Video: Royal National Orthopaedic Hospital on the art of co-designing & co-creating a modular care record

At our last HTN Now event, Dr Saroj Patel, Chief Digital Innovation Officer at the Royal National Orthopaedic Hospital NHS Trust (RNOH), delivered an insightful live webcast on ‘the goal and art of co-designing and co-creating a modular care record’.

Saroj started her live session by sharing the trust’s journey in creating a modular health record system, highlighting why they embarked on the process, as well as their core principles, and how they achieved it, before concluding the presentation with outcomes and lessons learnt.

On why her trust and team opted to develop a modular health record system, Saroj explained her views, “I have now been a CDIO in the NHS for nearly 20 years. During my time, I have seen that the market is consolidated, we have a stranglehold of a few big companies…the barriers to entry are very high because of the cost…the barriers to exit are very high as well. What this has done is create the ‘haves’ and the ‘have nots’, so the NHS as a whole has not been able to exploit the huge benefits from technology, to improve patient care.”

RNOH’s goals, she said, were to “create a modular health record…to change the paradigm” and have people in the NHS “collaboratively produce high-quality, intuitive software that uses flexible and modern architecture and tools.”

The overall plan was to democratise access to software, not just making it available to those who could afford it, but to have the technology available for everyone. Therefore, Saroj’s team adopted “three open principles” for their project.

The first was to use an entirely Open Source platform, modules and technologies, so that everything is published, transparent and free to use and download, with the sole condition that users must “adhere to Open Source principles” and share any improvements.

RNOH’s second principle was around Open Standards, as the team want data that “flows with the patient” and is not “trapped” in systems, therefore requiring use of, and adherence to, open data and interoperability standards.

The third and final principle shared was the Open Business Model, meaning no profits are sought from the work and the results are free for anyone to use, with RNOH partnering with the developer Interneuron, a not-for-profit company.

Saroj then moved on to discussing ideas around co-design and co-creation. During the process, she said her team’s core principles in this area were patient safety first, achieved through clinical safety processes and accreditation, as well as using an iterative process and creating software that was, first and foremost, intuitive and easy to use.

One principle in this area that was given particular emphasis was the ‘ONETEAM’ approach, or team working, with Saroj stating, “that is really, really important”. She noted that the stakeholders (users and clinicians), her digital team and development partner were “one team – there was no demarcation between us – we did not have the ‘us’ and the ‘them’ situation…we utilised the resources wherever it meant sense.”

Saroj then outlined the four different stages of the co-design and co-creation process – Define, Design, Develop, Deploy – and explained each one in detail. This included an overview of the creation of the team’s ‘Definition Document’, which explained the purpose of the module and the scope of the project, as well a run-through of the design document and process. The hand-off to Interneuron for development was also covered, and encompassed learnings about show and tell sessions, the build and the testing, before a summary of what was involved in the deployment, sign-off and go-live.

She outlined that for “each module or each component of the platform…we went through these four stages and this also acted as the payment stages for our development partner.”

Saroj then summed up what the project had achieved. “This is our third year in the process…we’ve now deployed the core platform [Synapse], as we call it, and every element, every layer is Open Source…we have been live with the core platform for nearly two years…we’ve got several modules which are already live…and we’ve also got some external integrations now working,” she said.

The CDIO then ran through some of the services being offered and provided, such as security, a database layer, integration with RNOH and external systems, common functions such as patient searches, lists and core information, data capture, clinical codes and a medical calculation engine.

As for modules, Saroj spoke of the roll-out of an inpatient management app, which tracks patient journeys and provides overviews to help with the management of patient flow, as well as observations, fluid balance, assessments, operation notes, and results and reports viewer modules.

This year, further modules are set to go live, with allergies, discharge summaries and Electronic Prescribing and Medicines Administration (EPMA) among those waiting in the wings.

On external integrations, Saroj mentioned an impending go-live around the Health Information Exchange, as well as planned connections to the ICS Population Health Management Platform, GP Connect, the national e-Referral Service (eRS) and the patient portal, Patients Know Best.

Saroj summed up the session with her learnings around ‘necessary conditions for success’, highlighting the importance of cultural change, trusting in the process, working as one team, maximising resources and skills, and having the overall vision being led and approved from “the top”.

Lessons learnt she said, were that “culture change is hard”, while underlining the need for strong stakeholders, being aware of ‘scope creep’, keeping on top of changes, trusting the principles when the process gets difficult and making sure you don’t compromise on key areas like patient safety and ease of use.

On the ONETEAM approach, she added, “everyone needs to understand” the ways of working and noted it was wise to be careful of stakeholders who “shout the loudest”.

“I have to say,” Saroj concluded, “on the whole, whatever we have developed has been very well received and it’s very well used, so it’s worth going through that process.”

Watch the full session below: