HTN Now: Panel on digital transformation, successes, challenges and learnings…

For our latest HTN Now thought leadership panel discussion, we were joined by Rob Birkett, CDIO at Calderdale and Huddersfield NHS Foundation Trust; Dr Paul Wright, GP and deputy clinical director/IT clinical lead at NHS Greater Manchester and CCIO at Manchester and Trafford Local Care Organisation; and Graham Etherington, Solutions Director at Kodak Alaris.

We began by asking our panellists to share some of the digital transformation programmes they were working on at the moment.

Paul kicked off the introductions, saying: “I work as a GP in South Manchester, and then work with the locality team in my role at NHS Greater Manchester, and with the local care organisation, who provide community services and work with the local trust.

“From a general practice perspective, the digital focus is aligned to the modern general practice model and all the work that’s going on in terms of recovery and transformation in that new model of of care, and I think one of the things central to that is agile working and digital enablement. Our practice is involved in two pieces of work that we’re particularly excited about at the moment – one is a research project called Progress, which is looking at the role of genomics and using pharmacogenetics to drive decisions around prescribing. Another is called ID LIVER, which is looking at how we use data that we hold around people’s different characteristics, risk scores, and how we can work with secondary care to better manage people at risk of developing liver disease.

“At a community level, we’ve got Hospital at Home and the community EPR. In secondary care with MFT, they’ve gone live with Epic, so that EPR implementation. I feel like we’re stood on the edge of a continued wave of transformation that we’re going to see over the years ahead as we implement and follow what was outlined in the Topol Review.”

Graham provided an overview of how Kodak Alaris supports healthcare organisations: “At Kodak Alaris, we work with many healthcare organisations, looking at digital transformation in various guises across the NHS. We’ve been working with NHS Trusts for over 3 decades now, capturing and managing data, and making sure that data is accurate. We’re now guiding and working with trusts to do what they do best, and that’s working with people and helping people. We’re making sure their data is correct when they go into the patient records, and when they need to go through the system. We have many case studies that we’re working on relating to transformation programmes such as what Paul and Rob are working on now.”

We moved on to Rob, who summarised some of the digital programmes at Calderdale and Huddersfield: “I’m CDIO at CHFT, which hosts the Health Informatics Service, which is a shared service across primary care, across a number of our system partners. In terms of our transformation programme, it’s been ongoing since 2015, and it started off with a tactical programme that looked at replacing a lot of our older systems, which preceded a “big bang” EPR go-live. We tried a couple of times at landing big optimisation programmes off the back of that go-live, but due to the costs and financial pressures across the system, they never really got off the ground. So what we’ve done instead is we’ve broken that down into smaller pieces, and we’ve looked at things that have caused us issues within the trust, and how we can take the solid digital foundation we’ve got to make improvements.”

Key learnings on digital transformation

We asked our panellists what stood out for them in terms of what had worked well for digital programmes they were working on at the moment.

Paul noted: “I’m lucky to be part of the NHS England digital leadership programme, and we spent a lot of our Christmas looking at the keys to transformation and change. It was really beneficial to spend that time to reflect on what we’re doing and why we’re doing it. Yesterday, we were looking at the outpatient transformation programme, and following the Epic implementation, there were departments that had been feeling a greater challenge in terms of the use of the software, whether it was around the software design or the processes, the training. The team had engaged actively with that department, identified the issues that were being felt, and then through a process of quality improvement, worked with the team to support them to move forward. The outcome was a 20 or 30 percent improvement in productivity. Having that that leadership and culture is important, whereby there’s that active reflection on where we are and how we’re performing.”

A remit to Paul’s work focuses on the primary-secondary care interface – we asked how can progress be achieved in this area and how can progress be measured?

Paul said: “I think that’s the key question – what does success look like? I think if we’ve not defined that from the outset, then we’re destined to fail. Although there’s ambitions set around the primary-secondary care interface, to me it means something that’s been borne out of the experience of the Epic implementation. And what we learned through that implementation is that it really shows you where the interfaces are, because where there are issues is where there are handovers of patient care, where the primary and secondary care systems meet, where the community and secondary care systems meet. The way I’m encouraging us to look at what success looks like, is to use the quadruple aim, so that we are thinking about patient outcomes, efficiency, workforce – because you certainly know when you’ve got it wrong. We’ve got a really active Teams chat with our GPs in Manchester, and that’s been really helpful to understand where we’re missing the mark. And I guess, when you don’t feel it, then it’s working well – when people aren’t upset by things like the content of discharge summaries, when people are getting information they need, where patient care is moving seamlessly between systems, and people don’t feel the gap between primary, secondary and community care.”

