Calderdale and Huddersfield NHS Foundation Trust (CHFT) presented at our most recent HTN Now event in September, sharing the learnings and experiences that the trust gained from its Cerner ‘big bang’ Electronic Patient Record (EPR) roll-out.
For this webcast we were joined by Mr Graham Walsh, CHFT’s Chief Clinical Information Officer and a consultant in knee surgery, Neil Stanforth, the trust’s Associate Director of Digital Health, and Director of Digital Transformation and InnovationThe Health Informatics Service (THIS).
While introducing the chat, Graham said: “We’ve got a bit of a different session today. What we are going to do is talk about our journey of bringing EPR in from a hospital that uses paper to a hospital that is now pretty much paperless. Rather than [just] me talking about the whole experience, we’ve brought along Neil and Luke, who are going to go through what it was like to bring in the EPR, the fears [and] pitfalls that people faced, [as well as] where we are now, where we want to be – some of that transformational change and the optimisation piece that we need to look at.”
Explaining more about his role and how he came to be involved in the EPR project, Graham stated: “My background is that I was just like any other clinician at the trust, back in 2017, when we were bringing in an EPR. At the time, I have to admit that I was fairly sceptical [of] the ‘big bang’, as it was described, that we were suddenly going to switch off paper and bring on an electronic record.
“Like many clinicians in many organisations that many of you probably work at, we were very kind of ‘ooh, this isn’t going to work’ and that was something that, I think, the majority of people felt. That was probably borne out more of fear – fear of the unknown, fear of the technology, rather than the reality.”
Casting his mind back to the go live, he added: “Back then, the day when we went live, and the CIO was in my clinic and things were going a little bit not as planned, I remember laughing and saying ‘this was a bad idea, wasn’t it?’ Some four or five years on, I now find myself as a CCIO promoting [it] because what I saw as a clinician is the benefits that EPR brought to both us as clinicians – simplifying work, making things safer – [and] from a patient perspective it’s just made a huge difference.
“What we don’t see now is clinicians like myself back then, who are anti tech [or] anti digital. Now we embrace it and we want to change because we see the benefits.”
Graham then handed over to Neil, the technical lead on the project, who shared a timeline, spoke about his work on the programme and gave guidance to those who may just be about to start on their own EPR journey. He said: “For people that haven’t started it, it’s not going to be a hive of activity on day one. It is a bit of a slow-burner to start with – there’s a lot of engagement, you’ll have a lot of the likes of Graham in the room, who don’t necessarily understand what it is going to be yet, and rightly so… there’s a lot of changing hearts and minds.”
Speaking of the CHFT ‘big bang’ go live specifically, he added: “At the time [2017]…I think most organisations thought we were crazy to do the whole hospital at the same time. To give people an understanding of that, we didn’t just do the ED, the inpatient wards, or the outpatient wards, [and] we didn’t just do PAS – we did it all, all at the same time.”
The team used a Bank Holiday weekend, to give themselves an extra day, he explained, and “went live with the lot”.
“It was a very, very big project,” Neil continued, “we had around 400 floor walkers at that time…helping clinicians. Some of them had that training eight weeks ago…you have to start that training so early.”
He also covered that the team had tailored some of the EPR functionality over the years since go live and that “having done the ‘big bang’ and done that successfully, and not come away with too many scars from doing it,” the team had also undertaken some other large pieces of work, such as digitising ECGs, and also now do yearly code updates.
Speaking of the now, Neil added that the team has a much greater understanding of the system as a whole, adding that, “if we knew what we know now back then, it would have been completely different story…having an EPR is like having a child, you have that really nice build up where people tell you it’s going to be really good…but they’ve forgotten what it’s like to have to get up in the middle of the night and change their nappies.”
The first two years of an EPR, he said, “are like having a newborn – it’s painful, it wakes you up a lot, keeps you awake at night but actually then you move past it…you get that greater understanding…you find your feet with it.”
Challenges, he stated, included stabilisation, training, adoption, finding workarounds, and resources. “If we’re being really honest, it’s taken maybe years in some areas to really stabilise,” said Neil, and he also raised the importance of training and ensuring a mix of staff in the sessions, so that everyone understands the importance of what they do and their impact on others.
Luke, who joined after the go live, spoke about the future and the team building on what they have, highlighting integration with other systems, a transformational approach to training and adoption, an appropriate resource pipeline and the need to push on with a digital roadmap.
“If we can get everything into the EPR system, then from a data rich perspective, that’s going to allow us to then really interrogate that data at a population health level, tackle health inequalities etc. That’s going to give us that wealth of information that we can drive forward,” he said on the topic of integration.
On ensuring the resource pipeline for the future, he added: “The thing for us as the senior team, the challenge we’ve got is making sure that…we bring the people in and they understand the organisation and that they understand the technical aspects of it. And also then taking an approach where they’re helping steer the clinicians as well, and trying to bring the digital world and the clinical world together to get the best results for our patients.”
“That’s the really challenging part. We need people in that world to come up with really innovative ideas. If a clinician comes up with an idea and we don’t think it’s feasible, the challenge for the team is ‘it’s not feasible that way but it could be done this, this or this way’,” he said.
To conclude, Graham said: “We didn’t know when we started this journey where we were going to get to, we didn’t know the lessons we were [going to be] learning. As organisations out there that haven’t embarked on this journey [yet], you’re going to learn your own lessons.”
To watch the full webcast, view the video below:
