HTN Digital Week June 2020: Day Five

Our final day of HTN Digital Week, and what a fantastic week we had, we kicked off with Paul Charnley, Director of IT and Information at the Wirral University Teaching Hospital.

Paul took us through an update on the digital transformation programme in the Wirral region.

Paul started the presentation talking about the past few months during COVID-19 and the work in the trust as part of the Global Digital Exemplar programme.

“We are almost paperless as an organisation, the only two aspects of going paperless that the Wirral have not yet achieved are the closed loop system and the lab network. We are talking early next year when we get those two parts of the trust looked at again to go paperless.”

Paul showed us the disparity between the poorest and richest areas in the peninsular; “there is a 10-year life expectancy between the two areas. One of the things we have done is to combine our systems at two levels. The health information exchange and health intent.”

Paul spoke about the exchange of information, as part of the Wirral Care Record and the blueprints developed. One blueprint is around information governance for direct care and secondary uses, the other is an implementation guide in engaging with stakeholders – building of dashboards, analytics.

Paul then went on to talk about what happens with data from across the peninsular: “We call the collected data ‘registries’, where in phase 1 we looked at adult diabetes, child diabetes and asthma. The registries are colour coded to flag up patients who have not recently been seen for their chronic condition. For example, if a patient has not been seen recently for their asthma check-up, this will flag up in red.”

“Our specialists can also look in the background to see what they can do to lower admission rates with certain patients. This is a vision of the Wirral Trust for new models of care, something which the trust is also looking at post-Covid response.”

“We are working with Greater Manchester as patients move around the northwest on sharing patient records and data.”

“Nearly 3 years ago now, we developed our digital programme ‘Digit@ll’ which is about connecting our organisations and empowering patients and clinicians to enhance what we already have.”

A total of £20.8million HSLI funding has been spent over 3 years. This includes spending on bed management, patient flow, system wide diagnostics, patient portals, securing systems and system wide Wi-Fi.

Helen McGuire and Ainhoa Arjona take us through the new role of Assistant Nursing Information Officer (ANIO) at the Royal Brompton & Harefield NHS Foundation Trust.

The ANIO is to improve nursing practice through technology to optimise patient care and staff experience as well as bridging the gap between nurses and the IT department.

Ainhoa started taking us through the new post; “when I arrived to my post, I had to face new challenges, as the post was very different from my clinical post in the past.  The Covid outbreak meant that I had to go back to ICU in a clinical capacity, but I saw how technology in the hospital was being pushed. After the peak, I went back to my ANIO role remotely where there was a new focus on telehealth and a new reality of working.”

“For the future, a digital nurse would be a more defined career path with an ANIO in every hospital and digital nurse teams across the UK.”

Helen then took us through her experience of the ANIO role: “an important part of our role is staff engagement and being the face of IT. We want to make sure we have kit that reduce login times, have high quality Wi-Fi, the systems are easy to navigate and are user friendly.”

“Making sure devices do everything you want them to do and making sure everything fits with what we currently have in terms of IT.”

“We are trying to promote person centred digital literacies and we feel we fit very nicely with digital literacy training going forward.”

Helen has been a qualified nurse since 2008 where she joined Harefield ITU in 2013. Her skills then combined together for her to become an ANIO.

The ANIO role that she is now in has changed in terms of joining a new department, hospital and team as well as learning new tech language.

“There is the challenge of having essentially two jobs; clinician and IT officer.”

In terms of digital progression at the trust sees the use of MS Teams, acceleration of paperless systems, and also the adapting to online everything.

The awareness of IT and a functioning hospital is something Helen says she now has. The trust is building on Covid progress and communicating in terms of their intranet; general information, current projects, trust plans and contact information.

Helen’s learnings and observations: “I have had to learn to plan a lot and learn to say ‘no’, sometimes there is too much. Also, speaking up at meetings is something I’ve had to start doing more of! Anyone with a clinical background would be hugely beneficial for the role.”

“We want to inspire and support women in tech as well as those people from a BAME background.”

Our penultimate session of the day saw Mark Hutchinson, Executive Chief Digital & Information Officer at Gloucestershire Hospitals NHS Foundation Trust talk about Gloucestershire’s EPR journey.

With the UK’s fastest deployments of Allscripts Sunrise EPR, they share their insights on delivering change at speed, including going live with e-obs during the COVID pandemic.