Graham also answered this question, saying: “I’d like to echo something that Paul said, and it’s about mindset and people changing. I think what we’re finding now is that people are open to taking on new ideas, especially with promoting agile working, because a lot of people now work remotely and can do their job from home. We’re doing a lot of work for the medical records management department, where we must make sure that their data is correct, and there’s two areas that we look at – the forward scanning and the back scanning. It’s also about engaging with the NHS Trust – it’s about having those conversations and guiding them to relieve some other pressures that they have at the back office that nobody sees, to take away that pain of manually extracting documents and manually checking documents, and improve that patient records system. We’re looking at how they do their quality audits and making sure that, as they’ve moved forward, they get the right information from the right patient. I think we find it encouraging that people want to engage on this now, and I think managing data and understanding that data is the key to success.”

Rob added his experience from Calderdale and Huddersfield, saying: “We’ve done things like special builds within the EPR for same day emergency care; we’ve made our controlled drug register electronic; we’ve just procured a new patient portal, and we’ve gone through a whole transformation programme around nursing documentation, which has a number of knock-on benefits around data quality, reshaping pathways, etc. In terms of what worked well, that real close relationship with clinical and operational colleagues, understanding what the organisation and its patients need, and then also breaking it down into manageable chunks that can be funded with some clear benefit.”

Overcoming challenges

We moved the conversation on to talk about some of the challenges that our panellists had experienced over the last year, and what steps they had taken to overcome them.

Graham started the discussion, saying: “I think one of the major challenges we have is how the trusts are budgeted. When you talk to a trust and it’s halfway through the year, even though you have solutions to help them solve problems, you have to wait until budgets are reallocated to start to put them in place. It’s maintaining appetite and the difficulties getting things implemented within a reasonable timescale.”

Paul agreed, saying: “Definitely the time frame around funding is something that does leap out. I think it’s really interesting seeing the difference between trying to implement change in general practice versus implementing change in the trust, because in the trust there’s recognition of the need for clinical digital leadership, the development of CIO’s, implementation of the EPR; and we’re working in an environment where although its vast and the change is complicated, it’s in a controlled environment where there’s a clear organisational structure, and a top-down, bottom-up implementation can work.

“If you think about trying to deliver change in general practice, we’re working with colleagues who operate in their own individual business units and then practices and PCNs, so we’ve got multi-layered complexity, and ultimately from a locality perspective, it’s not our place to control general practice. We’re working on the shoulder of, and in partnership with, general practice, to support that change.

“The workforce that supports that has a real challenge in terms of developing that shared vision, the culture, supporting the training and the communication, and if the funding is time-bound, then how do we develop and retain those skills when we’re only ever offering people 12 months of employment? We’ve got great people in Manchester, and I want to keep them there, but to do that we need to be able to to offer the positions or attract people in and then be able to lock them in. We’ve got locality, ICB and national priorities, and we’ve got this challenge of overlapping strategies. The ICB ambition is to have primary care, community care, secondary care, and social care working together, and yet those organisations independently are setting their own priorities, so there is a real challenge around how funding works across those domains and how some of the facilitating work that needs to happen, happens in a joined-up way.”

Rob added: “I talk to colleagues regionally and nationally, and recruitment’s always difficult. We’ve got good retention across the organisation – both digital and across other roles – but recruitment in specialist roles is always difficult. I think finding the right skills can be difficult, but we’ve done a lot in terms of growing our own, and looking at how the organisation invests in its people. When we say we want to develop people into roles, we get the backing of the trust to do that, and we’re always on the lookout for talent, whether that’s internally or across the region. If we’re going to deliver EPR optimisation over the next five years, we need to put a lot of time and effort into building a team that’s cohesive, that will get on well, that’s got the right set of skills.

“Finding the right partners is difficult sometimes. There’s a lot out there that can promise to do a lot of things, but I think what’s helped us is we’ve always looked at long-term, so we’ve not tried to get any quick wins. We’ve tried to build those relationships, and suppliers aren’t charities, they’re not doing it for free, but there’s definitely joint wins in there. I think finally is funding – are we going to get funding at the minute for a big digital optimisation programme? Probably not. But if I look back over the last 12 to 18 months, we’ve probably achieved the same as we would have done through that programme, but we’ve just done it in smaller chunks.”

