By David Kwo, EPR consultant and researcher, who provides a first-hand account of the EPR implementation and go-live at the Royal Devon and Exeter NHS Foundation Trust. David has supported the trust as an external EPR assurance agent and advisor.
On Saturday 10 October, at 4:45am, the Royal Devon and Exeter NHS Foundation Trust (RDE) switched on their Epic EPR system across their main hospital and 21 community/specialist centres. This moment represented the culmination of over 2 years work to prepare the organisation for its largest transformation programme ever.
To put this event into context, the RDE is the fourth NHS Trust to go live with Epic in the UK. Cambridge was first in 2014 followed by UCLH and GOSH 2019. This year, Manchester, Frimley, Guy’s and St Thomas’ and Northern Ireland announced their Epic signings with all their go-lives, along with the Cleveland Clinic London, to take place by 2023. There will then be 10 UK sites live with Epic in the 9 years up to 2023 – more than one Epic go-live per year on average.
Therefore, RDE is part of a growing group of NHS hospitals using Epic to drive transformation. RDE’s strategic vision has long been to transform its patient pathways across care settings which fits well with Integrated Care Systems rolling out across the NHS. RDE delivers acute and community services and has 850 beds, 21 community hospitals/centres, 9000 staff and a £600m budget. RDE went live with 29 Epic modules all at once, as did Cambridge (24 modules), ULCH (23 modules) and GOSH (24modules). The “all at once” approach was seen by each of these sites as safest, least disruptive and most clinically beneficial for patients.
RDE’s wide scope of applications includes: Pathology, Pharmacy, Maternity, Theatres, Anaesthesia, Orders, Clinical Documentation, ITU, A&E, Cardiology, Ophthalmology, GP Portal, Outpatients, Patient Portal, Community and Home Care, Enterprise Scheduling, PAS, Coding, Health Information Exchange, Medical Records, eConsenting, Data Warehouse, Document Scanning, Chart Abstraction, Medical Device Integration, Interfaces, Access and Security, Electronic Whiteboards, Voice Recognition and Kiosks.
Over the past two months, RDE trained over 9000 staff, most of it virtually. They learned a lot about how to work under COVID conditions whilst installing Epic into their regional Nightingale hospital. RDE is the first NHS site to use Epic in the acute and community settings. With RDE, GOSH and Frimley choosing Epic, there is now a suggestion that Epic can be suited to, and afforded by, a range of NHS acute hospitals, not just the large academics. The positive RDE go-live this week demonstrates high, across-the-board adoption levels by clinical and admin staff. This corroborates reports from the other NHS sites picking Epic that clinicians find Epic easier and better to use than other EPRs to which they compared.
As I published on social media this week, the signs were emerging clearly of RDE’s successful go-live: staff coping well on the wards, lots of Super Users stationed around the sites and a relatively low number of issues being logged on the helpdesk on Monday. The severity of issues was also lower than the other 3 Epic go-lives I have seen. Gold and Silver Commands, running 24 x 7, were calm and supportive at all times. When I walked the surgical wards, I found ward clerks, nurses, pharmacists and doctors all happily using the new system, with only occasional “how-to” questions. This shows how well their training programme had gone, despite the need for social distancing in classes (much of the training was done virtually – a new normal?).
The level of positivity amongst all the programme team and managers across the divisions was remarkable and heart-warming. There has been a great turnout from other UK Epic sites sending additional Super Users: GOSH sent 70 staff, UCLH sent 30 and Epic also sent an additional 120 staff.
The go-live event is often seen as the pinnacle of the EPR implementation project and switching the system on is certainly a significant moment. Everyone’s lives changes from that point on. I have been fortunate to have experienced over 9 large EPR go-lives, of which I was personally responsible for 3 in the NHS (Cambridge, UCLH and Chelsea & Westminster). It was a privilege to have been involved with the RDE Epic programme as their external Assurance agent.
I have to say that the RDE go-live has been the smoothest EPR go-live of the ones I have seen. They are still in their first week, the most intense week of EPR go-lives, but from the moment of activation in the early hours of Saturday morning, through the first Monday when clinics opened, it has been clear that they have it all well under control and that their hard work (over the 2 years) has really paid off.
During my time at RDE, I have witnessed how RDE has excelled at change management as the core of their transformation programme. Their change management programme was shaped and led by their top team which included: Suzanne Tracey (CEO), Tracey Cottam (Co-Senior Responsible Owner), Prof Adrian Harris (Co-Senior Responsible Owner); Martin Smith (People and Culture Transformation Lead), Raied Abdul-Karim (Programme Director) and Peter Adey (COO) and his amazing divisional managers. This team did a fantastic job in gaining total operational ownership of the Epic system. The divisions took possession of the EPR programme to redesign their pathways and apply modern tools for treating patients and running their facilities, rather than seeing EPR as some IT thing imposed on them.
Today is day 6 of RDE’s go-live and positive comments continue to come into Gold Command including today: “ED are absolutely loving Epic”; “A nurse said that being able to see the whole patient record in one place is nothing short of a miracle”; “Nurses have doubled their rate of patient scanning for administering drugs in 3 days which is amazing for patient safety”. This all bodes well for RDE’s EPR-enabled transformation programme going forward and of course, go-live of an EPR is just the beginning of the change journey.
On reflection, RDE’s go-live success this week highlights a key message for other large-scale digital change programmes in the NHS: an EPR system not only needs to be liked by the clinicians, offer deep clinical functionality and support the workflow seamlessly, it needs to be fully owned by the organisation at all levels, because if it isn’t owned, it won’t be used, and if it isn’t used, it will never be value for money, whatever the EPR price tag appears to be at first glance.
So congratulations RDE and thank you for your amazing achievements (especially during pandemic)!
