In April, East Lancashire Hospitals NHS Trust announced its plans to start its EPR journey, following a contract agreement with Cerner for its electronic patient record system.
HTN sat down, virtually, with Mark Johnson, Chief Information Officer at East Lancashire Hospitals NHS Trust to talk about the work on the programme up until now, what they have learned and what’s coming up next.
Tell us a bit about yourself and your role within East Lancashire NHS?
I’m a nurse by background, having worked as an intensive care nurse and a mental health nurse, and a family therapist. I got into IT when I worked in intensive care and helped to develop a mental health system in Manchester.
I went on to do a MSc in Health Informatics, to formalise the clinical and academic links there. I moved between trusts, last worked as the Associate Director of Performance at Aintree University Hospitals NHS Foundation Trust and then I moved to my role now, in my home trust, in the role of Chief Information Officer.
We have a team of around 160 people in the Informatics department, very much clinically led, with two CCIOs, a full time CNIO and a clinical informatics team, as well as a whole remit running from infrastructure, data capture to business intelligence.
EPR journey so far
When I came to the trust, we didn’t have an EPR, we had a stable PAS system for around 25 years, so it worked and is the backbone of what we do.
The original strategy was around best-of-breed, but the complexity of that model was quite daunting, so we decided on an integrated approach with a core EPR – that was back in 2015. We developed the outline business case towards the end of 2017, we also had two full days and 100 clinical and operational people to help us decide on the system.
We then completed the business case and went through the approval processes. We were looking to get some additional funding to support the programme, which eventually came in April 2020, as emergency funding and grants, which allowed us to progress.
We placed our contract with Cerner in December 2020 and we’ve now started work, but our official start date is 5 July 2021, and we’re aiming for activation (go live) in autumn 2022.
The good thing is…while we have been waiting for the business case approvals, we have been doing the infrastructure work, we have put in new networks, managed print, single sign on, a new PACs, and upgraded our wireless and desktop infrastructure. We’ve also started early work on the data migration; we’ve been cleaning the datasets in readiness.
First-hand learning from other trusts
We spent a lot to time going around other trusts; Calderdale and Huddersfield, Countess of Chester, Braford Teaching, Newcastle, for example and we asked them ‘what are the lessons learned?’, or what would they have liked to have done before implementing Cerner. So, we’re as prepared as we can be before we go for this. Our NHS colleagues’ advice has been invaluable.
A key lesson we heard was don’t forget the operational staff, the people who run the clinics, the booking centres, outpatients etc; have the same focus on clinical as operational.
Don’t focus on specialities, focus on pathways. We learnt from Calderdale and Huddersfield to move towards a focus on patient flow rather than speciality elements, but to be aware of them too.
The hard bit is (as always) the soft bit… the cultural change. Our biggest thing, is the team that will be delivering this, is the service improvement and transformation team, simulation and education team and informatics – together. This isn’t an IT project, it’s a transformation journey.
We have basically taken over a space in the hospital to design, build and test. We’re setting up simulated wards and we’re going to run simulations to make sure we hit the right things and that’s its operationally relevant.
We’re also bringing in people from other trusts, such as Blackpool Teaching Hospitals (with which we share a CEO) and other regional colleagues to help us implement and share learning. We see it as a way to build up that skill set, learn from them and explore those digital solutions that allow us to integrate. It’s also an excellent opportunity to build up wider regional capacity and capability.
How does this programme connect into the Integrated Care System (ICS) and direction of travel?
We built the ICS strategy and the requirements into the business cases. The business case took a while, so we’ve been able to embed the ICS vision as it’s evolved and developed.
The ICS overall strategy is that we have a consolidation of digital innovation within the region. We develop core EPR systems, we have an orchestration layer to bring information together into a combined data layer, allowing us to be much more flexible, separating the data from the applications where applicable.
With the ICS we also have joint systems too, for example we will have one maternity system across the region and one community system; in other areas we are looking at one system choice across the region (or example endoscopy, regional integration engines etc) but then to have interfaces into the core and use the data layer to support these applications. The future is bright for Lancashire and South Cumbria ICS and we’re proud to be a part of that.