In July, we covered the latest annual report on the Government Major Projects Portfolio from the Infrastructure and Projects Authority, which noted “major issues” with the frontline digitisation programme, including the insight that it “appears to be unachievable” for every NHS trust to reach a core level of digitisation and capability by March 2025.
The report highlights that three of the eight major projects falling under the remit of the Department of Health and Social Care are coded as red, defined as experiencing “major issues with project definition, schedule, budget, quality and/or benefits delivery, which at this stage do not appear to be manageable or resolvable.” This includes the drive of electronic patient records roll-out across all NHS trusts, although NHS England has added that the target to achieve roll-out to 90 percent of trusts is on track to be achieved.
Despite the difficulties faced with frontline digitisation, we’ve covered lots of EPR progress over the past year, including procurement announcements and go-lives, and we’ve also been joined by a variety of healthcare professionals sharing their learnings and experiences on the topic. Here, we’ll take a look at some of the key news and top insights in this field.
Procurements
Last month, we shared how Norfolk and Waveney Acute Hospital Collaborative has announced the procurement of MEDITECH as the EPR supplier across three acute trusts, with EPR programme director Martin Evans describing it as “one of the biggest pieces of clinical and operational transformation we will ever complete”.
The EPR will service Norfolk and Norwich University Hospitals NHS Foundation Trust, James Paget University Hospitals NHS Foundation Trust, and The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, and aims to go live in 2025.
In July, we noted how University Hospitals Sussex NHS Foundation Trust has started an early market engagement phase as part of its electronic patient records solution procurement. The trust plans to implement a modular EPR to meet the minimum digital foundation requirements outlined in the frontline digitisation programme.
April saw Princess Alexandra Hospital NHS Trust award a £28 million contract to implement Cerner EPR, awarding the deal using the London Procurement Partnership Clinical Digital Solution Framework. The deal is set to run for 10 years, until February 2033.
Go-lives
In November 2023, South Eastern Health and Social Care Trust will be the first to go live with their EPR as part of the Health and Social Care Northern Ireland ‘Encompass’ programme; a £300 million project set to deliver an new EPR for five trusts across Northern Ireland over a 10-year timespan. The trust’s chief executive Roisin Coulter commented that it is a “momentous opportunity that will enable us to replace outdated systems” and added that she is “really excited to see how the introduction of Encompass, with the new patient portal, will change the working lives of our staff and the care given to our community.”
On Monday, we shared how Royal Cornwall Hospitals NHS Trust has announced the development of their EPR programme with Oracle Health, currently at the design, development and testing phase; ongoing collaboration with clinical teams is planned over the next 18 months, ahead of an expected launch in spring 2025.
In August, we covered the news of London North West University Healthcare NHS Trust’s go-live, which began across emergency departments. As part of the implementation process, electronic prescribing across wards was to be staggered over a two-week period, with discharge notes to be a combination of paper and electronic during the transition.
In June, we heard how East Lancashire Hospitals NHS Trust went live with their EPR, eLancs. Linda Vernon, interim head of digital empowerment for the wider ICB, commented that she felt “quite privileged to be able to help the front line clinicians, admin and patient services teams navigate the day; the closest I’ve been in my digital career to an EPR procurement & deployment”. She commented that it was a day with “expected teething problems” but added that it was “refreshing for me to see the frontline fruits of the labour of digital transformation, in action”. Prior to the go-live, we also shared how the trust prepared for the launch through a 10-week training programme which involved recruiting 1,000 ambassadors and super users from a range of job roles and departments.
Back in spring, April brought the news that University Hospitals of Leicester NHS Trust deployed an order comms solution across its three hospitals part of the trust’s EPR roll-out. The solution supports clinical workflow and processes as part of the Nervecentre EPR and adds to a number of Nervecentre modules already live at the trust, including in emergency department, EPMA, infection control, patient flow and live flow modules.
In March, there was the news that the Royal Marsden NHS Foundation Trust had gone live with their EPR Connect, described as “the largest and most important digital transformation programme in The Royal Marsden’s history”. Alongside this, the trust also introduced a patient app and a website called MyMarsden.
