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Creating a blueprint for a new electronic patient record system

Summary

NHS England’s Global Digital Exemplar (GDE) programme is using blueprints based on the lessons learned by exemplars to help other trusts introduce similar improvements. Here, Robbie Cline, Director of ICT Programmes for Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust​, describes his experience.

By Robbie Cline. 11 March 2019

An animated image with people and various pieces of technology interconnected

A key aim of the Global Digital Exemplar programme is to create blueprints for digital innovation so that other NHS organisations can follow in their footsteps at a faster pace and for a lower cost.

Benefits for patient outcomes and safety will be achieved sooner with this structured sharing of knowledge and insights.

At Chelsea and Westminster, we found that joining forces with our neighbours at Imperial College Healthcare NHS Trust was the answer to a longstanding search for a new electronic patient record (EPR) system. By the end of 2019, the two trusts will be using a single shared system across seven hospitals, which together have 17,000 staff and over two million patient contacts a year.

Chelsea and Westminster Hospital was one of the first to introduce an EPR system back in 1999. Nearly 20 years on, it was starting to show its age and we needed a plan for replacing it.

So how did we come up with the idea of linking up with another trust on the same EPR system? We knew there were several benefits – not least, significant cost savings. These include reduced payments to EPR supplier partners as well as opportunities for shared IT services.

There are big potential benefits for patients and staff - those who work at both trusts who will now only have to learn one EPR system and patients who are treated at both trusts whose records will now be available at any of our seven hospitals. We are already working together to improve the shared system. We know we can achieve more than we could working alone, by drawing on the energy and expertise of administrative and clinical staff from two trusts.

There are also some challenges. It is inevitable that compromises will need to be made in the design of the system. Our written blueprint explains some of the strategic lessons we learned, such as:

  1. Executive mandate - Implementing an EPR system is a major undertaking which will affect the whole organisation, with very few staff not touched by it in some way. The effects are increased when the system is to be shared across two or more organisations. Support from the executive teams is therefore essential.
  2. Organisational engagement - Implementing an EPR system is a major change project. Clinical transformation requires behavioural change. Organisational engagement is essential for clinical and operational leaders to take ownership of the change and allow staff to get involved in shaping that change. All of this is made more complex when two trusts are involved.
  3. Information governance - The correct agreements must be in place to enable staff to use and support a system where there are details held of patients that have received care from both the organisations. This may include both data sharing and data processing agreements. Patients may not have an expectation that their data will be shared between two trusts, so steps need to be taken to engage with patients and communicate this.

We also learned many tactical lessons and my top three are:

  1. Identify additional costs - there are big savings but there are also some additional costs. For example, the trust already on the EPR will have to re-test all its interfaces when the new trust joins. Identify the costs and decide how they will be shared between the two trusts.
  2. Manage the change control process - a decision will need to be made around when the new trust should join the process for controlling what changes are made to the EPR. The quickest way for a new trust to get the benefit of full involvement may be to focus on the business of going live first and then participate in change control.
  3. Start data migration work early with a third-party provider - copying patient data into a system that is already in live use requires very careful handling. Get started as soon as you can. And don’t do it in-house. Use a third-party provider who has the right tools and experience.

We are already a long way down the road to a shared EPR. West Middlesex University Hospital joined the five Imperial hospitals in May 2018, and intense preparation is underway for the Chelsea and Westminster Hospital to go-live at the end of 2019.

Our written blueprint tells the story of this process, the benefits and challenges, and I hope it will be valuable to other trusts looking at going down this route. In recent weeks, I’ve spoken to five UK and overseas hospitals who are actively considering the same thing - clear evidence that there is a real appetite for this information.

Introducing a shared EPR system involves challenges and compromises but the benefits, including increased efficiency, better staff experience and improved patient care, make it all worthwhile. The whole project is a major step towards the goal of transforming clinical pathways across our two trusts.

This and other GDE blueprints are now available on the GDE Community Platform. Request access here.

Portrait Robbie Cline

Last edited: 13 March 2019 4:08 pm