Optimising Ward Management with Compucare Ward: A Technical Guide

Contents

• Executive Summary
• Introduction
• Technical Overview
  • Typical Topology
  • Testing and Validation
• Clinical Risk Management
  • Identification of Clinical Risks
  • Risk Assessment and Mitigation
  • Residual Risk and Monitoring
• Benefits of Implementation
  • Increased Efficiency
  • Real-time Updates
  • Improved Patient Care
  • Robust Security
• Prerequisites
• Security and Compliance
  • Authentication and Authorisation
  • Data Protection and Encryption
  • Secure and Resilient Hosting Environment
  • Compliance and Auditing
• Training and Support
• Contact Information

Executive Summary

Compucare Ward is a web application designed to assist nurses in recording observations and calculating NEWS2 scores. It enhances ward efficiency by automating NEWS2 score calculations and alerting users when a patient requires escalation, with the ultimate goal of fully digitising the patient booklet at the end of a patient's bed.

Optimised for mobile devices, the application enables nurses to access patient records, view location and bed information, record observations and perform patient handovers without being tethered to a workstation.

This white paper provides an in-depth look at Compucare Ward's features, benefits and implementation prerequisites. It also includes technical details about the application's network topology, security measures and clinical risk mitigation.

Key features include:

• Patient scanning: Scan a patient's wristband to access their record.
• Automatic NEWS2 calculations and escalations: See escalation prompts after submitting observations based on the NEWS2 score.
• Reminders: View reminders for upcoming observations and bookings.
• Resource allocation: View patients by ward and reassign patients to other nurses.
• Robust security: Compucare Ward is hosted on Azure and only accessible to users authorised via Entra ID and Compucare Authentication Services.

By leveraging Compucare Ward, hospitals can significantly enhance their ward management processes, leading to improved patient outcomes and more efficient use of resources.

Introduction

Efficient management of patient observations and NEWS2 scores is essential for maintaining high standards of care in hospital wards. Compucare Ward is a web application designed to help ward nurses meet these needs. While Compucare users already benefit from automatic NEWS2 score calculations, Compucare Ward takes this further by automatically recognising when a patient requires escalation based on their NEWS2 score and displaying an alert that cannot be dismissed without either completing the observation or contacting the responsible clinician. Additionally, the application is optimised for mobile devices, allowing nurses to complete observations and update patient information while doing their rounds.

Hosted on Microsoft Azure, Compucare Ward benefits from enhanced security features, such as requiring all users to be authorised via Entra ID and Compucare Authentication Services (see below for more information).

Through this white paper, healthcare facilities can gain insight into how Compucare Ward can enhance ward management processes, leading to improved efficiency and better patient outcomes.

Technical Overview

Compucare Ward is hosted on Microsoft Azure and connects exclusively to Azure-hosted Compucare databases. This focus on cloud integration enables the app to benefit from improved performance, reliability, automatic updates and reduced maintenance overheads. For more information on Compucare on Azure, see the White Paper for Adoption of Compucare (on Azure).

Typical Topology

The diagram below shows how Compucare Ward connects to a Compucare database.

Compucare Ward can only be accessed by authenticated users registered on Microsoft Entra ID. When a user logs in, the Access Control API checks that they are licensed for Compucare Ward. If they are, the Compucare Authentication Services API checks which group the user is in and the data source(s) within that group in Compucare Authentication Services. Then, the Ward API returns the data from the correct Compucare database.

Testing and Validation

The following testing and quality assurance checks are performed on Compucare Ward:

• Unit Testing: Each component of Compucare Ward is tested to ensure it works correctly.
• Integration Testing: The product is tested after new components are integrated to verify that combined components function together.
• User Acceptance Testing (UAT): Testing is performed with end-users to confirm the system meets their needs.
• Security Testing: Regular penetration testing and security audits are performed to assess the product's security and identify any vulnerabilities. See the Security and Compliance section of this white paper for more information.
• Final Validation: A final check is performed to confirm all tests are successful and Compucare Ward is ready for deployment.

Clinical Risk Management

Effective clinical risk management is crucial to ensuring the safety and reliability of Compucare Ward. This section provides an overview of the main risks identified with Compucare Ward and how these are documented, assessed, mitigated and monitored.

Identification of Clinical Risks

Streets Heaver's Clinical Safety Officer uses hazard workshops and SWIFT analysis to identify risks associated with Compucare Ward. These risks are then documented in the hazard log. From this process, the most significant clinical risks associated with the use of Compucare Ward are:

• The wrong information is entered into the NEWS2 calculator, causing the application to generate the wrong score
• A patient is not escalated when required
• A patient isn't handed over correctly
• The wrong barcode is scanned, causing information to be entered for the wrong patient
• Information is entered but not submitted to calculate the NEWS2 score and allow escalation if required

Risk Assessment and Mitigation

To assess and prioritise potential harms, each risk is given a score for likelihood and a score for severity. These scores are then entered into a risk matrix to provide a final score that determines whether further action is needed to mitigate the risk to an acceptable level.

To mitigate software risks, Streets Heaver utilises partial rollouts of updates that are monitored for any problems before they are released to all users. If any problems occur, the update is cancelled and rolled back.

To mitigate usability risks, validation is built into Compucare Ward. For example, on screens where the patient's current admission details are displayed, a warning is shown to the user if the patient has been admitted into multiple beds at once (this is configurable in Compucare 8).