“When I arrived, we had 3,000 PCs which were over 6 years old and 300 PCs with no antivirus software. We had a team of people from a technical point of view that were downtrodden and frustrated.”

“The average wait time was 26 minutes when logging a call to IT. We had 50 severity one incidents at that time.”

“I set about trying to convince the board that despite things not working too well, they should invest more.”

Mark then took us through the journey from that point.

“Engaging with clinicians was crucial; working with them to understand what their desires were and being able to show those teams success from other places.”

“Showing success from other Allscripts sites was really important for engaging clinicians and most importantly, the board.”

“We spent a lot of time talking to the board about successes from other organisations.”

“There’s no other sector in the country that really works on paper aside from the NHS and the council.”

“It was important to pick a solution that was delivering benefits in other institutions and demonstrate that.”

The trust chose AllScripts for their EPR implementation with the intention of going live in June 2020. The trust went live earlier in November 2019 with the approach being incremental and managing change as it happens.

“It didn’t make sense to me to change the organisation overnight and we picked areas where we knew needed more work first. My observations that with 1,800 nursing documents on paper at the moment will take years and years to get fully digital.”

“You must be able to articulate what you have made better for the organisation. We were very clear that it would take longer to type information into an EPR that just scribbling in a patient diary. But there are all sorts of advantages in an EPR” – crucially, information can be shared far more efficiently.

Mark’s changes so far have resulted in almost a 20% increase in the time nurses spend with patients away from administrative tasks. This results in over £1million of nursing time saved. “This time has be re-invested”, Mark said.

Mark then took us through his methods and learnings through Covid-19.

“In March, there was no PPE on our hospital wards; no masks, no gowns, looking back, how unbelievable this now is.”

“We needed to change all our outpatient procedures to remote working and we needed to ask how confident we were for our staff to change to remote working.”

“We implemented an electronic observation system where the benefits to this were identification of where the sickest patients were, remote access to clinical support decisions as well as reporting who was in need of oxygen.”

Mark then showed us testimonials from clinicians for how e-Obs had benefitted them in being able to identify deteriorating patients and where needs are not being met.

Some of the highlights from Mark’s Covid-19 experiences include 2,000 staff accessing trust systems remotely, having 5,000 support calls handled by remote IT service desk, 100 applications on the virtual desktop, 2,000 meetings being held across MS Teams and 75 iPads being distributed to wards for virtual patient visiting.

For our final presentation of the day and our final one of HTN Digital Week June 2020, Saira Arif, Implementation Manager at ORCHA took us through Digital Citizen Empowerment.  

“I think it is important to look at the definition of empowerment as we start; it is the authority or power given to someone to do something and the process of becoming stronger and more confident.”

Saira’s definition of empowerment is “Empowering citizens to use digital technology to improve their health & care outcomes.”

“The aim of empowering citizens I feel, is to help them to develop self-awareness and self-care.”

“The aim of digitally empowering citizens is to help them develop awareness of the digital tools on the market.”

Saira went on to share her learnings of what empowerment can look like for digital health and NHS organisations.

“Citizens need to understand what their roles are in using digital tools. They also need to receive sufficient knowledge and skills given by their health care provider to perform a task. It should be continuous learning and establishing a support system to create the appropriate culture.”

ORCHA are empowering their communities by providing ORCHA App Libraries, Digital Healthy Schools, Digital Health Career Zones, Digital Empowerment Programmes and Collaboration.

In terms of App Libraries, ORCHA work with NHS organisations, local authorities and in education which promote and disseminate digital health solutions.

“4 million apps are downloaded everyday where only 15% of apps are of good quality.”

“We are educating people to know that not all apps are the same; just because they have a 5-star rating, does not mean they are of good quality.”

Digital Healthy Schools provides teachers with information support and guidance in suggesting apps to students.

“We work with secondary schools in the age range of 12 to 16 and corollate appropriate apps for the appropriate age groups.”

“70% of students think that digital health is valuable to them or their families.”

“We have seen a 47% increase in positive use of health apps after a Digital Healthy School’s programme.”

With the Digital Empowerment Programme, the programme compliments ORCHA solutions and provides a channel of citizen empowerment, also, through Collaborate and Listen, ORCHA work alongside app developers and assist them through the review process.

To summarise, Saira shared her top tips:

“Remember that with any new digital health technology, there must be some form of education or training alongside it.”

“Don’t make assumptions!”

“Finally, you can only digitally activate citizens by understanding their needs first.”