The Cerner and Draper & Dash Digital Transformation, Glenn Winteringham, Chief Digital Officer, Royal Free London NHS Foundation Trust shares his experience.
At the recent Executive Patient Flow Summit, Royal Free London NHS Foundation Trust won the digital transformation award for its work with Draper & Dash. To learn more about the work behind this achievement, we interviewed Glenn Winteringham to hear his thoughts on the project, as well as the digitisation journey of the trust.
Could you tell me a bit about yourself and your role?
I am the Group Chief Digital Officer for the Royal Free in London, responsible for all digital services, covering digital transformation, patient systems, IT infrastructure, telecommunications, information governance, information management and clinical coding.
As one of the NHS’s Global Digital Exemplars, we are fortunate in having been able to invest in a team of 11 clinical informatics leads; six CMIOs (3 consultant, 3 junior doctors), CNIO, adult and paediatric nursing, pharmacy IT and maternity IT leads, all of whom are part of my team.
Could you tell me about your work with Draper and Dash?
Draper & Dash (D&D) are one of our key partners. Like many NHS Trusts, we have multiple IT systems and data warehouses with many different reports. There are huge swathes of data collected from hospitals which have an often-unrealised opportunity to provide further insights and analytics, but the way that it’s all currently stored and handled makes it incredibly difficult to unlock the full potential. We therefore wanted to standardise this and provide sophisticated data visualisation through the application of commercial dashboard analytics from D&D. This helped us to focus on providing access to clinical, operational and administrative data to improve visibility of data and ultimately reduce unwarranted variation.
We point the D&D dashboard at our data repository, for example our Emergency Department, and it provides staff with near real time data and visual graphics, taking us away from the need to use spreadsheets to handle our vast quantities of data. It works the same with all of D&D’s dashboards, and they provide the ability to filter all of this information by year, month, group, hospital, speciality, time, consultant, date – right down to patient level data. All of this is curated and presented in a way that’s then easily accessible to the clinicians and healthcare teams who know how best to utilise it, and subsequently apply it to optimising the care of their patients. You can truly slice and dice your data to your heart’s content.
We provide near real time access to ED data to manage our four hour wait compliance, so they can track patients and manage breaches.
Our relationship with Draper & Dash has evolved over the years to one which now looks at reducing unwarranted clinical variation in a number of high impact areas. While it is too soon to assess the impact of these efforts, we’re starting to see some fantastic data on the benefits to patient care through the strong clinical adoption of our standardised pathways, called Clinical Practice Groups (CPGs) and patient safety through the adoption of our new model content Cerner Millennium EPR.
How did the digital transformation project start?
We were selected as one of the original 12 Acute Global Digital Exemplars, and The Executive Patient Flow Summit award was in recognition for our work on delivering this programme. Our GDE comprised of four main components, one of which was to open a brand-new digital hospital at Chase Farm. Last September we moved clinical services into the new hospital, followed by the launch of our new EPR in November.
As a vanguard for the acute care collaborative or managing hospital chains, The Royal Free London strategy aims to deliver world class care and outcomes, excellent patient and experience, and all at a 10% reduced cost. There are lots of benefits of working as a group of hospitals such as ; economies of scale for shared corporate services ; shared clinical rotas and cover ; more opportunities for staff development ; and improve clinical services. For example, we are re-locating non-complex surgery to our elective site at Chase Farm hospital in order to improve the patient flow and reduce elective cancellations at Royal Free and Barnet Hospitals, as both have very large emergency flows.
We know reducing unwarranted variation will lead to reduced costs, so we have been tackling this by standardising pathways to deliver improved care and outcomes as well as driving efficiencies at a lower cost. We have plans digitised 18 care pathways into our new EPR, since go-live a year ago and we have plans to digitise another 40 pathways in the next two years.
We have had 600+ clinicians working on the Clinical Practice Groups (CPGs), co-designing with primary care and patients. We really wanted to understand the value equation. On a practical level, that means that if you’re put on a pathway it automatically triggers a series of actions, orders and alerts, all generated from a single button. Of course, there is warranted variation which they can document, but we are aiming for a 80-90% compliance with the pathway. If it is below that, it probably means the pathway design is wrong, and if it is above that then potentially people are following it too closely and may not be thinking about the individual patients to the degree that they need to be.
In implementing an EPR, it was key that clinicians could design the care pathway. What they really wanted was to be able to get back their data to improve care. They collate huge quantities of data and obviously they would like to then see and consume what they’ve input in order to review their practice to improve care and outcomes, understand variation and compare against peers. As it was very clinically driven, the adoption of digitised pathways and the EPR generally has been really good, with Chase Farm Hospital achieving HIMSS EMRAM stage 6 in July 2018.
We are also working with NCL STP to implement two digital transformation programmes, one is using Cerner’s Health Information Exchange (HIE) to provide real time access to a shared care record from all health and social care providers in NCL. This means GPs can see data from the hospital provides in real-time within their primary care systems. Conversely, if a patient presents to ED, we can view their GP record real time so our clinicians can deliver better, faster, safer care.
What has been the key success?
I’m most proud of achieving HIMMS EMRAM Stage 6 for Chase Farm Hospital, 9 months after go-live. We opened a new digital hospital during the 70th anniversary of the NHS, and we have transformed patient care as well as improving the patient and staff experience.
What learnings have there been?
Number one for me was to change the culture within the organisation, moving away from IT led technology projects to a culture of clinically led digital transformation, and by the end of the GDE programme we now describe it as clinical transformation, digitally enabled.
The GDE funding enabled us to employ 11 clinical informatics leads, who were fundamental to engaging with and communicating our GDE change programme to their peers.
We also developed a culture of being very open and transparent with our suppliers, seeing them as strategic partners rather than simply being vendors, so we could set expectations and hold each other to account. Because we were on such a condensed timeline to go-live with then new EPR across 5 hospitals in 11 months, we adopted other mantras during the project such as “be hard on the problem, not on the person” and “don’t let perfection get in the way of good”.
I am also very fortunate that as the CIO I report into the group medical director, which means we are clinically led. We also changed our digital governance, with the Group CEO chairing the Digital Board, and the hospital CEOs chairing the local implementation boards, which again made it clear this was a clinical and digital transformation programme and not an IT project. And lastly investment, as the £10 million GDE funding, locally matched, meant we were able to spend £20m over two years on hardware, software and resources to implement the new EPR.