Nervecentre, an Electronic Patient Record (EPR) software supplier to the NHS, recently shared a presentation on the topic of its ‘EPR as a service’, sharing how trusts can use the company’s fully-integrated platform as a cloud SaaS [software as a service] model.
Delivering the live webcast was a panel comprised of Paul Volkaerts, Nervecentre Founder and CEO, Jatinder Punia, Director of Sales, and Mike Barnes, Director of Products.
Jatinder hosted the session, leading with his ‘take home messages’ about the cloud SaaS model. These highlighted the ability for users to get “new features faster” through “faster and easy access” to the “feature-rich” EPR, as well as the upsides of zero downtime for upgrades and continuous delivery of features.
“This is great for IT,” he said, “[there’s] no need to plan any major upgrades each year, on the weekends or out of hours, …for clinicians there is no more offline working during an upgrade, no disruption to the services you provide for patients – ED [emergency department] can function as normal, [and so can] prescribing, orders etc.”
Jatinder then provided a brief overview of Nervecentre, explaining that the supplier works with around 40 NHS trusts, and mentioned that 2016 was a key date in the company’s history, due to go-live and deployment of its software at the University Hospitals of Leicester, which was achieved in just seven months.
“Leicester gave us the confidence that we could work on more complex systems and they also had the confidence that we could deliver more complex systems,” he said, later adding that Nervecentre’s aim was to try to create “something that was modern, intuitive, mobile and just a really good user experience.”
Moving onto their EPR SaaS, Jatinder explained that Nervecentre is accredited by the NHS England EPR Health System Support Framework, and that all our modules are together in a single integrated EPR, designed and developed entirely by Nervecentre, written in the same programming language.”
Use cases and benefits given as examples by Jatinder included a sepsis module go-live at County Durham Hospitals, where digital prescribing of antibiotics has increased from 29 to 93 per cent, with inpatient screening of sepsis having increased to 100 per cent. While, at Nottingham University Hospitals, Nervecentre is being used as part of a discharge initiative to potentially save the trust 21,000 bed days per annum.
In an Electronic Prescribing and Medicines Administration (EPMA) example, Jatinder said Nervecentre had gone live with its solution across all the hospital sites in Leicester, providing closed loop administration for complex medications with high levels of compliance.
Jatinder then handed over to Paul, so that the CEO could share more about the cloud SaaS model and its benefits, as well as providing detail on the technical architecture.
“The SaaS journey for us really started in anger during the pandemic…a lot of people say to you, ‘what have you learnt from the pandemic in terms of how hospitals should be looking at IT?’, and the one message that resonated most strongly with me was the need for adaptability, to be able to move more quickly,” Paul stated.
“Very few organisations, very few trusts were able to leverage new software during that 12-18 month period, whereas, if you look at other industries, even Google, within a couple of months I could Google ‘COVID, France’ and it would tell me what the COVID charts were looking like in any country in the world. So, that’s the difference, really, that any service can give you – it can give you the agility and the adaptability to move at real pace,” he added.
“Our architecture has always lent itself well to a software as a service model but we hadn’t really focused on it until then…there are a number of things we wanted to make sure we delivered right from the outset…we wanted to make sure it was a fully featured version of Nervecentre,” Paul explained. This meant, he said, no reduction of flexibility or access.
He continued: “To me, a move to the cloud has to be purely positive – there can’t be a compromise there that says, ‘you can move to the cloud but you’re going to lose some things as part of that journey’…it was really important that it was fully featured, the same software. We’ll be running with a SaaS model and an on-premise model in parallel for a period of time, maybe a couple of years – we’ll see what the adoption curve looks like.
“In that time, we don’t want to have two different software versions that we’re developing – we wanted to make sure it was the same software that was available in the SaaS model.”
On scaling, Paul noted that Nervecentre wants to make sure the software “scales really well in the first instance” and to offer Integrated Care System (ICS)-level scalability of a single cluster, with the company live in “some of the biggest hospitals in the country” and having “no scalability issues per se” in regards to those deployments.
Other important points platformed by Paul include the supplier’s adherence to the ‘Twelve-Factor best practices for cloud-based services, the emphasis on working at pace and removing downtime, Nervecentre’s alignment with interoperability standards, and challenges around regression testing.
The Nervecentre CEO then went on to display the architecture of the service, touching on feature servers for EPMA, order comms, vital signs, assessments, and outpatient clinics, which are run on individual servers, so that components can be upgraded without regression testing the entire platform.
On cloud products and services used by Nervecentre, such as Kafka and ZooKeeper, Paul stated that, “they are world-class products used in some of the biggest cloud-based services that exist – Netflix, for instance, uses Zookeeper extensively. They’re really good products, they provide reasonably simple functionality at a very high scale. I think Kafka is rated at something like a trillion messages a day. They’re really high-scale, cloud-class services that run on multiple instances and [they] can handle downtime and upgrades.”
Paul continued to guide the audience through a variety of tools and layers included in the functionality and offering, and illustrated how upgrades and roll-backs can be made, before touching on Nervecentre’s three different security mechanisms for providing access – VPN security, 4G devices over the internet through certificates, and OpenID certification for GPs and non-trust users.
“There will be no direct internet access to the cluster unless you have a certificate that’s been assigned by a manual allocation or a negotiated allocation,” he said, before noting that the SaaS model would be ready to go from January, for any trusts that want to move with Nervecentre.
Mike then took over the talk to discuss more about the operational side of the offering. On timings, he said, “the bottom line is, with the SaaS model,customers will get new features and other beneficial changes faster; less than two months compared to 6-18 months. ”
“We’re doing this on a continuous basis, so there’s always an ongoing next build that will be deployed, and a cycle, so that you can line up your resources,” he said, explaining how customers will receive ‘transfer of information’ sessions and time to go through the changes so that they can prepare for deployment.
Mike took the audience through the process of a typical release cycle and extensive testing. He summed up by saying: “We run the data centre, we operate the platform, you control the services – so we’re not taking on or changing what Nervecentre can do, it’s the same Nervecentre product…all of that still remains in your control. But all of the service that sits on top of is going to be managed by us. You obviously need to continue to maintain clients, the network on-premise etc.”
Rounding up the session, Jatinder concluded, The goal of this is to ensure that clinicians get features faster. The benefit of them getting features faster is that the ultimate gain is for the patient…what we’re essentially doing is providing you with a best-in-class EPR, in a best-in-class cloud infrastructure.”
Find out more about the presentation on the dedicated page at nervecentresoftware.com.
