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HTN Now: NHS blueprinting and the national EPR programme

As part of our HTN Now focus on electronic patient records (EPR), we were joined by the central NHS blueprinting team and a panel of digital leaders to discuss the national EPR programme and share how blueprints have supported them.

The team included Head of National Operations and Delivery for the frontline digitisation programme, Sue Thompson, Joint Chief Information Officer at Imperial College Healthcare NHS Trust Robbie Cline, Co-Chair of the Blueprinting Steering Group Paul Charnley, and Assistant Director of Blueprinting at NHS England and Improvement Saj Kahrod.

To start, Paul provided an introduction to blueprinting. “The idea behind blueprinting is about sharing the knowledge that we gain through investment in digital systems,” said Paul. “It began with the GDE programme and all the investment that went into those sites, but it’s spreading across all of the initiatives that NHS England invests in with a view to making things much more cost-effective, to avoid the pitfalls of previous projects, and to enable quicker digital transformation.”

The team have been linking their work into the What Good Looks Like framework and its seven success measures. “Today, we’re hoping to convince you to look at the EPR digitisation blueprints as part of the progression towards the levelling-up agenda,” he explained.

The presentation shared a definition of a blueprint – a “structured collection of knowledge assets and associated methodology” which can be tailored to suit local needs and requirements – and a range of benefits, including the ability to accelerate delivery of digital transformation, enable confident decision-making, inspire and guide others on their digital journeys, and reduce the risk.

Paul shared information on the NHS’s blueprint library, which contains blueprints on a wide range of subjects, some focusing on general digital features and some focusing specifically on EPR development. “We have an overall capability map that we’re trying to find blueprints to cover,” said Paul, to provide “at least one example of people’s experience if not more, so that we can show you people’s experiences from a different type of organisation or using a different type of technology.”

The library currently holds approximately 200 blueprints, with more in production and development.

“The content on the platform is constantly changing,” said Paul. “If you haven’t visited it for a while, I recommend going back and having a look at what’s on there now.”

Next, Paul showed “some of the pieces of the jigsaw” of EPR implementation. “As people progress from patient administration systems to clinical noting, observations, order comms, through to more sophisticated departmental applications, pathways and automated support, the EPR functionality grows,” he said, “as does the maturity on measures like the HIMSS scale. The idea is that if you have a plan to develop your EPR, there’s likely to be a blueprint for it.” Blueprints currently exist for most of the features shown by Paul on the presentation, including patient portal, eRostering, mobile working and bed management.

Robbie Cline joined the conversation to discuss implementing a shared EPR. “What we’re aiming to do in North West London is to implement a single Cerner EPR across the four acute trusts,” Robbie said. “Imperial and Chelsea & Westminster are live already… in August 2021, we started the project roll-out at London North West and Hillingdon. Our vision is that by the end of 2023, all four acutes in the sector, covering 12 hospitals, will all be sharing the same EPR system.”

Robbie discussed some of the challenges that can be faced when implementing a shared EPR, such as the structure of the contract. This is about “the contractual relationship between the organisations, and also how you manage the relationship between the NHS organisations,” said Robbie. “So what we’ve opted for is for each NHS organisation to have a separate contract with the supplier. Another approach would be to have a single contract held by one of the NHS trusts in which the other organisations are named. There are pros and cons to each.” Robbie added that the reason that his team chose the first approach is because “we could use those contracts to form the contractual needs and the relationship between the NHS organisations.”

Other challenges include building a virtual replica of the new hospitals, testing the migration of data, integration with other clinical systems, agreeing to common ways of working, reporting, IT back office functions and cross-organisation benefits. Robbie discussed each, sharing his experiences and advice; to hear what Robbie has to say on each challenge, you can watch the video below from 8:35.

Next we heard from Sue Thompson to discuss the frontline digitisation programme, which was launched in 2021.

“The vision is to have a digitised health and care system where the health service has got access to information that they need at the point of care,” said Sue, “which should then help them to manage and improve health and wellbeing.”

The Frontline Digitisation programme supports the levelling-up agenda, seeking to bring systems and providers to a baseline level of core digital capability as set out in the What Good Looks Like framework. This level of capability will mean that frontline clinical staff can make the best use of digital technology to deliver care in the most efficient, effective and safe way, reducing variations and improving outcomes.

“We’ve done some investment in digital maturity and we’ve got some a certain amount of organisations that have got some level of technology and they’re often using that really well. We’ve got about 23 percent of organisations who are already classed as being highly digitally mature, but unfortunately we also have about 15 percent of NHS secondary care providers that are reliant on paper. That means we’ve still got a job of work to do when we’ve still got those significant gaps.”

Ultimately, Sue said, “where we want to get to is that there’s no longer a reliance on central funding, and organisations are set up for long-term sustainability and use of digital, so it becomes part of what the organisations do, with continued investment in the future.”

When it comes to the ambition of the frontline digitisation programme, Sue shared “the three Cs” – coverage, capability and convergence.
Coverage means that the team hope to have 93 percent of providers with an EPR in place, with all other providers in implementation, by December 2023, and 100 percent of providers having completed the process by March 2025. Capability means that as many providers as possible will meet the minimum capability standard for digitisation by March 2025. Finally, convergence means that all ICSs will develop a convergence strategy, appropriate to local context, their Digital Investment Plans.

Next, Sue provided some insight into the current EPR landscape. “In terms of investment and categorising organisations, we’ve grouped organisations into one of four groupings,” Sue said.

19 trusts are currently in group zero, where they have no EPR and are developing their business case. 11 trusts are in group one, in the procurement or implementation stage. The bulk of trusts, 137, are in group two, with they have an existing EPR but it needs extending and optimising to meet the required standard. In group three, 45 trusts have an existing EPR meeting the standard.

Sue picked up on the high number of trusts sitting in group two. “We’re doing a piece of work at the moment where we are working with each of the regions and the ICSs, and the individual providers in group two,” she said, “to make sure that we’ve got them in the right category and also to make sure that those organisations know the extent of funding that they will get from us centrally, and what that means in terms of their business cases and plans going forward.

“That work is expected to conclude by the end of July and that will then result in us being able to confirm what the ICS and regional allocations will be for frontline digitisation. It will enable organisations to produce multi-year plans. This is the first time we’ve got the ability to be able to fund for multiple years, so when we get the business case approved, it will be a multi-year settlement and so it gives organisations confirmation and assurance on their future allocations.”

The presentation moved on the topic of the whole system approach. “We recognise as part of this programme that there’s often a reason why organisations haven’t been able to deliver the efficiencies and digitise in a way that other organisations have already achieved, so we’re going to have to put a support wrapper around them.

“To do that, we’re going to be working as part of the system. It’s not going to be about centralised command and control, it’s not going to be parent and child, it will be very much a peer-to-peer relationship. We’ll continue to strengthen relationships and work in partnership with regional digital colleagues, ICSs and trusts, we’ll continue to adopt a proportionate approach.”

To achieve this, Sue said, the team are putting in place a provider support model. The key principles of this model are to leverage the capability in the NHS and suppliers; to act as a learning organisation; to demonstrate NHS values; to operate on a trusted, peer-to-peer basis; and to provide timely support. It involves setting up a centre of expertise to act as a flexible resource pool, providing assistance with engagement, business case review service, delivery support and more. It also places emphasis on making use of the wider capability through digital partnership function, regional digital teams, frontline support service and more.

“We try to do things centrally that make sense to do so, but we want to make sure that we’re still maintaining local influences and local control,” said Sue.

At this point, the session opened up for questions which you can watch from 39:15 below.