HTN sat down to talk with Louise Croxall, chief nursing information officer for Calderdale and Huddersfield NHS Foundation Trust, to hear more about the trust’s digital priorities, the data work that has led to achievement of HIMSS stage six validation, thoughts on developing a strong digital workforce, and more.
Louise has been CNIO for Calderdale and Huddersfield for around two and a half years, having come to the role from extensive experience in emergency care. She first came involved in digital work with the trust’s implementation of its electronic patient record, which went live seven years ago, when she became the A&E workstream lead and helped design the A&E module of the EPR.
“I enjoyed getting into digital, so when the CNIO role came up I went for it. I enjoy seeing the trust as a whole and being able to help the different teams with their digital work,” Louise shared. “I work closely with our health informatics service on new projects, identifying how projects can help clinical staff in their jobs rather than hinder them, because you’ve got to be able to see the benefit of the project. I also work with clinical staff, exploring how digital can help release time to care. I’m essentially the clinical translator for the digital team, and equally the digital translator for the clinical team.”
Louise also highlighted how she collaborates with Calderdale and Huddersfield’s chief clinical information officer, making sure they are aligned in terms of priorities and the direction moving forward for the trust. “We’re very much on the same page when it comes to where we are and what we want to do,” she said. “Seven years down the line, we need to optimise our EPR and make it easier for the clinical staff to use; but our staff understand the potential of the system now and their skills are at a higher level.”
Digital programmes at Calderdale and Huddersfield
Louise highlighted how the team has recently reconfigured the nursing admission system and involved nursing staff throughout the design of it. “It’s been a really successful implementation,” she noted. “We’ve done exactly what they wanted, and they’ve really embraced it and come forwards with it. The feedback has been really positive – patients are not receiving a more comprehensive assessment and care is being given to meet their individual needs.”
In terms of other work around the EPR, Louise shared that Airedale NHS Foundation Trust is set to join Calderdale and Huddersfield and Bradford’s domain. “We’re in a change-freeze at the moment with our EPR whilst that happens, and they are planning to go live in September. Whilst in the freeze, we are a 12-month programme of intensive ward intervention work with clinical staff to make sure they are using the system to its full potential.”
Over the last 12 months the trust has also been implementing an electronic controlled drug (CD) register, Louise shared, but “deliberately taking a slow implementation approach with that. We’re taking it ward by ward, making sure all the staff on a ward are trained, competent and confident before we move on to the next. It’s an approach that has proven really successful for us.”
She also highlighted how Calderdale and Huddersfield worked closely with the supplier’s design team when developing their electronic CD register, focusing on making it personalised and fit-for-purpose, with clinical staff involved in the entire design process. “The staff on the wards where the register has gone live have been really positive about it,” Louise said. “They tell us that it’s reduced the amount of time they spend on audits and it alerts them when needed, for example if a drug hasn’t been signed for. Overall, they find it much easier to maintain.”
Louise went on to discuss how Calderdale and Huddersfield procured a patient portal at the start of the year which went live in April. “We’ve been really busy with that, getting the functionality of our previous portal replicated in the new one. We set up appointment letters in spring and we are now looking at enabling access to other documentation and patient health records; that’s due to go live in September. From there, we’ll be able to focus on the more exciting opportunities around the portal and looking to optimise the experience for patients. We’ll be exploring features such as video consultations and information around health promotion and education. For example, if someone attends A&E with an ankle injury, we’ll be looking to use the portal to supply the patient with information and guidance on helping themselves recover from that injury. It’s all about achieving patient-centred care.”
Data, and achieving HIMSS stage six validation
In May, HTN covered how Calderdale and Huddersfield achieved HIMSS stage six validation for its use of data (Adoption Model for Analytics Maturity – AMAM). We asked Louise to share her perspective on the data work that led the trust to this point.
“We’ve always been a data-rich organisation,” Louise reflected, “but previously I don’t think we always used it to its best potential. Now, we have dashboards for staff to check and use to help them make decisions or identify where work needs to be done. Our nursing staff use the data extensively in their day-to-day working lives now; for example a nurse in charge of a ward will be looking at a dashboard to identify which assessments have been completed and which are still outstanding so that they can keep the work flowing. Every day, our ward managers and matrons are logging on to the dashboards to look at the data and use it to improve care quality and safety.”