What does “good” look like for digital transformation?

We asked our panellists what they thought “good” looked like for digital transformation, and what some of the key elements were for success.

Graham said: “From a Kodak Alaris point of view, where we can implement department assessment quite quickly, without having to go to a very large strategy meeting, because once it goes up to the large strategy meeting, it gets lost in the bigger picture, and then has to go to budget and planning. One of the areas what “good” looks like is where we supply and we create that kind of workflow, that helps the NHS Trust, making sure that the back office is working correctly, or where automation can come in and help this. We try and streamline everything that we put in, to make sure it promotes agile working, and to make sure we make performance improvements so the funding can go to where it’s really needed. Then we find that the waiting lists come down, because it’s more agile.”

Paul also responded, saying: “A good patient experience, where patients and staff would reflect positively on the experience, and then we would be able to identify the population health benefits of the work that we’re doing. I think as you get into a project or programme-specific piece of work, you then get into what the ambitions are, what the targets are, and the measurables that you’ve set yourself. “Good” would look like having the clarity of that and being able to evidence the work done in the learning from that piece of work, within that framework. The NHS change model is a really good way of looking at delivering transformation, and that sort of self-scrutiny is key.”

Plans for the next 12 months

We asked our panellists about their plans for the future, and what the next 12 months looks like for them.

Paul began by saying: “I think it’s going to be a really progressive year for general practice. There’s lots of work going on around cloud telephony and the recovery programme. We’ve got the GP improvement programme, which will see continued efforts around the improvement of the delivery of that model of care. So that’s getting back to how we implement that and support data at locality level.

“Then seeing trusts move to an EPR, which puts them into a new place in terms of the ability to support system integration, because now we’ve got robust clinically-coded data sat in secondary care, around that patient’s care journey, and what that means in terms of improving the quality of communication between primary and secondary care. We’re just on the fringes of that, so I think we’ll see more of that interoperability and data exchange, which in turn will enable the automation of other things. I’m excited by the Progress work, the pharmacogenomics, and hoping that we see those results being embedded into the primary care system, driving the clinical decision support software. We’re stood on the edge of a really exciting time, where the opportunities are substantial, and I was reading back through the Topol review just before this conversation, and it all just resonates with where we are at the moment, so what I would expect is for a lot of those things that have been proposed to to become reality and part of everyday practice.”

Rob answered: “We’ve procured a patient portal, and got some really tight timelines to get that in, in the first quarter of 2024, so that’s going to be a big one. Then we’re working towards our HIMSS standards – we put eprescribing in a number of years ago and we did a whole Scan4Safety programme, but we’re looking at how we can now scan dosage at the bedside in relation to the patient, so that’s going to be big for this year.

“Continuing with relationship building, we’ve just done a joint initiative with Huddersfield University around digital nursing, and we’re looking to continue that this year. There seems to be a disconnect between what they’re learning in university, digitally, on a nursing degree, and what they see when they come to work in the hospital, so we put together a programme where those nursing students come into the hospital and spend 2 weeks looking at all those digital aspects of social care.”

Finally, Graham talked about plans for Kodak Alaris over the next 12 months, saying: “We’ve been developing our data product, which is called KODAK Info Input Solution, and we’re wanting to bring everything together into one shared platform. We’re working with the trust to bring that data together, where you can have information coming from a physical document, a PDF, or an electronic document, and we can pass it through to the care systems, or the EPR systems, within one platform, making it a really seamless process that will bring a lot of advantages. It means one platform and one supplier, which brings what we would call a return on investment quite quickly. And instead of being over five years or three years, it can be a 12-to-18-month period, which helps with what we spoke about earlier with budgeting. We’re making sure that every piece of information and data they get is correct and accurate, to bring that performance and productivity to the front end, whilst really looking after the patients. We’re hoping to bring the awareness to our partners in the NHS Trusts we’ve been working with for over 3 decades on data capture and data management, that we’re here to help, we’re here to guide, and we can help with data transformation, especially in the one-platform scenario.”

Our panel then moved on to take questions from our live audience.

We’d like to extend our thanks to our panel for taking the time to share their valuable insights with us and our audience at HTN.