This week we focus on electronic patient record (EPR) systems across health and care through a series of articles to explore approaches, learnings and advice from health tech leaders.
HTN spoke with Michael Beckett, Interim Director of IT at Medway NHS Foundation Trust, to find out about his team’s EPR journey with Allscripts Sunrise and his learnings over the past year.
Can you tell me about your role and background?
I’m interim Director of IT and started with the trust in April 2020. I’ve worked in a multitude of IT roles, most notably as interim IT Director at Maidstone and Tunbridge Wells NHS Trust. Medway brought me in for a number of reasons: firstly, stabilisation of the department where they had previously discussed the potential outsourcing of the IT department and had eventually arrived at the decision not to do that. Secondly, to drive forward a digital strategy for the organisation, and thirdly, to start them on this journey of the EPR.
Can you summarise the journey of the EPR implementation to present day?
The trust has already successfully used Allscripts’ PAS system and for about five years now; it was, therefore, always on Allscripts’ agenda for the EPR to be the next logical step using a clinical wrap approach to incrementally build upon that.
Part of my role was helping the trust understand the best way forward in implementing an EPR, so we conducted a review of what was already in place across the trust in terms of clinical system mix.
We wanted to understand the appetite of the users and that led us back into restarting conversations with Allscripts to make sure the functionality of the product was right for the organisation – it’s all very well us already having the Allscripts PAS as scope for the Sunrise solution, but we still needed to analyse whether it was the right solution and not just choosing it because it was the easiest solution.
Part of this analysis was looking at what else was on the market, how the Sunrise solution could fit with the integrated care system and integrated care routes, and how the company would work as a partner – any EPR is a long-term investment and implementation. We were looking for an EPR that was capable of transformation moving forwards.
There was a great deal of parallel working within the trust and also with the wider STP and ICS, as well as with NHS England, to make sure we were strategically making the right decisions.
In parallel, we focused on user engagement to make sure it was the right product and fit user requirements, and also for the regional strategy. We managed to get the contract signed just before Christmas.
What are the key learnings for you from the EPR process?
I don’t think it matters how many times I’ve been through this process, the engagement with the staff has always required asking the question “can we do more?”
At that early stage, some people think that just getting the business case over the line is enough to progress but, actually, the earlier you can engage clinicians, the better they can input into the product specification requirements. It’s been hard to get that clinical engagement over the COVID period, even though the clinical engagement process was mainly conducted over the lull in transmission rates, in July to September, last year.
Anything we could have done to align the integrated care models across the various trusts would have been useful too; we have been lucky with Kent and Medway to a certain extent, due to how the acute EPR setup is. It would have been great if one of the trusts had selected the product and named us on the procurement route so we could have ‘piggy-backed’ upon it.
Do you have any advice you would like to share with other trusts about going through the EPR process?
Clear strategy is always a key factor; I think it isn’t just about deciding you need an EPR, it is about selecting the correct EPR for you. There are a range of products out there on the market which refer to themselves as EPRs with different price points and different functionality.
The strategy was the first piece of work completed when I came in to make sure we understood our roadmap. This, in turn, made the business case easier and highlighted the clinical systems functionality we wanted to deliver; how would the system integrate with the Kent and Medway care record, what were we going to do with PACS and LIMS and so on?
Getting the buy-in from the trust executive and board, as well as further afield, is also key: you have got to think about NHS England vision and engagement, as well as the ICS now as well, particularly when thinking about funding routes.
What is the core functionality that you are going live with?
For the initial go live in September, we will be deploying core clinical documentation and a number of context aware links into the system. This includes an existing order comms system, ED, the regional care record KMCR, maternity and PACS.
We are almost creating a clinical portal at this stage – but we felt that it was really key to deliver early benefits, ensuring we maintain clinical engagement. The trust is engaged and clinicians are excited. So we feel a ‘quick win’ will build confidence in the project and maintain user engagement . For phase 2 we start to get into some of those bigger ticket items: order comms, ED and e-prescribing.
There’s not necessarily a right or wrong way through the programme, I think the key piece is that not everyone should follow the same path. I’ve been involved in EPR implementations before that have had wildly different routes; you need to understand the appetite and ability from the organisation to adopt change.
What have been the main challenges?
It took a lot of work to get people to believe in the EPR implementation; it took many hours of presentations, meetings, stakeholder events and corridor conversations to ensure that staff at the trust believed it was going to happen.
From there, we’ve tried to utilise that belief and make sure engagement in the project is maintained. We’ve tried to ring-fence staff time and ensured we have specialist clinical roles appointed within the team. It is a constant drive to keep people engaged; with the deployment methodology, we have thought about how best we can keep clinical engagement throughout the implementation.
COVID-19 has, of course, been an issue. The implementation and timescales have had to be realistic and have been influenced by COVID, as to where we should be at any particular stage. But, that said, we have an ambitious go-live plan in just six months time, which is almost unheard of with EPR roll-outs, but we believe this is achievable. When writing a business case, no one including myself wrote in risks associated with the onset of a pandemic and so we’ve had to deal with related challenges as they’ve emerged.
With other trusts in the area using this EPR, what could this mean in the future?
It’s definitely something that has been supported within the Kent and Medway ICS. There are clear benefits of three of the acute trusts having the same EPR. Primarily this provides opportunities to support application and data interoperability to supplier service transformation across the region.
There’s also the wider piece around support and management of those environments; opportunities for centralised teams, integration, config teams, looking at the development of how we are taking that forwards, and also standardisation of functionality that we are using across the organisation.
Although the ICS is still developing its digital strategy, this approach ensures we keeping our options open about how the systems can work together.
Our community and mental health systems across the region are also reasonably standardised too, so that interoperability piece is definitely a focal point across Kent and Medway, and will allow us to accelerate some of the digital solutions we have planned.