The dashboards include feedback from friends and family on patient care, Louise added, with the trust placing focus on what the available data means for patient experience.
“We use a lot of data in our collaboratives, particularly around areas such as pressure ulcers, falls and deteriorating patients, to try and reduce challenges like this. We will look at our data and see which teams are best placed to help, which areas are struggling, and what we can learn from the data trends. It’s about triangulation of the data as well – for example if assessments aren’t completed properly, that means the care plans in turn aren’t completed properly, which could be a reason for an increased number of falls in an area. We explore all of our data together across different dashboards to try and work out what is happening and then take action.”
The falls dashboard in particular has been successful, Louise noted, with a reduction in falls observed “just by using that data and learning from it”.
Are there any future opportunities Louise would like to see harnessed, when it comes to data? “I think there is a wider opportunity around different organisations working together,” she considered. “We have a lot of our own data within Calderdale and Huddersfield, and we should be sharing that with the ICB and local health councils. We should all be working more closely. They’ve got a lot of data, we’ve got a lot, and I think if everybody came together we could really focus on preventative health and tackling inequalities. We do a lot of work around those areas within the trust, but bringing everyone’s data into play would be really useful in terms of drilling down and exploring why inequalities exist and what we can do about them.”
She added: “I’d like to see more work with data across the community in general – for example, if there’s an area within our footprint that has high levels of respiratory disease, we should be targeting flu vaccinations in that area.”
Developing a digital workforce
“You need to work very closely with your data quality team and your health informatics team. There is a lot of disparity from trust to trust when it comes to digital teams,” Louise said. “Some trusts in our area have a massive digital team; some have barely any digital representation in the workforce and are in a position where they need to build that up. I think that nationally, there should be dedicated funding for each trust for a digital team. It’s the direction that every trust is going, and I believe that along with bookmarking funding for it there should also be national guidance on what a digital team structure should look like.”
When Louise first started in her role, she explained, she was the only clinical and digital representation; now she has managed to develop a team including five full-time equivalent members of staff focusing on change and transformation, as well as a digital matron. “Building my team from the ground up has meant a lot of business cases and a lot of hard work,” she pointed out. “Having more support on this from a national perspective would be really helpful in building a strong, extensive team.”
Emerging technologies
The trust started using artificial intelligence in radiology interpretation in 2023, Louise shared, and also utilises robotic process automation to help reduce the administrative burden.
“We’ve done a lot in that area, and now we are looking at going a bit further – going into divisions within the trust and actively looking for how RPA could help,” she said. “For example, we’re using RPA to add reasonable adjustment flags to patient profiles where needed.”
Work in this space is “ever evolving”, Louise acknowledged. “We want to increase our RPA use, but again, it comes back to completing business cases to try and get funding. But there is certainly a huge appetite for it within the trust.”
Regarding AI, Louise shared the view that it is an “exciting time”, but stressed the need for caution. “I don’t think we should take decision-making away from clinicians, and I think we also need to be very careful around using AI for documentation. We shouldn’t be using it for copying and pasting into notes, because our clinicians need to have the knowledge and oversight of what we are writing and sharing in there, as well as any information in there that needs acting upon.”
Priorities for the future
Louise and her team are due to write their new digital strategy over the next year, which will be based around the What Good Looks Like framework.
“Our work on the patient portal is a priority,” she noted. “We need to keep pushing in that area to deliver as much benefit as we can.”
Another priority is continuing the ward intervention work. “As part of this, we are also planning to embed wristband scanning for our drugs administration, and bringing in a medication scanning to add to the full closed loop system.”
Finally, Louise highlighted the focus on building digital literacy across the workforce, along with furthering the HIMSS stage six validation. “We achieved AMAM – the Adoption Model for Analytics Maturity. We’ll be going for the other models next, to try and get level six across the board. It all comes back to our focus on patient safety.”
Thank you to Louise for taking the time to join us.
