For this instalment of our Interview Series, the first of 2022, HTN spoke to Glenn Winteringham, Group Chief Digital Officer for Royal Free London NHS Foundation Trust, about the latest developments in their digital transformation programmes.
In this piece, Glenn guides us through the Royal Free’s Electronic Patient Record journey, explains the benefits of recent work, and looks forward to the next innovations.
This interview is part of our agenda for the HTN Now January event, which features a wide variety of content from health tech professionals and digital teams across industry and the NHS. The first in our 2022 series takes place from 17 to 20 January, and you can find out what else to expect from the sessions, here.
Hi Glenn, thanks for joining us. Tell us about your career background and role as Group CDO.
I’m the Group Chief Digital Officer at the Royal Free London and I manage five main functions – telecommunications, IT infrastructure, patient systems, information management and clinical informatics.
In the mid 90s I switched from information management to IT. I was Director of IT at the Whittington [Hospital] for 20 years, and a contract consultant for much of that period. I’ve done lots of contract [projects] and I’ve worked at places like GOSH (Great Ormond Street Hospital for Children Foundation Trust), North Middlesex University Hospital NHS Trust, and Moorfields Eye Hospital NHS Foundation Trust.
I joined the Royal Free London NHS Foundation trust in 2017 and was very fortunate that they had been selected as a Global Digital Exemplar (GDE) – one of the original 12. We were also building a brand new digital hospital at Chase Farm in Enfield. That’s what I walked into and I feel very proud and privileged to be in the role and to work with such an amazing team.
What’s different about us as a GDE is that we had a vision to reduce unwanted clinical variation across all our sites. To do that we had a change programme called Clinical Practice Groups (CPGs) and the purpose was to let clinicians, GPs, and patients co-design the best possible care pathways. We knew using standardised care pathways would deliver better, safer care, improved outcomes and reduced costs. Part of the GDE programme was to digitise the CPGs into our new EPR. We went live with seven digitised care pathways and we now have nearly 50.
Tell us about your Electronic Patient Record journey
We opened the brand-new digital hospital, Chase Farm, in 2018 and that was the main focus for our GDE. But, for historical reasons, Chase Farm and Barnet Hospital shared an EPR.
It became apparent that if we were going to put an EPR into Chase Farm, we’d have to put one into Barnet at the same time and also into our two community hospitals at Finchley and Edgware, as well. Our GDE started out as implementing the new digital hospital but it soon expanded into deploying a new EPR across four sites.
To deliver the GDE we had to replace the EPR at Barnet, Chase Farm, Finchley and Edgware with a brand new one. We were very fortunate that at the time Cerner were just bringing to market what they call their model content EPR, which was just what we needed. It was comprised of the best of their UK solutions in a single EPR platform which was also aligned to best practice such as the Professional Record Standards Body (PRSB).
As part of the new Chase Farm Hospital there was no medical records library and no paper or outpatient receptions. The new digital workflow in Outpatients relied on patients self-checking into kiosks and way finding. We successfully deployed the new EPR in November 2018 and seven months later we achieved HIMMS EMRAM level 6 accreditation. We are very proud of that and are planning to achieve HIMSS EMRAM level 7 in 2022.
That still left us with the legacy EPR at Royal Free Hospital, which was deployed in 2008 as part of the National Programme for IT (NPfIT). We were the only Cerner client to have two separate instances of Millennium EPR in the same organisation. This caused significant operational and clinical workflow problems working across two separate EPRs.
So our next priority was to merge them and establish a single EPR platform. When the COVID pandemic started, we paused most of our digital transformation projects to focus on delivering new ways of working such as rolling out Microsoft Teams, Attend Anywhere virtual consultations and remote working. However, EPR was the one digital transformation programme we kept going because it was so fundamental to how we deliver care across the Trust.
We recently went live with the new EPR in October 2021 which had four major components. We migrated data from our legacy EPR into the new EPR; we rolled-out the new EPR into the Royal Free Hospital; we upgraded the EPR across all our other sites; and we established a shared domain with West Hertfordshire University Hospitals Trust.
What were the main challenges you faced?
Data migration was a significant issue because of the volume and complexity of moving data between two separate instances of Cerner EPR, which was very challenging, but we worked with some great partners and we were successful.
When you roll out an EPR, one of the biggest issues is ensuring the IT infrastructure is fit for purpose. We upgraded the Wi-Fi at the Royal Free Hospital to improve performance and installed nearly 2,000 new PCs, including over 700 new Workstations on Wheels (WoWs). Prior to the new EPR, the Royal Free Hospital was very paper-based but now they have electronic prescribing and medicines administration, nursing assessments, care plans and treatment, and new modules in ITU and theatres, including medical device integration.
