Article in Health IT Central (HIMMS publication), published on 6th February 2017
The NHS is struggling to keep up with the impact of the consumerisation of IT, but some trusts are making steady progress towards digitisation. BJ-HC took the opportunity to visit the University Hospitals of Leicester NHS Trust and take a closer look at how progress is being achieved.[Leicestershire, UK] Ahead of the move to a new Emergency Department (ED) this spring, University Hospitals of Leicester NHS Trust had to develop an EPR solution from scratch.
With nearly 494 million sheets of paper mostly stored offsite, the consensus was that the waterfall approach was not working anymore, they had to be more agile.
Moving from EDIS to Nervecentre
Plan A was to deploy the Cerner EPR. That was put on hold due to a lack of funding, making them turn towards plan B, the Nervecentre solution, which meant the trust could finally move away from the Emergency Department Information System (EDIS):
“We agreed in July last year that this was going to be the case, we spoke to Nervecentre and we started gathering the specifications to effectively write a system from scratch and at that time to deliver the first phase on December the 7th,” says John Clarke, CIO at the trust.
Dr Damian Roland, Consultant and Honorary Senior Lecturer in Paediatric Emergency Medicine, who assisted Dr Ben Tisdale, Lead of the Nervecentre project, reveals EDIS was “pretty easy to use, but greater functionality” was needed for the new ED.
The team managed to complete the switch in two days, introducing it in a small part of the department first and then swapping the system over in the early hours of the morning in December last year, delivering a whole solution in less than a six-month period.
“This was handled very well, especially by the clinical guys, and I suppose it’s coming back to the whole consumerisation of IT bit. If I go back five years ago, the thought that my digital strategy was going to be delivered by two of our senior consultants and they were going to be the driving force to make technology change happen, it probably wasn’t on our agenda.
“We all talked a good job, we all said that that was how we wanted to work, but now it’s a reality in the organisation,” says Clarke.
‘Luring integration in’ the hospital
The Nervecentre software was firstly introduced at the hospital to help them manage junior doctors at night, allowing them to ‘lure integration in’:
“Nervecentre has greater user interoperability and it’s a bit more intuitive in terms of where everything is, it doesn’t have what we used to call the ‘circle of death’. EDIS used to take ages to do anything, whereas now you go on, you click on something, you get it and it’s done,” commented Dr Roland.
Clarke describes the implementation process as one of the ‘smoothest go-lives’ at the trust, as the Department of Health had just issued new rules regarding ways EDs have to code their data:
“That meant we got information in time so that we could build this into the system straight away, which means we’re probably one of the very first systems in the UK to do this. Completely serendipitous,” Clarke adds while revealing the clinical team is now using SNOMED CT to capture coding within the ED.
“We don’t have a full, all singing, all dancing, Epic EPR, but I have full electronic orders, clinical and nursing documentation, automated rules based on data collected through eOBS, electronic prescribing, and we’ve got lots of stuff coming in,” he says.
Delivering IT with a ‘world class’ partner
After joining the trust five years ago, Clarke brought in a ‘world-class’ partner to help them deliver IT solutions: “We brought in IBM and they’ve been with us four years now to help us along our journey. It’s quite exciting to have a blue chip company, but also quite scary, because their abilities far outstretch our IT in the NHS and it creates a healthy tension.
“We challenge them to think differently, they challenge us to think differently and, in the middle of it, we get a good mix of approaching things in a slightly different way to how the NHS would normally approach things,” he states.
Part of the partnership means the trust retains strategy, programme management, and technical architecture, while IBM deals with the delivery process and helps the IT team shape the digital strategy going forward:
“That’s really interesting, because what they’re very good at is not doing an IBM view. I think it’s a real measure of the maturity of their organisation that they’re not trying to sell me their equipment,” Clarke adds.
However, he reveals his relationship with suppliers has been ‘schizophrenic’: “If they’re trying to help me, they’re on the good list, if they get in the way, they’re on the bad list. But you have to work with the suppliers.”
Challenges appear around the trust’s financial capabilities, as the transformation process is slowed down by the baseline budget and further funding allocations:
“We always need more, but can we deliver safe services? Yes, we can,” he says.
Local Digital Roadmap progress
Leicestershire has a wide delivery group for IT which meets every month to discuss ways they could further the digital agenda of the area; three years ago, they decided to unify Wi-Fi across the public sector.
Clarke, who is also their Senior Information Risk Owner (SIRO), argues that the Local Digital Roadmap is readable and accessible, while the overarching theme is making sure that ‘when the ship goes out to the harbour, it just doesn’t sink’.
“What we’re saying is, let’s look at what we’ve got and what we can do with it. Criticism I get from people outside IT is that we don’t deliver stuff quick enough and this is about momentum gaining,” Clarke goes on to explain.
The trust has been investing heavily in cybersecurity defence, ensuring that all devices are as ‘robust’ as they can be, although Clarke acknowledges that the biggest risk is based on ‘human factors’:
“The easiest way to get access to information in the NHS would cost you about £70 off eBay to buy a stethoscope and put it around your neck. Most people would give you the information you require if you just go and ask them,” he says, while adding that the trust will run a campaign this year to make sure all staff are trained accordingly.
While they have not had any major problems such as other organisations, Clarke laughs it off by recalling the classic phrase: “If you haven’t had one, you don’t know you’ve had one.”
‘Game changer’ plans
In terms of future plans, Nervecentre are expected to design an eOBS software, described by Roland as a ‘game changer’ which will help clinicians access patient observations on a screen, while Clarke adds that at any given time his team is working on more than 140 projects, 20 or 30 are being worked on and the rest are in the pipeline.
“When we have a solution that is entirely electronic, we will be able to examine the entire patient pathway from a digital perspective and I think that will be really transformative because we will have the data to empower us to make the changes and look at the data,” Dr Roland concludes.