This week we hosted a webinar on driving innovation and digital adoption in the NHS, in which we were joined by Emma Arrowsmith, digital matron at County Durham and Darlington NHS Trust, and Daniel Johnston, who works as senior clinical workflow specialist and clinical safety officer at Imprivata in addition to his role at a registered staff nurse at Cambridge University Hospitals NHS Foundation Trust.
Emma and Dan discussed County Durham and Darlington’s EPR implementation and wider digital journey, and how Imprivata supported their mobility workflows through use of their single sign-on solution.
Digital journey
Emma began by sharing some background on the trust, which includes two acute sites, a sub-acute site and five community hospitals.
In October 2022, County Durham and Darlington went live with their Cerner electronic patient record. To compliment the EPR, they also went live with a hand-held solution from Medanet. The solution enables a hand-held device such as a mobile to make use of applications that are available through the EPR.
“This is where Imprivata comes in – we already knew that the organisational change was going to be a massive challenge for our staff, it’s a very stressful time, there’s lots to learn, there’s lots of change going on. We wanted to make it as simple as possible. Imprivata’s single sign-on was the tool that helped us reduce that burden.”
As the trust implemented a big bang approach with their EPR, Emma shared that they “needed to do what we could to make the journey as smooth as possible for those end users who were already working under significant pressure throughout our organisations.”
Imprivata’s input
Emma shared some statistics from June 2023, indicating that on average, the trust sees about 600 users of hand-held devices per day.
She emphasised how Imprivata’s single sign-on solution reduced the need for members of staff to use multiple passwords for different applications, ultimately saving time across the organisation. “All the user has to do is tap the hand-held device on the back with their badge and enter their pin or password that they have set. That logs them into the rest of the applications. It means that you can pick up a device and you can get going with what you need to do on shift very quickly. You don’t have to wait for it to load, one tap and off you go.”
Single sign-on was also installed across other devices including desktops and laptops, with Emma noting that trust’s wards and departments “are incredibly busy with a range of multi-disciplinary teams coming and going from patient to patient. This means people can quickly tap on, access records, do what they need to do, then tap off and move on.”
Emma highlighted the scope of the challenge, and therefore the extent of Imprivata’s support. “The 600 daily users that I mentioned earlier – they are recording things like vital signs, completing admission and ongoing assessments, placing orders. They are logging into their devices multiple times throughout their shift. The reduced burden of logging in is massive with single sign-on. If we had 600 users trying to log into all their applications separately, it would really impact our end user feedback.”
Training and support
With regards to how training was managed across the trust at the time of EPR implementation, Emma described how it was initially completed online, with an opportunity for staff for follow through with face-to-face training after that. The digital team monitored compliance of the e-learning and extra help was provided, with “intensive at-the-elbow support” as the solution went live and super-users on every department.
The Imprivata side of it was “very straightforward”, Emma added, as it was just a case of “going out, getting everyone familiar, and signing them up”.
Dan commented on the trust’s strong focus on digital champions, involving them from the point of user acceptance testing. Emma agreed, noting the importance of “bridging the gap between IT health informatics and clinicians on the frontline. We brought people into that testing to ensure that we were doing the right thing.”
The experience of go-live
Asked how the team felt at the time of go-live, Emma considered: “I think it was as expected. We were bracing ourselves, it was such a big change. With the big bang approach, we knew it was going to be an intense time.”
She described how the trust decided to hold off on the community sites until a couple of days after the initial go-live data, focusing on acute and sub-acute sites to begin with. Members of the digital health team were posted into different sites at different times to ensure that staff had 24-hour support.
“All in all, they coped amazingly well,” said Emma. “We got through it, we probably felt a bit like we were stepping into the fire at the time, but a week later we already felt better. We had some teething issues but we were able to work through them quite quickly.”
As with most things, Emma noted that in hindsight there are always things that you would probably do differently – and people will probably have different opinions on what those things would be. She emphasised the importance of continuous learning; they learned lessons from previous go-lives which were utilised for this project, she said, and they will use learnings from this go-live when embarking on future plans.
Working together
In terms of the approach to implementation, Emma raised the importance of testing. “We worked together on this, Imprivata, Medanet and Cerner. That includes our IT and health informatics teams and end users as well. We did lots of user testing to make sure that the solution that we were going to deploy was fit for purpose and easy to use, and that the single sign-on process was straightforward.”
Dan agreed: “It was very innovative, the way that your clinical and technical teams came together. That approach came across from leadership too and it was fully immersive and inclusive of frontline staff. We often talk about how that is the ideal way to do things, but it was wonderful to see in practice.”
He added that the trust’s approach of bringing all of the suppliers together into one room “so that we could work it out and understand what we were all trying to accomplish” was “refreshing and an exciting process to be a part of.”
It came down to collaboration, Emma reiterated: “Teamwork made this work. We had a great deal of trust in each other. We looked to each other for help and supported each other, and in doing so we were able to define a solution that really worked for us.”
Becoming normal practice
On what that feedback looks like from staff, Emma pointed out that the trust had been utilising hand-held devices before the EPR launch, but at that point they had to log in and out of all their different systems; so staff have had the direct experience of streamlining the process via the single sign-on solution. “We introduced the tap-in, tap-off process just before we went live with the EPR so that we could embed the practice. It’s become very much normal practice for our staff. No-one will talk about it in that sense, because it works, it’s quick, it gives them access at the bedside as they need it. Now, it’s like it’s always been there.”
Emma noted that the digital health team, which she leads, hears all about any barriers that staff are facing. Silence is a good thing, she said, because “we hear about something it’s not working – it’s so inconvenient, and staff are loud!”
Clinical value of tech
Exploring the clinical value of technology is part of Dan’s role with Imprivata; the discussion turned to reflect this.
“It feels like we are still very much at the beginning of the journey in terms of what we are trying to do with mobile. It sounds like it will be fantastic; will it? We’ve still got a long way to go to generate the evidence to support that,” he said. He posed a question to Emma: “What is mobile doing for you as a trust at the frontline of care, as opposed to working at a static workstation?”
Before their EPR launch, Emma said, the trust was generally mobile with hand-held devices in use, albeit ones that staff had to log in and out of. “We do as much on our mobile devices as we can; the majority of the time, it’s a case of hand-helds in staff pockets and work being done on the go. As an organisation, we’ve seen the benefits of that; we’ve had really good compliance with observations being completed on time, for example, and our sepsis compliance has been really good because it gets flagged on the hand-held device.
“We have pushed the limits on what can be done through mobile solutions. It’s a work in progress – we can see the data coming out, and there’s always work to be done, but it does show that the mobility workflows are being used very well.”
Emma continued: “We also have a big cohort of staff who are not registered but are incredibly valued within our system, such as our healthcare assistants or maternity care assistants. They provide excellent care every single shift, but they are highly unlikely to log into an EPR. They’re very unlikely to go onto a desktop and document what they have done. For some it’s quite daunting – the EPR can seem huge if you’re trying to navigate through a lot of information to add to a document or pop in a measurement. So we really value the mobility workflows in this sense too, because our staff, regardless of grade, tend to be comfortable with the mobile solution. It’s easy to use, it’s intuitive, and it gives them that safe place to document their care.”
She added that as a trust, they see the value of both mobile care and desktop-based care. “I think mobility is in early stages, as you say, and there are lots of improvements to make. But we’re quite happy with where we’re at at the moment, and what the future looks like.”
Many thanks to Emma and Dan for joining us.
