Interview, NP

Interview: “Transformation is people, process and technology” Stephen Bromhall, CDIO at East of England Ambulance Service

In a recent interview, we caught up with Stephen Bromhall, chief digital information officer at East of England Ambulance Service NHS Trust (EEAST), to talk about recent digital projects and priorities and the way that digital is being used to make improvements across areas such as workforce, operations and patient engagement.

Offering a brief introduction to his role and background, Stephen explained that he has been in post as chief digital information officer at East of England Ambulance Service since the end of 2019.

“I’ve been in healthcare since 1983 and I’ve been involved in other parts of digital delivery – not only in healthcare, but also in financial services for a short period of time,” said Stephen. “But my true roots are in healthcare, where most of my career has been.”

On his role with EEAST, Stephen said that as well as leading the trust’s digital services, projects and programmes, he is also responsible for the organisation’s data repository and the data that it uses for performance reporting.

“Additionally, I am the national chair of the digital group of the association of ambulance chief execs, which is where we come together as 14 ambulance services to discuss the ways that technology impacts us at a local and national level,” he shared. “We take a lot of national technology into the ambulance service, so we come together as a group to discuss cybersecurity issues; control rooms; how we dispatch our ambulances; communications with citizens; and technology advancements around things like Airwave (critical national infrastructure for emergency services).”

Digital projects and priorities at EEAST

What are some of the digital projects and priorities at EEAST? Stephen shared that priorities include transforming citizen care, using tech to make improvements for frontline crews and call centre staff, connecting telephony platforms across ambulance services, and upgrading the trust’s 999 telephony platform, to help improve collaboration and better manage demand across services.

“We are continuing to work with our electronic patient care record platform, starting to bring more functionality into that solution; and we’re now connecting via our integration engine to our first ICS, so that we can share information jointly between our frontline clinicians and the hospital staff,” he said. “We’re looking at then rolling that out across the other five ICSs this year. It’s been a long-term piece of work, but it gives us the ability to share our records through a national stage, this makes a real difference to our patients. When our crews need to look at historic records, we’re making sure that we can both consume and supply our records across different care settings.”

Stephen also discussed another key element of the trust’s digital strategy around the continuation of the national records locator service, which EEAST has been piloting over the last few years on behalf of the ambulance services. Stephen highlighted that that programme of work is “now being viewed as a key enabler for crews to access core systems such as the child information protection system and end of life care plans, which road crews have never been able to do before.”

They are doing this “by making Spine connected services on the move, which is really exciting for us. We’re working with national colleagues to build what that looks like, and we’ve deployed it to around 2,000 of our staff now. I think that is really what digital transformation is about.”

Another programme of work the trust is undertaking some trial work on behalf of the Department of Health with the European Space Agency, to determine whether it is possible to bond 3G/4G and satellite connectivity from multiple providers. The aim is to enable always-on connections in those places where the mobile network doesn’t currently offer coverage.

“We have noticed positive results with our crews – in areas where there was previously zero signal, they can get a high-speed connection on the move. We were excited to be asked to do this on behalf of the European Space Agency, and that really has shown benefits to our staff. It was a challenge to get connections into a number of our double-staffed ambulances and rapid response vehicles, but it’s definitely made a difference to us.”

Stephen moved on to discuss the trust’s work around automation, explaining that they are in the latter stages of piloting automation in their control rooms.

“We work in out-of-hospital hubs with our system partners, and we’ve looked at automating some of the  work that we need to do in those, where a patient needs our service but maybe doesn’t need an ambulance service,” he explained. “That will mean that we are using automation to pass things very quickly to our community partners, through the community hubs. For us, that’s been an evolution of technology that we’ve been building for the last 18 months, in terms of how we can help drive more effective and efficient service delivery where it is needed most.”

This year, Stephen said, EEAST is “bringing in the new national control room solutions from the ambulance radio programme, which will replace our dispatch system with a modern platform. We’re really looking forward to the opportunities that will bring. We’re also halfway through deploying new technology in the ambulances, to enable us to connect with and pass messages more effectively.”

Approaching large-scale digital transformation

Sharing some advice and insights on approaching large-scale digital transformation, Stephen emphasised that digital is an enabler and is “just one part” of the transformation process.

“I would say work with your executive colleagues, work with your people; this is not a digital thing, this is about teams working together in a multidisciplinary approach. We always remember that transformation is people, process and technology. As colleagues in digital, we can come up the ways to deliver the technology; but it’s all about working with your existing teams and colleagues as a joint project. We need a joint plan, and to think about sponsorship, programme activity, and getting the right teams to work together in a collaborative way, so that there is no boundary. We all come together as one, and run things in small bite-sized chunks, so that we can actually notice tangible results very quickly.”

From a workforce perspective, Stephen shared that the trust is currently looking at the opportunities available to support staff through the ESR platform, with “a number of projects that are aligning to help towards using ESR more effectively and efficiently.”

Another workforce-focused project, currently in its early stages, has the trust building a large language model with the aim of putting a chatbot into its people services request function. “That would mean that staff don’t need to get into a ticketing system or to make a call to find answers,” said Stephen. “We’re working with a partner to put something in that will provide answers to staff questions about things like holidays, to improve our service for our staff.”

Are there any key considerations for ambulance trusts in particular when it comes to digital?

“From an ambulance service perspective, our key focus needs to be about delivering the national standards that we are set from the Department of Health. From a technology perspective, we need to make sure that we’re using the best options available to us to make that a reality. For me, it’s about sharing best practice amongst ourselves, because there is only a small number of us, and we use commonality in terms of platforms and technology,” Stephen reflected.

“Let’s make sure that we can take what we’ve learned from working with our own vendors, but let’s also think about what other organisations are using. There are lots of good things going on in the NHS, not just in ambulance services. We need to be curious about the things happening in acute, mental health, primary care, that we could lift and bring into our world.”

Looking ahead

Stephen shared that he had recently spent time with colleagues, debating what the future might look like within the ambulance service.

“We feel that we need to explore things like AI to support us in the call handling process, not only with a view to speeding up the process, but also in helping our colleagues who are taking those very difficult and challenging conversations. Also, there are opportunities for robotic process automation in our back office services to promote efficiency and effectiveness.”

An area of particular excitement for EEAST at the moment, Stephen said, is video conferencing opportunities for the mobile workforce, whereby video from frontline crew members who are with patients can be used for clinical triage and shared with support services. “The key challenge at the moment is connectivity, but I believe this that as a real opportunity in the future for us.”

He continued: “Also, there is fact that the shared care record is going to become more nationalised through the work that is being done at the Department of Health, with the ability to have a national view on a patient. When we attend to them and we can pull their information through from wherever their GP record or acute record is held, and we have more insight when we’re delivering care. It’s about using what we’ve got at early parts of the process to help our team to diagnose quickly, and make sure that we can provide the right level of care. I do envisadge that artificial intelligence will take away what we’ve got within our call handling and clinical processes; it’s just going to support them with richer data and richer advice.”

Stephen said that the ambulance service is “an exciting place to be” at the moment, adding: “We are really accelerating our use of tech, and for me that’s all for the good. The next decade can really be transformative for us. If we could solve the challenges around connectivity, and if we could always have a high-speed connection, I believe that we could make a real difference”.

We’d like to thank Stephen for taking the time to share with us his insights and experience from EEAST.