HTN Now: NHSE blueprinting team and Manchester NHS FT on their journey with EMIS migration

At one of our latest webinars for HTN Now, we welcomed Paul Charnley, digital lead and chair of the national blueprinting steering group; Saj Kahrod, assistant director of programmes – blueprinting, NHS England; Anne-Marie Redford, senior programme manager for community and apps at Hive Clinical for Manchester University NHS FT; and Ed Beech, head of digital programmes, informatics at Manchester University NHS FT.

The team joined us their insights and experience of the EMIS Migration and Merger Project at Manchester University NHS Foundation Trust.

Paul started us off with a quick introduction to the blueprinting programme, describing how he has been involved with the blueprinting since he was the CIO at a global digital exemplar site. “It began there in terms of writing-up what we had done, so as to provide information for those that followed, along with lots of artefacts, job descriptions, plans, presentations, training material, etc., that could be used by people following us on these projects. It’s about peer-to-peer learning – not about doing it in a perfect way, but good enough to get good results.

“It’s also broadly about digital transformation, but I cover a range of topics, from technology to people and change, so hopefully it is helpful for a lot of different audiences. The blueprints are there as a step-by-step narrative on how some of these transformations took place.”

Paul added that the programme is “looking to expand our library all the time, so if you’ve got anything you think would be worth blueprinting, then please do get in touch.”

Paul handed over to Saj, who talked with us in a little more depth about the work of the blueprinting to date.

“We’ve got key objectives that we’re working to, like looking to increase our blueprinting portfolio and reflecting good practice, to enable people to access information more quickly and easily,” she said. “We’ve created a number of key bespoke blueprints to meet key national priorities, such as better bed management; and then we’re also looking to increase our portfolio around EPR, levelling-up, and the greener NHS and sustainability. We’ve got a learning ecosystem strategy, where we’re looking to share more information and then develop some key blueprints, and we’ve got some examples already on our platform. We’re also looking to enhance the content, to engage with staff and have some interactive models, and we’ve got blogs and videos – if you’ve got any suggestions, please do reach out to us, we’re always keen to enhance the platform.”

Why get involved with blueprinting? “It’s about raising the profile of good practice at a national level, but it’s also to showcase some of the issues around digital transformation and implementation that you might want to shape, around quality, safety and efficiency, and the opportunity to work in a more integrated way,” Saj shared.

The platform is currently home to just under 4,000 users and around 209 blueprints. The blueprint library can be explored by topic, covering topics such as single sign-on, e-comms, kiosks, clinical noting, and e-prescribing.

EMIS Migration and Merger, Manchester University NHS FT

Ed led the discussion at this point to discuss the EMIS Migration and Merger project at Manchester University NHS Foundation Trust.

“I’ll talk you through our community EPR journey, which started long before this project, but it’s all relevant,” he said. He explained that the trust covers a large section of Manchester, and in 2016 there was a merger with Central and South, with the two EPRs that were using EMIS merged into a single instance. “In 2021, which is where the blueprint starts, the project was to bring in the North Manchester community services under the same EPR.”

Between 2021 and 2022, the project focused on getting Central and South joined with North Manchester, bringing 28 services from Pennine EMIS instance to MFT instance with a total of 260,000 patient records. In 2023, the project expanded to include Trafford, including 100,000 referrals, 600 users and 36 services.

“Our objectives and outcomes, as well as to roll out EMIS, were to roll out an SMS reminder service, the rationalisation of clinical templates and improve data sharing through a single community record,” Ed continued. “It’s really important to reduce clinical templates to make sure that your EPR is performing at its best, and also makes it a lot easier to have staff that are mobile to work in different services if they’re operating the same workflows. Also, standardisation of workflows, configuration and processes – a lot of this came from getting the business case through in the first place.”

For a long time, the services had been run by Manchester, but not on the same EPR, he noted. “We had quite a big journey and a lot of patient information to travel with. The main takeaways from the earlier mergers were that we didn’t operationally merge, or workflow merge, or optimise merge; we just put everything that was there into a single EPR, which didn’t really get the benefits, then, of standardisation. We also had an overly configured EMIS solution – if you overly-configure EMIS, it runs slow, and it crashes, and we had huge amounts of templates in there because every service had its own set.

“We now have all of those four areas of Manchester on the same EMIS, and they are closer to being aligned in workflows. We’re not 100 percent through the journey of optimisation at this stage, but we’re working towards it,” Ed said.

A particular learning is that “it’s really a journey that our local community organisation came on with us,” Ed observed. “I think when we first looked at this in 2021, we looked at it in the sense of ‘what is informatics going to do to match how we work now?’ I think we’ve worked well together to the point that even post-closure of the project; our community organisation is carrying on optimising and reviewing where there are opportunities to have less templates, merge workflows. They’ve really gone on that transformation journey with us – it’s been a real success from the expectation that maybe informatics is going to come and just bend a solution around how you work today. I think they’re seeing that with their statutory returns and reporting, as well as the improvements in terms of performance.”

Benefits of blueprinting at Manchester University NHS FT

Next, Anne-Marie discussed the benefits of blueprinting from the Manchester University NHS FT EMIS migration project.

“The main thing is that it enables a deeper analysis for benefits realisation – we go through the benefits in our business cases on projects, but it really did make us go back into that business case and go through the real benefits,” she said. “I think we did a bit more analysis than we do normally on some projects, because we had the opportunity in the blueprint to go back to the first part of the programme of work, and really look at what we thought the cost savings would be, against the savings that would be realised. So just by rationalising the instances, we’ve got what will be a £60,000 saving with contracts being renegotiated, so that’s a start.

Once the SMS work is fully live, Anne-Marie noted that it “should help reduce the 12,000 did-not-attend rate that we had historically, which was effectively costing us £1.8 million. It wouldn’t reduce all of those DNAs, but it would certainly reduce a good proportion of them. By doing blueprinting and including technical documentation, it helped us also record some of the technical changes we’d done. Sometimes on projects, it can be easy to move on before you’ve dotted the Is and crossed all the Ts, but that hasn’t happened here.”

She also raised how the project “gave us a really good reflection opportunity, by looking at what we’d done as part of the first project.” With Trafford, she said, the team moved to more of a ‘cohort approach’ with services, aiming to group together services who traditionally tend to have more relationships with each other.

“The other thing we found, in developing a better way to work on Trafford, was that it was a good idea to get a temporary team of specialist service providers in. They were knowledgeable about EMIS, so whilst they were doing the discussions and workshops with people on the ground, they could then go and directly update templates and build new templates. That saved time, and meant we weren’t taking up excess time with application support.”

On further learnings from Trafford, Anne-Marie shared that being able to look back on their previous success boosted the team’s confidence, as well as allowing them to consider how they would approach things differently which hadn’t gone so well before.

She shared: “It was all about that early engagement and being really clear with the supplier about what we wanted to do with the cohorts. We had a good plan of attack with data migration, and we purchased a certain number of migrations with the supplier. So blueprinting was good for capturing our approach during the delivery, capturing the technical elements all in one place.

“If anyone else picks up that blueprint who is trying to do something similar with an EPR across a big geographical area with all these different aspects in it, they’ll be able to pick it up and read it through, and go, ‘Oh, that might be a good way of doing it’. I think there’s another blueprint in the pipeline coming through from MFT, around our Hive Epic EPR, as well, so that should be a good one coming through as well. The blueprint will be great for further optimisation work.”

Many thanks to Paul, Saj, Ed and Anne-Marie for joining us.