there will be one electronic record for every patient across King Edward VII Memorial Hospital, Mid-Atlantic Wellness Institute and the Lamb Foggo Urgent Care Centre. PEARL will include medical history, test results, physician notes, and important information such as allergies, which will be available to clinicians, whichever service a patient is accessing at any time.

With all the information immediately at hand, care should be more efficient. With safety alerts built into the system, it will be safer too. PEARL will speed up access to critical data, centralise the scheduling of appointments for all BHB services and replace older paper-based processes such as referrals.

As staff members have to sign in to access PEARL, there is also greater confidentiality as the system records every person who opens a record even just to view it.

In line with plans, the patient portal will not be part of the initial go-live in October, but will be a benefit of the system and is planned for phase two of the project.

Progress on the electronic medical record implementation:

  • The design and build of PEARL, which involved frontline staff across BHB, is complete.
  • Integrated testing – in which BHB staff test the entire breadth of the system (including registration, scheduling, prescribing, referring, documenting, coding and billing) using differing patient scenarios – has been completed.
  • Organisation-wide training started in June and continued through to go-live in October. About 1,400 staff have to be trained. The training is customised for different roles and professions within BHB. It includes different ways to learn, from videos and online simulations to intensive class room training.
  • Over 200 BHB staff have been selected as PEARL experts, called super users, in each department. They will be on hand to support their colleagues in their department through and beyond go-live.

In the first two weeks after go-live on 29 October, staff will be adjusting to a new way of working so things may take a little longer than usual. Where pressure can be relieved by reducing activity for non-urgent appointments and consultations this is being planned, to avoid increasing delays or potential risks to care. This will also help ensure that emergency and urgent care continues as needed.

CEO & President, Michael Richmond, MD, explains: “While our need to implement an electronic medical record relates to the critical replacement of an old clinical system, PEARL is a true game-changer for patient care and is a major driver of our vision to pursue excellence through improvement, to make Bermuda proud. It has been a huge commitment for our staff through a very challenging period. I’m immensely proud of our progress so far, very appreciative of the hard work by staff, and very much looking forward to PEARL going live in October.”

Chief of Staff, Wesley Miller, MD, says: “BHB physicians have been part of the BHB clinical teams working with Cerner to design and build PEARL. Cerner’s Millennium product is used in hospitals across the world, so we have the benefit of starting with a system that has international standards of care and safety built in that BHB staff have helped adapt for Bermuda.”

Chief Financial Officer, Bill Shields, comments: “This is a major transformation of how BHB works and delivers care. Our focus for go-live is to have the internal system working well for staff to use. As we are working hospitals and Bermuda’s only hospitals, ensuring a smooth and safe transition is our priority. We look forward to keeping the community updated on our progress.”

Chief of Nursing, Judy Richardson, adds: “PEARL is going to be a great asset for staff. It is going to be a tool nurses can use to improve quality and safety, and the efficiencies it will bring means more of their time can be spent where it is most needed – with our patients.”

Supporting documents:

PEARL – Frequently Asked Questions

PEARL Project Background and Overview

20 September 2022 Home Page, News

Over 500 patient encounters in Integrated Health Clinic’s first year

Friday 2 September 2022: Bermuda Hospitals Board (BHB) is celebrating the first year of the Integrated Healthcare Clinic (IHC) a year after it opened at the Lamb Foggo Urgent Care Centre. Having launched in July 2021, the IHC offers people in the East End who need mental health and chronic illness services a place to receive care closer to home.

The IHC runs once a week on Wednesday mornings at the Lamb Foggo Urgent Care Centre, so it does not impact the delivery of urgent care services, which start later in the day on weekdays and on weekends.

IHC project lead and Chief of Psychiatry Dr Anna Neilson-Williams notes: “It has been a very positive experience for our clients. For mental health clients especially, it provides a more relaxed feel, compared to visiting the Mid-Atlantic Wellness Institute, but across all the services people appreciate having their regular appointments closer to home. We have managed through multiple COVID waves, using remote consults when required for safety. This means just over a quarter of our patient encounters have been via telephone, but the feedback has been consistent that using this location improves access and experience of patients.”

