Earlier this month as part of HTN Now, we welcomed Adrian Byrne, Chief Information Officer (CIO) at University Hospital Southampton NHS Trust (UHS) to reveal the organisation’s new digital strategy, and how it relates to its Integrated Care System.
Adrian covered the wider goals that UHS has about the ICS landscape, the challenges that had been faced so far, their approach to integration, and the details of a digital maternity project with BadgerNet.
Introducing the latest version of University Hospital Southampton’s strategy, which has been “refreshed” across the last 12 months in response to the changes and demands triggered by the COVID-19 pandemic, he noted that, “it was time for a refresh but, also, undoubtedly everywhere the COVID pandemic and crisis has led us to do things in a different order than we would have done, and has changed some of our thinking.”
“We’ve delivered some things, undoubtedly, within the last two years that we wouldn’t have expected to have delivered by now…of course, the emerging ICS is affecting the way the that we think about things as an organisation, as well,” he said.
Summing up UHS’s digital strategy, Adrian said, “we became an exemplar under the NHS England programme, through a system of working with integration and interoperability…we’ve got less systems than many people might think we have.”
“Broadly speaking, we work with a set of strategic vendors and we make those interoperate with each other – and we’ve been quite successful at that by using our engine integration technology.”
After looking at the drivers for refreshing the strategy, Adrian highlighted the need for “patient pathways to be handled in a much wider sense than they are, historically, where you’ve been referred to a single organisation for a series of treatments and then been handed back over.”
“What we all see now,” he added, “is the need for different health organisations within any ICS to be able to handle the concept of a patient moving around with continuity within that system. The emerging clinical strategy that we saw was certainly starting to put some pressure on us to do that, at least for some pathways.”
Adrian also highlighted the aim to become more efficient and effective, and to meet “increasing and more complex patient expectations” for an “overall improved experience”.
The roll-out of Microsoft Teams at the trust led to thousands of staff working from home, and the shift to cancer Multi-Disciplinary Teams meetings, clinical handover meetings, outpatient consultations and trust board meetings all being delivered remotely, with UHS now looking to grow its virtual outpatients environment.
“What we did show during the pandemic…is that technology can make a positive experience and we did that in a particularly rapid way. I know a lot of people talk about governance being pushed out of the way, and we just got on and did things. My own personal view is that we were held back a lot more by money, previously, really,” he added.
On areas for improvement, Adrian also noted that feedback from clinical staff was mainly focused on old and outdated equipment. “If you’re investing money in your clinical software, your EPR, and the rest of it, you’re really shooting yourself in the foot if you’re not investing in the associated networks, desktops, and server environments etc,” he commented.
On what makes UHS different, Adrian mentioned that they have “quite an innovative approach”: “We interoperate and haven’t yet decided to invest in a large Electronic Patient Record system. Whilst many hospitals do work with a single vendor, we’ve integrated our platforms through our integration engine.
“I think it’s fair for me to say, without wanting to speak for too many people, the Electronic Patient Record systems cover varying amounts of functionality – but you’ll almost always find an ophthalmology system, or a cardiology system, or a critical care system…that’s running a specialist database within an organisation. So you’ll always need to interoperate to a certain degree, it seems, about whatever you do.”
Adrian also explained that the UHS model is highly flexible and adaptable to different ways of working, thereby reducing vendor lock-in, and provided some visuals to show how the integrated approach “stacks up” against the singular EPR, with differences including a separate prescribing system.
“We’ve looked at it time and again,” he explained, “and found that it makes sense for us to keep going with what we’re doing, in largely the same manner.”
On the UHS strategic themes that are supported by the digital strategy – such as outstanding patient outcomes, pioneering research and innovation, world class people, integrated networks and collaboration, and foundations for the future – he added that, “we support all of those – obviously they don’t map exactly onto our digital themes…we’re trying to map them onto the UHS strategic themes, and they resonate quite well against the NHSX missions – it’s all about putting information in the hands of clinicians, [in] real-time.”
Switching to how UHS fits into the ICS, Adrian said: “What we see, at the very centre of this, is that systems have to be very patient-centric. We say that a lot – but I do wonder how many times we actually deliver it. Certainly the patient record is at the centre of the EPR system – it might feel sometimes that the patient is on the periphery of all the activity but…quite clearly there is a point of care element to what we do.
“Outside of that….I think it’s fair to say [that] one of the key risks is patient handover…in digital, one of our key objectives must be to try and minimise it…that’s a key thing, in terms of having the architecture right, to enable that.
“Wider than that…we have to provide not only good, local services with handover etc to the ICS, we’re a specialist centre as well…so we have to figure out how we are going to communicate with other hospitals…luckily, these things also underpin two of our trust strategic themes around integration and collaboration, and what are [our] foundations for the future – enabling infrastructure right across the landscape.
“We are, in fact, working a lot more already with the ICS, in terms of putting bids forward. One of the things we’re interested in, across the provider landscape, is to put in a patient index, regional interoperability engine, and a enterprise-wide scheduler, which will hopefully replace some of the legacy patient administration systems that exist.”
Adrian also outlined the trust’s five programmes of work within the strategy: digital patients; digital at the point of care; supporting team working; information and insight; and increased trust productivity.
He explained that the digital patient programme had actually been in place since 2013, with the trust having “one of the earliest and most established secondary care, patient online services”, singling out the achievement of reducing unnecessary cancer patient appointments and the use of NHS login.
On digital at the point of care – digitising the frontline and digital maturity – he noted that “we build most of our Electronic Patient Record layer – the layer above the administration – the clinical side, the task management, order comms, and on top of that some artificial intelligence and decision support…the core EPR is our own.”
Secure messaging and linking messaging into the medical record, such as sending pathology results, were highlighted for the topic of team working, while his thoughts on information and insight focused around the business intelligence programme – the construction of a “truly intelligent warehouse”.
“In doing that procurement,” he continued, “we decided we would move all of that out into Microsoft Azure, so we’re working with Trustmarque and Acuma, to build that platform…we went live with our first true apps on that environment only a couple of weeks ago…we don’t get data locked into individual reporting apps, which makes it more flexible.”
Returning later to ICSs, Adrian touched back upon the digital maternity system, explaining that, “our view on this, generally, is that we will implement the index, the regional implementation technology, [and] we already have digital imaging running across the whole of Hampshire and the Isle of Wight…we’re working on scheduling…you can see a number of pillars appearing in this space.”
The ultimate aim, by working with Clevermed’s BadgerNet, is to introduce a common digital maternity service across four maternity units in Portsmouth, Hampshire, the Isle of Wight and Southampton.
Concluding the session, Adrian also covered what’s coming up next for the trust, adding that, “we need to do more work on connecting shared care, we need to do the work I mentioned on joining that up to My Medical Record platform, we need to integrate with medications prescribing fully…bring access to maternity notes through the NHS App…there’s still a lot to do [and] there always will be.”
“Our mission is to give world class digital support and offer world class care for everyone.”
Watch the session in full below: