Mr Richard Slater, Chief Clinical Information Officer, and Laura Mumby, Head of EPR, recently took time out of a jam-packed digital schedule to chat to HTN about Rotherham NHS Foundation Trust’s latest digital initiatives.
The South Yorkshire trust had a lot to update us on, including their EPR choices, tips for boosting clinician engagement and what exciting digital developments are yet to come.
Tell us a bit about yourselves and your roles within Rotherham NHS FT
Laura: I’m head of EPR at Rotherham. We have two EPRs – some people can’t get one but, lucky for us, we have two. We have MEDITECH on the acute side and the SystmOne in our community arm. It’s because we’re an integrated trust and we do both acute and community services, but with an integrated pathway. So it can cause us some tricky circumstances but also gives us a range of expertise and we can use different systems, so that’s good for us.
Richard: My background is a general surgeon within the trust, in colorectal disease. I’ve been actively involved in a lot of IT projects over the years and was invited to apply for the clinical lead role here about five years ago. That role has gradually evolved into what we’re now badging as the Chief Clinical Information Officer role, which I’ve been doing for three or four years under that banner. It started off as just a small scale job…but it’s got bigger and bigger over the years.
What programmes are you currently working on?
Laura: We’re at an exciting time, because we’ve had our EPRs embedded for quite a while. So we’ve done the hard bit. We might say it’s even harder as we go on. But we’ve got the systems, we’ve gone through the pain of user change and embedding, and reducing the paper, for quite some years.
Now we’re at the stage where the users are engaged. They’re actively asking us for projects; to do things, to change things, and they take ownership.
Now we’re really looking at the integration side – making all the systems tie together. The fun stuff, such as the obs machines – nurses can take machines to patients and the vitals will just flow through to the EPR. All of the stuff that, I think, makes us look very digital and fun. And doing the clinical support [too]…so the system can come back to the doctors and say ‘what about this?’
What makes Rotherham’s digital offering different?
Richard: What I think is interesting is our strategies and approach. What we’ve achieved in the last two or three years and, particularly, over the last 12 months in the midst of the pandemic, I think is phenomenal.
Our strategy has always been to go for an integrated EPR solution, rather than the ‘best of breed’ solutions that other trusts have employed. Because we think that integration approach brings with it certain advantages that the best of breed approach doesn’t have…particularly in terms of interoperability.
So the general strategy has always been to amalgamate everybody onto as few platforms as possible, and get away from multiple ancillary software packages. Now, we still have a few – radiology and labs are on separate systems – but in terms of what the end user can see in front of them, the more they can do within a single system, the better.
That’s been the strategy. We’ve made massive progress in the last two years – from completely paper-based nursing observations and assessments to all of that being completely digital in the last 18 months.
Laura: I think we’re up to nearly 20 million single entries in the EPR, from when we first went live. It’s just spiked.
Richard: We went live with electronic prescribing and medicines administration really quickly. The next big thing for us was to get all of our clinical notation onto the EPR as well. We took the opportunity during the initial lockdown period to accelerate some of our plans…digitising the whole of patient clinical notation, pretty much.
What we’re currently doing now is digitising the whole of outpatient notation, a lot of which is still paper-based. I thought outpatients would be dead easy…but actually it’s not, people have pathways they want to stick to and it’s a lot of time and effort.
Tell us more about the process for that
Laura: We’re three months [into that] out of 12, so we’ve got another nine to go. And we’ve got paediatrics nearly ready, we’re working with dermatology – so we’re picking off the big ones first and the most complex.
Richard: There are always one or two really tough to digitise documents, things like ECGs, various other third party reports, testing machines…
Laura: Height and weight for the scales [too] – patients will walk into outpatients and jump on the scales and their height and weight will just go straight into the EPR…we’re doing self-service check-in now, we’ve done a pilot in maternity services outpatients and we’re just procuring the rest of the kit that we’ll need. When the patients come into the hospital they’ll check in and then they’ll get called when they’re ready and they can even sit in the car. And we’re going to have a mobile app.
We’ve been really lucky as well, as we’ve been on the Digital Aspirant programme so we’ve had some good funding to help. You do need the money and the resource. But because we’re quite far on with our digital journey, we were then able to buy the fancy stuff, the different kit that will benefit patients more but can be costly.
Richard: Until you get people on the system [though] you can’t leverage all the advantages and benefits of using an electronic system. So all of those exciting bits, in terms of clinical decision support, we’re now in a position to leverage.
And what’s next?
Richard: Next bits for us will be tying up all the loose ends – looking at how we’ll digitise consent documents. They’re the type of projects we’ll be looking at over the next 12 months.
Laura: One exciting thing that we have been doing is reaching out and connecting other systems. We’ve been working with Yorkshire and Humber and, in particular, with the Yorkshire Ambulance Service. Leeds have gone live and we’re second, whereby we get an interface from their EPR, when the patients are on route. So we can see patients that are on the way and then we can get the electronic ambulance form into our EPR. We’re reaching out and trying to join up all our systems up and share that data. It’s making a big benefit for patients.
It’s making sure everyone has what they need at the right time – and not having to log into another system. It’s very hard to sell something when you have to log-in but if you can just click a button…if you can be in one system it’s easier for the end user. That has big value.
How have you been bringing people on board?
Laura: I think we learnt early on about managing expectations. Not over-selling, trying to be honest about what the system can do and what’s required, and doing more of a learning approach. Me and Richard went on the NHS Digital Academy, so we’re a bit preachy now on how we deliver our transformations. We acknowledge this is difficult but if we aim for perfect we’ll never start. So we aim for something, knowing that we are then going to review it, make changes and learn. That approach seems to be more accepted by the organisation.
Richard: Yep, and MVPs – minimum viable products. Put something in and get it working. The other thing that’s very important is clinician buy-in. In the past…if we’ve made it an IT project…you don’t get a lot of support with that. Sometimes selling the idea that digital change is going to bring benefits, convincing them and letting them lead that process and embedding, is what you need to do. Because we can’t be there all the time, holding hands.
With general medicine we got a team of very keen junior doctors that just really wanted to do this to prove their own service. They convinced our colleagues – we didn’t have to go around convincing the whole of general medicine to do it. Their own colleagues on the ground were going around doing that.
Do you have any key learnings you’d like to share from the past year?
Laura: I learnt to be a bit faster. But we had to be in that pressured situation. Sometimes we can take a long time designing and building, trying for this perfect thing that just doesn’t exist. So we’ve changed our tack a bit, so that we’re a bit quicker: we produce something, it might not be the right thing but it’s something that’s live and can be tweaked and made better.
I think, and I hope the organisation thinks, that we’ve got quicker. And we’re more accessible, because we needed to be.
Richard: We were changing the way we worked very rapidly…but yes, working at pace and getting something in quickly, even if it’s not perfect at first and then refining it later, is better than over-engineering and trying to make this perfect solution to a problem. You’ll always have problems when you then put it into a live environment. If you don’t work fast enough, end users will find their own work-arounds.