Health Tech Trends, News, Secondary Care

HTN Trends Series: System Wide Digital in Cornwall

As part of the Health Tech Trends Series sponsored by InterSystems, we explore how Cornwall IT Services working with the teams at Kernow CCG, Cornwall Partnership NHS Foundation Trust and Royal Cornwall Hospitals Trust responded to the COVID-19 pandemic.

In this article we hear from Kelvyn Hipperson, Chief Information Officer, about the significant contribution from the teams, their work over the past few weeks, the changes and how they are supporting their colleagues and patients in difficult times.

Kelvyn said to HTN “First and foremost everything we’re doing wouldn’t have been possible if it weren’t for our clinical, admin and IT/Digital teams across Cornwall working in partnership to embrace technical solutions with pace, enthusiasm and adaptability to an extent I’ve never seen before.

Technology push to user pull overnight

We’ve gone from technology push to user pull virtually overnight and knowing how much better the outcomes are when you have that pull. I’m feeling optimistic that we’re in the midst of a sustainable transformation. Virtually everyone is saying they don’t want to go back to the old ways of doing things after this.

Delivering common platforms provided by NHS Digital and NHS England

We’re part of the wider southwest digital community and across the region we’re all delivering similar outcomes wherever possible with common platforms provided by NHSD and NHSE. There are some variations of course and these are mainly set by local priorities and/or available resources.

This has resulted in whole system collaboration, remote working and video consultation were our first priorities. We initially trialled three systems and went forward with one quickly.

In fact, my initial concern was that if we didn’t get them out really quickly, we’d have had massive fragmentation with everyone picking up on whatever solutions they came across first.

Microsoft Teams has taken off amazingly quickly particularly in acute and community/mental health. We’re even running virtual board meetings in RCHT and CFT. A nice innovation is where we do need to have some people in the same room, we’re using our lecture theatres. With everyone really spread out, often more than 2metres, remote participants projected onto the large screen and a presenter/facilitator on stage we’re finding that we still get a really good meeting feel and interactions.

Scaling platforms alongside Teams and delivering remote working

Rather than trying to bring in an unproven new solution for remote working we’ve used our existing platforms, massively scaled up alongside Teams. So, for an existing laptop user, secure remote access allows access to our corporate applications and a good selection of clinical.

Some digital savvy groups have also been allowed to use desktops at home as they’re fully encrypted on Windows 10 as standard.

We also had Virtual Desktop Infrastructure for some specialist clinical apps, so we’ve widened out that portfolio for users without access to a trust laptop or desktop to take home allowing them to securely use their own devices. We also have remote logon which is being used extensively in primary care. For anyone without significant app needs, NHSMail and Teams allows them to keep in touch, participate in meetings and work on a wide variety of documents.

As a result, we have a large number of colleagues working remotely, including a very significant proportion of our IT/Digital staff with only those who need to be working on-site e.g. critical projects, engineers and records management. We’re running typically around 5-6 times the normal level of remote traffic and although help desk calls are quite a bit higher than usual, it’s nothing like the same proportion as the increased traffic so most are managing to work remotely very well.

Video consultations

CFT implemented Lync/Skype for Business for video consultation a few years ago and although it hadn’t really taken off in the clinical setting, it has been widely used corporately.

In acute we started trials last summer with a health specific platform which had been going well and so we were just beginning to think about larger scale rollout. Again, virtually overnight we had clinicians everywhere clamouring for video consultation, so we’ve rolled out the NHSE provided solution across acute and community.

GPs are using a different specialised solution which integrates well with their practice systems and its helping the PCNs to run a new model of care with ‘hot hubs’ used for caring for patients with coronavirus symptoms while ‘cold hubs’ will treat all other conditions.

The experience with GPs was a good example of the benefits of the wider regional community, as we were going to use the video consultation solutions from the different GP systems providers.

The feedback from the regional group though was that the rollout of a single specialist system was much simpler and getting very good acceptance from practices, so we’ve quickly changed tack.

Supporting communities

An absolutely fundamental aspect of the response is supporting people in their communities. CFT working with system and delivery partners has introduced a new combined community service and the technology solution based on Teams which allows partners across the health and care system to manage referrals and to coordinate the delivery of care through an expanded single community care service i.e. replacing multiple uncoordinated health and care services . The capabilities of the service will be developed further as NHSD release updates to the national Teams service and seamless collaboration between health and external partners will be one of the biggest benefits of the approach.

What’s next?

We’ve just this week upgraded our voice recognition system, trialling had shown much better recognition capability with no user voice training burden. With the upgrade we’ll have much better resilience in our clinical documentation processes. We’re also implementing the NHSD virtual smartcard solution which we were planning to do independently, again it’s about improving our resilience in the face of uncertain staffing levels and removing a need for face to face contact.

Prior to the emergency we were in the early stages of an EPR project and were just starting to ramp up clinical and wider engagement prior to submitting our outline business case. Given the Covid-19 response is absolutely our no 1 priority and it won’t be possible to engage widely or go to market for a while yet. The business case will be aligned with our wider recovery planning and ensuring that it will sustain the long-term use of new clinical processes and our clinician’s very strong desire not to go back to the old ways of doing things.”