HTN recently sat down virtually with Jennifer Dunne, Mobilisation and Implementation Practice Director at Ideal Health to talk all about the world of implementing electronic patient record systems, change management and how to get it right.
As well as answering our questions about implementation, the expert – who has seen her career in this area take her across the globe – also provided her thoughts on the challenges, changes, and trends in this sector over the past year.
Can you give me a brief introduction of your role and background?
I’m the Mobilisation and Implementation Practice Director. I work alongside four other practice areas, including strategy, data and BI, change and optimisation – which makes Ideal uniquely placed to support our NHS clients through their entire digital health journey.
My first EPR implementation was in Victoria (Australia) with Cerner, through a programme called HealthSmart. Following that experience, I came back to the UK and worked for EMIS Health on their Gibraltar whole health economy transformation programme.
Since then, I’ve been supporting health organisations with their EPR procurement and implementations, such as Chelsea and Westminster Hospital NHS Trust and the Manchester University NHS FT, as well as countries such as Belgium. Now I’m at Ideal focusing on growing the Mobilisation and Implementation practice – it’s a real passion!
What are the challenges in implementing an EPR?
Not placing the correct attention at the mobilisation phase. As soon as the vendor comes on site to start the implementation, the trust has to have the right team in place. It sometimes comes down to a degree of naivety, sometimes it’s a business case issue where there is not enough funding to do it in the right way, and sometimes you just can’t find the people with the required expertise, a problem I think we will see a lot of this year with the amount of EPR implementations happening across the UK.
The underestimation of effort can also be a huge issue and the idea that a trust can use their existing team to cover the activities and tasks is not always realistic. ICT is always an example of this, the trust’s existing ICT team is already busy keeping the lights on looking after the live service and they have to keep doing this whilst you’re in the middle of an implementation.
No CIO is going to buy-in a new group of ICT people; it’s rarely done, but the magnitude of the effort of implementing an EPR needs to be realised. Even when the realisation comes that a new group of ICT people are needed, CIOs still do not tend to hire, thinking that it is too late in the process.
Another challenge is the trust believing the vendor will run the entire implementation, while the trust just has to provide some clinical staff to act as work-stream leads. It actually doesn’t work that way – the trust has to be responsible for the organisational change programme of work.
The challenge, therefore, is making the trust believe in themselves to manage and lead. The EPR is an enabler where the technology itself is only 10%; and the people and processes are the 90%.
The final key challenge for me is executive support; trusts have to make sure they have the right sponsor, the right champion in place, the right SRO, the right group of people and programme governance, and without any of these elements, the programme will not progress well.
Could you take me through a successful approach to EPR implementation?
One of my favourites, which I saw first at Chelsea and Westminster [Hospital NHS Foundation Trust] and copied into Manchester University Trust, was the ‘Clinical Innovation Council’.
The model is that you recruit from inside the organisation, so you’re trying to recruit a few people from most service departments: clinicians, or nurses, or operational staff for a few hours each week.
The innovation council will start at the procurement stage and run all the way through into the implementation stage to become change champions and super users. They will have the whole picture, so they will know what the initial requirements were, they will have been involved in the benefits work and process mapping, and it creates a very effective communication and engagement chain within the trust.
With this approach, the time will be allocated to the EPR programme and agreed with the trust’s services in advance – ‘begging and borrowing’ time doesn’t always work.
Can you tell me about a notable customer project?
We are working as the end-to-end implementation partner with the Countess of Chester Hospital NHS Foundation Trust and I believe this is the first time a trust has gone for a full implementation partner from a consultancy in the UK. Countess are implementing Cerner and have been successful in keeping the programme running all the way through the COVID period, which is no mean feat.
One of the key benefits in taking this approach is that Ideal quoted to deliver for a set cost, therefore it is in our best interest to deliver the programme on time and to budget. We are able to do this using our tried and tested methodologies and using our experienced delivery team who have worked with us on multiple programmes and projects.
Additionally, we can scale up and down with resources, in line with the demands of the programme and we work closely with the trust staff to ensure effective knowledge transfer for when the project is completed.
However, some trusts try to deliver these projects through bringing in large numbers of contractors or recruit new staff on fixed-term contracts and then try to deliver the project themselves. This, from what I have seen, inevitably results in excess costs, project overruns and other issues that affect the success of the implementation.
How has the EPR implementation process changed over the past year?
Personally, I found that from the minute everyone was told to work remotely, the implementation I was running continued to progress well. The challenges came later with a fragmented approach when some of the team were back in the office and some still working remotely – I don’t think we can ever underestimate the power of the ‘water cooler’ conversations.
What has been surprising is that the e-learning format has now changed forever; EPRs have traditionally been trained in the classroom, some suppliers offering a minimum of 16 hours for example, whereas now e-learning modules are available which are shorter and more succinct. These are then re-usable for staff who may feel under-equipped with knowledge from the first time around but also for business as usual training delivery.
What trends are there in EPR implementation at the moment?
One trend – whether trusts get this right or wrong – is aligning their EPR strategy with their Integrated Care System. Bath, Swindon and Wiltshire want a shared domain across the ICS, and Norfolk, Norwich, James Paget and Queen Elizabeth want one ICS implementation, and the funding is starting to be released to achieve those results.
From an Ideal perspective, we are working a lot with ICSs on digital maturity assessments and helping them with their HIMSS journey.
A lot more healthcare software vendors that offer fully integrated EPRs and/or a best of breed approach are now shining through too, it’s no longer just two or three vendors to choose from.
What’s coming up over the next 12 months?
In January, we received more tenders this year than we have in the last three years combined. Cerner has many active implementations this year, and Epic have got a few things happening with Manchester, Guy’s and St Thomas, Frimley, North Devon and Northern Ireland. There is so much happening in the UK at the moment and we have been working on a lot of bid responses for EPR implementation partner programmes.
As for Ideal, there has been a recent change in business strategy – we now have five distinct practices. We have a strategy practice that is about digital maturity assessments, business case writing procurements etc, a practice that supports trusts with their data and BI needs – specifically RTT in a lot of places. And then there is my practice that focuses on mobilisation and implementation, a change practice that provides transformation and change expertise, as well as training delivery. And, finally, an optimisation practice that is very much focused on supporting our clients in ensuring that they get the most out of the investments they make and clinical and operational adoption of the solutions continues to progress.
These practices are moving Ideal away from what has traditionally been known as a training and go-live support consultancy to a full-service offering consultancy. With presence in the Middle East as well, there is enough happening to keep us all very busy.
Our team at Ideal is made up of a lot of diverse experience in primary care, acute and acute mental health. We have Epic experts and consultants with a lot of Cerner experience, for example. And our large resource pool covers experience and expertise in pretty much all other healthcare solutions – such as TPP and RiO – so we are looking forward to supporting many trusts this year with their digital healthcare journey.