To mitigate risks associated with the NEWS2 calculation, Compucare Ward undergoes multiple layers of automated testing, which cover different scenarios to ensure the scores are accurate. Any changes to these areas of the application are highly controlled.

The effectiveness of these controls is evaluated by monitoring the number and severity of any outages and any updates that contain breakages. These are then assessed through retrospectives and investigations if necessary.

Residual Risk and Monitoring

Residual risks are evaluated according to the DCB0129 standard for clinical risk management. Following this specification allows for a repeatable and robust risk management process. You can read more about this standard on the NHS Digital website.

Streets Heaver monitors the performance and stability of Compucare Ward. Any errors are automatically reported to the Engineering team. See Security, Monitoring and Alerting of Azure Apps for more information.

Benefits of Implementation

This section provides more information on the benefits of using Compucare Ward.

Increased Efficiency

Compucare Ward is designed for mobile devices, meaning nurses can make notes, update patient information and record observations while on their rounds. They can quickly access patient records by scanning a patient's wristband, removing the need to manually search and freeing up time to focus on the patient.

Real-time Updates

Changes made in Compucare are reflected in Compucare Ward in real time, ensuring nurses have access to the latest patient data during their rounds. Likewise, observations and updates recorded in Compucare Ward are immediately visible in Compucare. Most data syncs instantly, with only a few exceptions where brief caching may apply to optimise performance.

Improved Patient Care

Compucare Ward displays reminders for upcoming observations and alerts when patients require escalation. This enables nurses to make more informed decisions and provide timely care, enhancing overall patient outcomes.

Robust Security

Compucare Ward uses Microsoft Entra and Compucare Authentication Services to strictly control what data each user can access. In addition, all patient data is kept within Compucare, minimising opportunities for unauthorised access.

Prerequisites

Before Compucare Ward can be implemented, the following prerequisites must be met:

• You must have the latest version of Compucare 8
• Your Compucare 8 database must be hosted in Streets Heaver's Azure Environment
• Depending on the features you wish to utilise, you must have the following Compucare 8 modules configured:
  • Inpatients - Required for viewing and modifying inpatient bookings
  • Form Results - Required for adding observations, viewing NEWS2 charts, and modifying and completing forms
  • Procedures - Required for viewing patient procedures

For users to be able to access Compucare Ward, the following prerequisites must be met:

• Users must be licensed for Compucare Ward via the Client Console
• Users must have the Nurse role with the "Ward Nurse" toggle enabled
• Users must have access to a location with at least one bed

Security and Compliance

This section provides details on the security and compliance of Compucare Ward.

See also:

• Security, Monitoring and Alerting of Azure Apps
• Disaster Recovery Policy

Authentication and Authorisation

• All authentication is handled by Microsoft Entra and Compucare Authentication Services.
• Compucare Authentication Services ensures users can only access groups and data sources for which they have explicit permissions.

Data Protection and Encryption

• Encryption in Transit: The application queries Compucare SQL databases hosted on Azure. All queries use secure connection protocols TLS 1.2 to ensure that data in transit is encrypted.
• Microsoft Entra ID Authentication: Access to the application is restricted to authenticated users via Entra ID.
  • MFA is enforced via the client's tenant configuration within Entra ID.
  • The enterprise application will need to be approved. Assigned Access can be enabled, and then the users and groups are restricted to the application.
• Azure Front Door: All web applications are fronted by Azure Front Door, which serves as a secure entry point for web traffic, offering several security benefits.
• Azure API Management: All web application APIs are managed through Azure API Management, allowing for varying rate limiting of endpoints based on sensitivity.

Secure and Resilient Hosting Environment

• Azure Static Web Apps: Compucare Ward utilises Azure's global distribution network to host the application's front end, ensuring efficient delivery and improved performance for users worldwide.
• Geo-Replicated and Load Balanced APIs: Compucare Ward benefits from redundancy and failover capabilities. Architecture is replicated in the UK South and UK West regions to provide load balancing and resilience.

Compliance and Auditing

• Data Storage and Handling: All data, including but not limited to patient data and clinical availability, is stored and accessed through Compucare 8.
• Logging and Monitoring: The application's activities are logged and monitored in Compucare 8. This allows auditing capabilities for changes made by the application. Additional logging uses Application Insights to identify and respond to potential security incidents.
• Regular Security Audits: The application undergoes annual external CREST-approved PEN testing and regular vulnerability audits to assess its security and identify vulnerabilities. Any findings are promptly addressed to maintain a robust security posture. Internal and external reports are available upon request. Additional PEN testing is performed for new features, scoped to the changes made for the feature.

Training and Support

To help new users familiarise themselves with Compucare Ward, Streets Heaver provides personalised training via remote sessions, which is usually included in the project costs of the system setup.

Further guidance can also be found through quarterly release webinars and detailed product "lunchtime webinars" available via the Streets Heaver YouTube channel.

Additionally, the Streets Heaver Knowledge Base is regularly updated with tutorials and how-to guides. Visit the Compucare Ward section of the Knowledge Base (login required) for the latest updates and support materials.

Contact Information

For enquiries, please contact the Streets Heaver Commercials team at marketing@streets-heaver.com.

For technical support, please contact the Streets Heaver Support team at support@streets-heaver.com or call 01522 872000.