In the year it has been open, 145 patients have been seen at the IHC and there have been over 500 patient encounters. The IHC services include mental health, diabetes and asthma services, as well as the Patient-Centred Medical Home (PCMH), which sees patients who have one or more chronic illnesses but who do not have insurance or who are under-insured.

R Scott Pearman, executive sponsor for the integrated healthcare programme at BHB and deputy CEO, comments: “We are so pleased at the positive response from patients who have been using the IHC, and we are excited about next steps. The IHC is part of a broader strategy at BHB to improve access to care, and improve the outcomes for and wellbeing of our community.
Our integrated approach is to listen to and work with our patients to make improvements, bring hospital services closer to people who need them, and coordinate more closely with our partners in the community.”

In this first year, the IHC has been run as a pilot to see if delivering hospital services closer to home is beneficial to patients. BHB asked a number of patients to explain what difference it has made to them coming to the Lamb Foggo Urgent Care Centre, and these are some of the responses.

It has made a huge difference as I live in St George’s and am elderly”

“I am disabled and the Lamb Foggo Urgent Care Centre is not a long walk as parking is close and always available. Not like the other places.”

“What was good about my care at the IHC was the pleasant receptionist on the front line, the sincerity and concern of the nurse in attendance. And location…location…location. Parking is never an issue.”

One mental health services patient explained the impact of the location compared to MWI:

“As soon as you pull into MWI and get out of your car the stigma starts. It’s with Bermudians period. If you actually go inside the building it’s worse – not from the psychiatric staff but from other staff like security – that’s when it really starts. When I went over to the clinic even though the hospital part wasn’t open, I didn’t have those types of feelings when I walked in. Feeling like anyone was watching or was going to say something. I felt so much more relaxed going to my therapy because the whole atmosphere was 100 percent different. Different in a real positive way. When I would leave MWI, although I may have had a very good session, the stress kicks right back in just like it did when I entered. All the people seeing me and looking, and me feeling bad about myself and my situation. Coming out in St David’s I feel refreshed it’s really hard to explain the depth of it, but the good feeling from the session stayed with me and that’s the first time I had experienced that feeling in all the years that I’ve been in therapy. I started when I was 21 and now I’m in my 60s, so that’s a long, long, time.”

2 September 2022 Home Page, News

Last chance to join the 10th Corporate Blood Drive!

12 August 2022: Bermuda companies and organisations still have a chance to join the tenth Corporate Blood Drive, with the deadline for signing up 31 August 2022. Any company interested in joining up should email blood.donor@bhb.bm or call 236-5067.

“This is a special tenth anniversary for the Corporate Blood Drive,” said Lucy Correia, nurse phlebotomist at the Bermuda Blood Donor Centre. “This competition has made such a big difference to people in Bermuda who need transfusions. Companies who sign up have helped sustain our blood donor pool in Bermuda, whether they won the competition or not. All our blood is from local donors, and when companies join the competition they are supporting their existing donors and helping encourage new people to consider donating.

“One of our regular donors Janice Richards, who won the blood donor Hamilton Princess raffle this year, has been donating for many years – but it all started with an email in her workplace that was encouraging people to donate because the hospital was in need. This is the difference employers can make.

“This is our 10th competition so we are going to make it special, and we hope companies who have previously participated as well as new companies will consider joining in. While there will be a winner announced in June 2023, in this competition every company, every donation makes a big difference.”

Ms Correia adds: “Even just participating helps encourage blood donation so please consider joining. For the more serious competitors, having blood drives and promotions, and encouraging friends, family and even visiting consultants to donate, with a focus on getting as high as possible in the competition listing, can make it fun. Plus, there is nothing more rewarding than knowing you are saving lives. Give us a call or email, and we can sign you up.”

12 August 2022 Home Page, News

Donate blood and win a ride on a Whip

Tuesday 9 August 2022: Bermuda Hospitals Board (BHB) and the Bermuda Blood Donor Centre today announce that blood and apheresis donors who donate between 1 August and 30 September 2022 will be entered into a raffle draw for two $50 Whip Rideshare credit prizes. This is thanks to Whip Rideshare, which has donated the Whip ride credits. The winner will be announced on 1 October 2022.

