Health Tech Trends, Insight

Industry views: digital leaders on EPR approaches, learnings and advice

As part of our latest HTN EPR event, we reached out to peers and industry experts to share their views on their own electronic patient record implementation journeys, key learnings and advice, as well as adding value to an EPR. Here’s what they had to say…

To begin, Craig York, chief information officer at Milton Keynes University Hospitals NHS Foundation Trust, explained how his trust opted for a split implementation approach, with their journey beginning in 2008 before steps were taken to enhance clinical functionality in 2018, followed by another upgrade in 2021.

“Our decision to adopt a gradual implementation approach was driven by various factors, including financial considerations, available staff, and consideration for our ability to absorb that amount of change over a short period of time, while simultaneously balancing competing organisational pressures,” Craig said. “While our preference and recommendation to others would be to implement all functionalities at once, we recognised the importance of balancing the financial and resource constraints that come with such a comprehensive transition.”
Craig shared his seven top tips on EPR implementation:
  1. Clinical engagement is a key factor for success, with the feedback from clinical and digital staff “invaluable for tailoring the system to meet the unique needs of patient care”
  2. Comprehensive training is “essential”, including a diverse range of training methods to “ensure that staff members were comfortable and proficient in using the new EPR system”. Craig shared how his trust “provided various forms of training, including workshops, online modules, and hands-on simulations” and “short update documents and videos are often distributed now via our own digital app”, which “helped staff transition smoothly to the new system.”
  3. Early live support is needed, with Craig praising the efforts of his trust’s dedicated support team who were readily available to address issues and concerns, a proactive approach that he says “reduced the impact of any early challenges.”
  4. Having a well-staffed and trained digital team in place is key, Craig noted, and they need to be able to act with authority and delegation.
  5. Continuous improvement is another important success factor. “The EPR journey doesn’t end with implementation. Continuous system improvements are needed based on user feedback, real-world usage and evolving needs. We have found that regular engagement from the clinical teams was essential in embedding a successful digital system.”
  6. Flexibility is also necessary – Craig advised that teams “be prepared to adapt and make necessary adjustments as you learn more about how the system is used and its impact on workflows. Taking ownership of the system is important. You should aim to understand and have the ability to configure the system to the same proficiency as the supplier.”
  7. Finally, Craig raised the importance of having executive support. “During change, there will be challenges that require support to hold the right strategy direction for the organisation,” he said. “Ensuring the CEO, executive team, and board fully support the digital transformation is paramount.”

“In summary,” Craig concluded, “our experience with our EPR system has taught us the importance of strategic planning, clinical engagement, comprehensive training, and a well-prepared digital team. Practical considerations drove our gradual implementation approach, and we would recommend it to organisations facing similar challenges.”

Tamara Everington, chief clinical information officer at Hampshire Hospitals NHS Foundation Trust, described how her trust developed their own in-house EPR on top of a commercial patient administration system, which was “very popular with frontline clinicians as it enabled immediate responsiveness to their needs with monthly release cycles”. She added that it took Hampshire Hospitals through the GDE programme as fast-followers to University Southampton Hospitals NHS Trust, who took a similar approach.

In response to the frontline digitisation programme, Tamara shared that her trust is currently exploring options with partners to “embark on a journey to a shared EPR across the acute providers in our ICS.” She raised the importance of taking affordability and resource commitment to deliver a new EPR into consideration, particularly at a time of heavy operational NHS system pressures.

Tamara acknowledged the advantages of both big bang and gradual implications approaches from an academic perspective, but concluded that the move forward “has to be grounded in NHS reality.” She said: “A relevant metaphor might be a clinician choosing with a patient whether to have surgery or follow a protracted treatment course. Either choice might be reasonable and surgery might feel appealing for an early fix, but someone in poor general health may not survive surgery or be able to afford the time off work.