Insights
So what do the health tech professionals that we’ve talked to over the past few months have to say when it comes to electronic patient records?
EPR programme director for Norfolk and Waveney Acute Hospital Collaborative, Martin Evans, shared his top tip for EPR deployment with the announcement of the collaborative’s new procurement across three trusts. “As someone who has overseen the implementation of several EPRs across the country, the biggest piece of advice I’d give to everyone is to get involved now – so many times I’ve heard clinicians and operational staff say that they wished they’d got involved in an EPR programme earlier!”
On the topic of developing EPR business cases, Hampshire Hospitals NHS Foundation Trust chief clinical information officer Tamara Everington commented: “Cases are often thrown together in short order to fix an immediate gap in current practice or respond to a cash drop. Some attention is given to describing the context but we often build cases based on the problems we see today rather than taking time to reflect on what might be needed as healthcare naturally evolves.”
Tamara continued: “The alternative approach is to invest time in building your business case working directly with end users to understand what gets in the way of them doing their job well and what they need from a future system. Don’t think about it the other way round and prioritise data over human factors. Ultimately, if the new solution works for your end users, the data coming out the back end will be reliable in real time and your business will be supported to run more effectively. This means better personal care for all in need.”
Also on the topic of EPR business cases, Katie Trott, head of digital delivery and engagement for New Hospitals Programme at NHS England, said: “From experience, I would say that the most often overlooked aspect in an EPR business case is the permanent team who remain after go-live. We consistently say to stakeholders that go-live is just the start and the EPR is a foundation. It should be used as a springboard for ongoing digital maturity that drives better patient care, better staff experience and improved data use.
“For the use and optimisation of EPRs to be effective, it’s essential that you have a permanent team of clinical digital experts and change advocates, along with those with sufficient technical knowledge, to drive improvements. Without them, true adoption will be slow to achieve.”
At the end of last year, we spoke to Andy and Georgie from Leeds Teaching Hospitals about the development of their own in-house EPR. Georgie stresses the importance of having a clear digital strategy in place that “encompasses not just the EHR development but all digital transformation that we support” and added: “It’s about engaging our workforce including the clinicians who use it and we as a CCIO group. With our operations team, we look at how we prioritise the work that needs to happen against the digital strategy.”
She noted that lots of communication and “robust analysis” happens, but “there’s also supporting and running a busy hospital, and national reporting requirements. There are lots of different things that come into the mix when we are considering what developments we need to do, when we need to do them and how we prioritise them. It’s very much a collaborative conversation.”
Chris Mason, chief information officer at Wirral University Teaching Hospitals NHS Foundation Trust, chatted with HTN last summer and shared how the trust was planning optimisation activities around their EPR, with particular focus on alerts and how to present them to clinicians, along with standardising workflows. Chris raised the usefulness of an organisation getting used to a new system, noting that when moving forward with an EPR, “you obviously learn the best way of using the tools, so we’re refining those now and making standardised recommendations based on best practice.”
Resources
Along with talking to staff from across the NHS and other health and social care organisations, we also regularly chat with consultants and tech companies to get their views and tips.
In December last year, former NHS chief information officer and current independent consultant David Kwo discussed his experiences working with NHS trusts to develop their EPR outline business cases, including strategic, economic, financial, commercial and management.
Paul Volkaerts, Nervecentre’s CEO, joined us to chat about the requirements and challenges of EPR markets in February, in which he shared his insights on approaching EPR procurement, tackling challenges around integration, and his thoughts on deployment methodology.
In February, we were joined by a team from digital consultants Apira for a discussion on EPR affordability, in which they outlined the finances associated with an EPR for an NHS trust and how EPRs can – or should – be affordable.
Also in February, Ideal Health’s director of implementation services Rod Gamble joined us to talk about the total cost of EPR ownership. Rod focused on the cycle of an EPR programme, and how getting it right from the start can reduce implementation costs.
This summer, we interviewed Eleanor Rollason and Simone Collins, lead partners at Channel 3 Consulting, to hear more about their experiences with EPR implementation and digital transformation at scale, including examples of the projects they have worked on and the importance of having a “positive risk culture”.