Because we’re on Cerner we use smart cards to login and provide role based access control (RBAC) to the EPR, which was another big challenge given the volume and complexity.
One of the key things we did when the GDE programme started was establish a clinical informatics team, in order to change the culture from IT led technology projects to clinically led digital transformation programmes.
With the GDE money we appointed six Chief Medical Information Officers – three were consultants and three were junior doctors – to support our CCIO. We also appointed a Chief Nursing Information Officer and an Electronic Prescribing Medicines Administration (EPMA) team to support the EPR roll-out. However, when the GDE funding ended, a lot of skilled resource and expertise left which hindered our capacity to drive the adoption and optimisation of the EPR.
As part of this EPR go-live, we have also enhanced our clinical informatics team by recruiting 11 new permanent clinical leads, five Nursing Information Officers and six change managers. We now have a team 20 plus clinical informatics leads, which means all our digital transformation programmes are all clinically led. We’ve worked really hard to change the culture and establish a strong digital governance structure to ensure we have executive, clinical and operational ownership.
What have been the benefits of your EPR project?
We see the deployment of a single EPR across the RFL Group as the start and not the end of our digital transformation journey. We now have a HIMSS EMRAM stage 6 EPR in place which provides us with a foundation to deliver benefits and drive innovation.
If you’re a clinician, you can access a comprehensive patient record from any location in real time which enables better, safer, faster care. The biggest benefit has been the digitisation of 50 standardised pathways which has transformed how we deliver care. For example, if a patient presents with a broken neck of femur and they are admitted onto that standardised pathway, it will automatically place a number of agreed diagnostic tests and clinical tasks which will reduce unwarranted clinical variation and improve patient outcomes. We now have we have a lot of data demonstrating improvements in care such as reductions in length of stay, adverse events, and cost as well as better outcomes.
The other big win of having a digitally mature EPR is that we can now share patient data across our Integrated Care System (ICS). In North Central London, we have deployed two major data sharing platforms.
We have a Health Information Exchange, which gives all clinicians in NCL a real time view of a patient’s record across all healthcare providers. This enables clinicians to make more informed and better decisions and reduces delays, so for example when a patient attends ED they can access their primary care record and view their conditions, medications and allergies etc.
We also have a Population Health Management platform. It was used a lot during COVID using new dashboards, and we now have a number of disease registers live to risk stratify our population such as Cancer, Learning Difficulties and Hypertension.
The third major platform the EPR has allowed us to implement is a patient portal. We’re very keen to engage with, and empower, our patients so that they get the best possible care in the most appropriate setting. In September 2020, we deployed a patient portal from Induction Healthcare Group called Zesty, and we now have over 160,000 patients registered.
Patients can view their appointment letters and rebook their follow ups, which goes straight back into the EPR. Now we have a single EPR, they will be able to access other clinical correspondence such as discharge summaries, test results and their own medical record. This will reduce our Did Not Attend rate and stop unnecessary visits to hospital for routine test results.
We also want to monitor patients remotely to reduce hospital visits, which also supports our sustainability and carbon reduction plans. For example, patients will be able to complete pre-op assessments online, rather than come on site to complete a form, and it will automatically assess whether they are high risk or low risk for surgery.
What else are you working on?
Looking forward to 2022, our top priority for the EPR is to drive adoption and optimisation. We have a really good foundation in place, but we need to support users to use the EPR workflows properly. We know we have a big job to get alongside our frontline clinicians to make sure they optimise their use of the EPR and improve their digital experience.
We have made significant investments in digital transformation over the last four years and recently, and we’ve been successful in bidding for technology infrastructure funding. We’re going to use it to deploy three new modules in our EPR.
Firstly, we will give our clinicians mobile access to the EPR ; secondly, we will deploy speech recognition to replace the current digital dictation solution to enable faster data entry and clinical correspondence; and thirdly we’re going to deploy patient flow to improve our bed management and patient discharge processes.
As an organisation, we have an ambition to be the best healthcare group and most digitally advanced trust in the NHS, We have a new Digital Strategy for 2022-2025, to deliver which is aligned to both the RFL Group and the NCL ICS priorities going forward. Undoubtedly, during COVID we have seen unprecedented levels of digital transformation, so these are very exciting times to be delivering digital services working in the NHS.