“There are no easy answers here. What we need to take us all to the right endpoint is consistency and clarity of digital vision and investment alongside close on the ground collaboration to ensure we move forward together. We should not be afraid to explore openly and honestly where we have failed despite best intent. Any evaluation we have to inform costs and benefits of digital choices should be published and shared. Openness and transparency are absolutely vital to delivering better digitally-supported patient care.”

London North West University Healthcare NHS Trust has gone live with their EPR in August this year. Media and communications manager Steve Watkins commented on the trust’s successful data migration, stating that the transition “exceeded expectations” and completed ahead of schedule. Steve added that high quality data supported this data migration and meant that there were “no surprises from the trail loads and full dress rehearsal”. Another lesson learned was that the trust faced some technical issues with Smartcard user logins, which reduced the number of staff able to test before go-live, with Steve noting that this is an area the trust is looking to improve.

Andy Webster, CCIO at Leeds Teaching Hospitals NHS Trust said that his trust also developed their own bespoke EHR using an “iterative development process” which allowed them to evolve the EPR according to business requirements and not “necessarily the functionality the vendor is offering.” The reason they chose this approach, Andy explained, was “multi-factorial” and enabled them to avoid a “rip out and replace” approach to the business case. In terms of key learnings, Andy advised it is important “not to underestimate the size and cost of business change.”

Felicia Akubue, nurse and group CQC compliance officer at the Royal Free London NHS Foundation Trust, described how the Royal Free’s EPR was launched in November 2018 for the first phase, with the second phase following in late 2021/2022. She commented on the importance of being well organised, with the trust’s management teams signposting staff to what needed to be learned and ensuring that EPR training sessions were in place for those who needed it.

A key learning, Felicia said, is that, “Even after training, until you are using constantly on ward or area, it does not come together until you use frequently.”

Joshua Chandler, chief digital transformation officer for Bedfordshire Hospital NHS Trust, shared his experiences of the trust’s recent EPR journey which he noted is “part-way” through the implementation process. Joshua explained that the trust opted for a gradual implementation “in order to realise benefits sooner” and to improve the way they work “iteratively” as they deployed the system across their “complex environment.”

Reflecting on the approach so far, Joshua said: “We have deployed bundles of functionality, normally consisting of two to four modules or features, at once or in very close proximity. This has enabled our staff to settle with the system and become familiar with its user interface. We believe this has enabled us to realise benefits sooner and reduced the overall risk profile of the programme, as we have not had to wait for years of planning and configuration work to conclude before seeing any material change. In terms of advice, I would say: be clear on the reasons for doing it, communicate the benefits, ask for staff engagement and involvement at every level and stage.”

Amanda Cox, change management and benefits realisation lead at University Hospitals of Leicester NHS Trust, shared her insights around her trust’s gradual EPR implementation journey. She  acknowledged that this “is a challenging area in change management” and added: “I have used my benefits experience to date to develop a bespoke approach for UHL in benefits mapping from a ground up level.”

The next big challenge, Amanda said, is on developing “the measures and the capacity to work up baselines and process mapping”, and whether to do so on a modular/project basis, a programme basis, or even a trust holistic level for EPR, versus the different requirements from NHS England.

She said: “I believe in terms of benefits realisation that a gradual implementation is the best approach. However for any trusts looking to change their patient administration system, they may need to consider a big bang approach to this.”

With regards to tips and advice, Amanda commented: “In terms of planning – I’d suggest allow for slippage in a plan and ensure the dependencies and inter-dependencies are well mapped out early on, so if one project slips or fails, there is clarity on the knock on effect of others.

“Sufficient resources and expertise are needed in benefits realisation from the outset through every stage of the EPR journey, and trusts should consider their own priorities in terms of areas they wish to formally work up benefits around.” She added that there also needs to be “consideration of this work being appropriate and in proportion to the size of the investment (of any project/programme) which is one of the fundamental precepts of the HM Treasury formal guidance.”

In addition, Amanda emphasised the need for a “practical and sensible management approach to the agreement and apportionment of benefits”, noting that there is no formal guidance on this even at HM Treasury Green Book level.

Many thanks to our digital leaders for taking the time to share their thoughts.