Whip Rideshare is Bermuda’s first e-scooter ridesharing micro mobility service and affordable eco-transport.

Alex Marshall, the founder of Whip Rideshare, states: “I have previously been a blood donor and wanted to help encourage people to donate as it is important for our community. We are all one family in Bermuda and this is one way we can help each other. Whip is proud to be a part of such a worthy cause. I encourage everyone to come to the Blood Donor Centre at the hospital and donate. Your donation will help save lives.”

The Bermuda Blood Donor Centre is the island’s sole donation centre supporting the hospital. In 2021 there were over 2,000 transfusions, and the need for donors continues to grow.

Bermuda Blood Donor Centre Nurse Phlebotomist Lucy Correia adds: “We are so grateful for the donation from Whip. If you are considering donating for the first time we promise to make it as comfortable as possible. The process only takes about 30 minutes and your one gift of blood can help up to three people, as well as put you in the raffle for the Whip ride credits.

“We are located on the first floor of the General Wing of the King Edward VII Memorial Hospital and are open Monday to Thursday 8:30am to 2:30pm, and Friday 8:30am to 1pm for appointments. Call 236-5067. You can also visit www.bermudahospitals.bm for more information about donating.”

9 August 2022 Home Page, News

Anna Neilson-Williams appointed as chief of psychiatry

Monday 1 August 2022: Bermuda Hospitals Board today announces that Dr Anna Neilson-Williams has been appointed as chief of psychiatry. Dr Neilson-Williams has been the acting chief of psychiatry since September 2021.

The chief of psychiatry provides clinical direction and administrative leadership for mental health, substance use and intellectual disability services, and is accountable for the quality of care delivered. The position reports to the chief of staff and to the Board, and is a member of the Executive Team.

Dr Neilson-Williams first joined BHB in 2000 as a resident psychiatrist. She was a general practitioner from 2003 to 2009 with The Family Practice Group. During this time, from 2007-8, Dr Neilson-Williams was also the physician lead for the MWI Medical Outpatient Clinic, and between 2008-9 she was the physician lead for the Continuing Care Unit at KEMH. Dr Neilson-Williams was previously the deputy chief of psychiatry, and from 2014 has been the director of the Continuing Medical Education Programme.

Dr Neilson-Williams gained her medical degree with the University of Glasgow in Scotland. She also has a MSc with distinction in mental health: transcultural mental healthcare from the University of London, Queen Mary’s and Westfield College. In 2020 Dr Neilson-Williams was awarded a Fellowship from the Royal College of Psychiatrists, UK, in recognition to her contribution in psychiatry. She also holds a diploma in leadership and management from the City & Guild of London Institute.

Chief of Staff Dr Wesley Miller comments: “I am very pleased to appoint Dr Neilson-Williams to this critical position at BHB. She has a deep understanding of the needs of mental health, substance use and intellectual disability services in Bermuda and helped lead the MWI Directorate Plan 2021-2026, which is guiding the development of services. As the project lead for the establishment of the Integrated Healthcare Clinic, Dr Neilson-Williams also is part of the evolution of services within BHB that is seeing better coordination and collaboration across sites and within the community. It is an exciting time to be in this vital role and Dr Neilson-Williams is the ideal person to help lead us through this time of change.”

 

1 August 2022 Home Page, News

Lamb Foggo Urgent Care Centre temporary weekday hours

Friday 15 July 2022: There will be a temporary change to the Lamb Foggo Urgent Care Centre (UCC) hours on weekdays from Monday 18 July. Weekend hours will remain the same (9am to 9pm), but Monday to Friday and public holiday hours will be 6pm to 10pm, rather than 2pm to 10pm. Please note that an x-ray service will be available on Sundays only from 9am to 8:45pm.

Dr Chikezie Dean Okereke, Chief of Emergency, comments: “We apologise for any inconvenience the later opening on weekdays causes. This arrangement means we can cover the busiest hours of the UCC, while maintaining adequate staff in the Emergency Department and KEMH Diagnostic Imaging department where the sickest patients receive care. We will review the situation again next month and appreciate the community’s understanding.”

15 July 2022 Home Page, News