Insight, NHS trust

Legacy information systems: approaches from across the NHS

As part of this week’s focus on legacy information systems, we’re exploring views from NHS professionals on their organisation’s approach.

Mark Chester, assistant director of digital services at University Hospitals of Derby and Burton NHS Foundation Trust, said: “All organisations face challenges with legacy systems and what happens to the data within that system once it has been replaced. This challenge is made even harder in the NHS due to the variety of systems in use and requirements to maintain data for differing periods of time. Maintaining legacy systems within the NHS not only poses significant cyber security challenges it is also an expensive way to maintain historical data, as quite often maintenance costs on legacy systems is very high.

“University Hospitals of Derby and Burton NHS Foundation Trust was formed in 2018 following the merger of Derby Teaching Hospitals and Burton Hospitals. The trust has taken the approach to decommission legacy systems as soon as possible and to migrate any data remaining in those systems into a single cloud based data archive system (Bridgehead Healthstore). This system does not replicate the original system, but allows the data to be stored in such a way that clinicians can easily access the data from links within the core electronic patient record. The system is built in such a way that the data is presented to the clinician in an easy to read format so that they can quickly and easily refer back to historical data when treating patients. In addition, as the data is also held as discrete data items, other tools such as PowerBI can be used to query the data specialist reports are required

“With the system being cloud based, it is easy to expand the system to incorporate more patient data as systems are decommissioned. This system will play a key role over the next three years as the trust migrates from using two separate electronic patient record systems onto a single system.  Not only will it ensure that the data is still available for patient care but it will also save money for the trust in not having to maintain the legacy EPRs.”

When we interviewed Lorna Allen, chief digital and information officer at Northern Care Alliance, she commented on the need to monitor challenges on an ongoing basis. “Sometimes you need to make a conscious compromise about how fast you need to launch a service if you’ve got an urgent need – I think all organisations have to do that. That’s okay, but organisations should make sure that they note it down and keep a record of the compromise so that they can regularly check on it and make sure that it’s still okay. But you need to know when to take action. We’re seeing this at the moment in the Northern Care Alliance with legacy buildings and legacy systems; we have some selective choices to make and some fundamental changes to undertake. This all feeds into the development of your digital strategy,” Lorna stated.

Reflecting on her previous experience in the corporate sector as well as the NHS, she added: “There are always challenges around the age of systems, the integration abilities, the extracting of data. They are common issues across every organisation I’ve worked in.”

We recently heard from Matthew Hopkins, chief executive at Mid and South Essex NHS Foundation Trust, on the trust’s digital progress so far as well as priorities. Matthew shared that Mid and South Essex has “started a major transformational programme, working in partnership with Essex Partnership University Foundation Trust, to implement a first of type system-wide EPR. This programme connects patient data across community, mental health and acute care settings, and will change the way we deliver care to embed truly integrated whole system pathways.”

To underpin this, he continued, and to ensure focus on safety and security, the trust has “begun a sustained programme of investment in our foundational technology that will bring the legacy systems of previously separate hospitals together as a single trust configuration. We recognise that having a sound technology base is critical for supporting patient safety, connected care and innovation into the future.”

Dr Penny Kechagioglou, chief clinical information officer and deputy chief medical officer at University Hospitals Coventry and Warwick, raised legacy systems as a key challenge that her trust has faced. “If I were to break down the challenges, I’d categorise them as technical challenges like legacy systems that we’re trying to solve and bring together and decommission, and infrastructure – how we are going to use our existing infrastructure and build on it, for example so that it can be more efficient for remote working and remote patient monitoring,” she said.

She added that another challenge here is that “digital transformation is happening really fast. There is a lot of conflict between transformation and change and ‘business as usual’ because our organisation is very busy at present delivering above and beyond our usual service targets. As a result, change activities often come into conflict with the day-to-day business deliverables and what changes we need to make to support big programmes like the EPR and other digital projects.”

We spoke with previous chief information officer from The Royal Marsden, David Newey, on digital programmes including the trust’s EPR go-live last spring. David described how the implementation was not just a case of launching a new EPR, “it was replacing our existing EPR which we had developed in-house. Also, we were extending the coverage to incorporate the replacement of the JAC pharmacy system and the Technidata laboratory system.” Both of these areas are “very complex to address on their own”, David said, aside from the rest of the EPR implementation.

Along with deploying over 6,000 devices, redeveloping more than 90 interfaces and testing over 4,000 devices across a 10-week period, The Royal Marsden needed to migrate data over from their legacy EPR.

“One of the ways we approached this was by developing our legacy clinical viewer,” David said, describing this as a “fully embedded read-only view of our old EPR data” providing the trust with around 30 years of historical data. “We developed this from the ground up, mainly because our old EPR was solely reliant on internet explorer 11. We had to ensure that the legacy viewer was able to run on modern browser technology.”

Catch up with David’s interview in full, including advice for teams approaching EPR go-lives, here.

Chris Mason, chief information officer at Wirral University Teaching Hospital NHS Foundation Trust, also shared his experience of tackling legacy systems with us. He explained that one of the first projects he undertook at Wirral involved decommissioning their legacy system, with the trust’s first intention to move what they already had within their legacy system and build upon it. “We already had some sort of digital care pathways, the inpatients PAS, an element of e-prescribing,” said Chris. “We’ve now got the vast majority of our medical devices integrated into our EPR with all of that data flowing in from our medical devices. Where we have specialist systems, again the vast majority are integrated with a small amount of specialisms still to go. Most of our clinicians probably only log into one system, which is great. It’s a one-stop shop for everything.”

Earlier in the week, we chatted with BridgeHead Software’s vice president of global marketing, John McCann, on legacy systems – from the different kinds of legacy applications to the challenges they pose and BridgeHead’s solution for tackling those challenges. Catch up here.