HTN recently caught up with Mark Hutchinson, executive vice president at Altera Digital Health UK & EMEA; Jackie Edwards, chief clinical digital engagement officer at Worcestershire Acute Hospitals NHS Trust; and Marc Tarrant, digital matron at Worcestershire Acute Hospitals NHS Trust; to learn more about the organisation’s current EPR programme and how it is supporting emergency and unplanned care.
“Prior to joining Altera, I spent 25 years in the NHS, the last 20 of those as a CIO working in four large hospitals and dealing with the many challenges that people in hospitals are dealing with today,” Mark told us. “In three of those organisations, I implemented an EPR, and in every one of those instances we chose the Altera EPR as the tool we wanted to use to improve the safety and reliability of care.”
Picking up on key ways Altera’s digital offering can help overcome health and care challenges, particularly for emergency and unplanned care, Mark highlighted the importance of having a live EPR within emergency care departments. “It helps get rid of the chaos that can ensue when you’re using paper,” he noted, speaking of personal experience visiting A&E in early 2000 with chest pains and having his care delayed by a paper jam in the printer.
“People coming to harm as a result of paper processes has been an unfortunate and unacceptable feature of emergency care in hospitals for years,” Mark said, “so we can never underestimate the benefit of having an electronic process.” With the Altera system, the tracking board prevents this type of oversight from happening, he continued, “and me coming in with chest pain would have been flagged up, ensuring I was seen more quickly.”
Once a patient has progressed through the emergency department and onto an acute medical unit, they are cared for by a different team of clinicians, Mark explained, “In my experience working at organisations without an EPR, the junior doctors would come and see me, and tell me that, when going on to that unit, they had 30 patients who had all been admitted through A&E, and they didn’t know who needed to be seen first.”
By having a system in the ED at the point of admission, that contains all of the information collected on a patient and offers insight into their condition and latest observations or test results, those on the acute medical unit can provide safer and more efficient care, according to Mark. “Too often I’ve heard stories where, without that information, patients on that acute medical unit didn’t get assessed in a timely manner and sometimes came to significant harm,” he added.
“The other thing we’ve worked with our clients to develop is a long-stay assessment tool,” Mark shared. “It uses AI to identify at the point of initial assessment in A&E to determine whether a patient is likely to end up in a hospital bed for more than 21 days.” There are two main benefits to this: preventing patients losing mobility and strength during longer stays, and improving hospital bed capacity. “The tool alerts clinicians when it identifies those at-risk patients,” he said, “so interventions can be taken like referral into the community to prevent that harm.”
Altera’s implementation at Worcestershire Acute Hospitals
Jackie Edwards told us about her 40 years as a nurse, moving more recently into her role as chief clinical digital engagement officer. “My aim is to see how we can enhance clinicians’ involvement in digital transformation,” she said, “and that comes from having that lived experience and working alongside digital teams and other stakeholders involved in the deployment of EPR to make sure it is clinician-led, operationally delivered and digitally enabled.”
Marc Tarrant shared his background, with 21 years of experience as an A&E nurse and matron. “Jackie very kindly suggested that I get involved with digital when it came to deploying the Sunrise EPR into ED,” he told us. “I went into that thinking I would do one or two days a week in a consulting type of role, but that very quickly turned into a full-time secondment for a year, and now I’ve decided to take the plunge and stick with digital full time.”
Clinical experience in digital is crucial, Marc considered, “as we need clinicians to be able to describe the system, how we build it, what it looks like and how we’re going to interact with it on the shop floor. Not only is that important in the design process, but it can also inform how you deploy it, which is essential when you’re deploying it into a live environment like ED.”
Reflecting on the trust’s journey to date, Jackie shared how a business case was signed off in 2019, before being delayed by the emergence of COVID-19. “We ultimately started the project in January 2023 with our adult inpatient areas,” she went on, “and then we’ve deployed it in phases, which has been very successful, and which is one of the benefits of the Altera product for us.”
Now in year three of the project, the solution has been rolled out across adult inpatient areas, ED, and cardiology, Jackie shared. “We’re in the throes right now of our EPMA, and we’ve deployed some functionality into our AHPs, the key thing we’ve learned is that it’s a marathon, not a sprint, even though each drop certainly can feel like a sprint!”
“We’ve separated out allergy documentation from the main EPMA part of the product, and that’s going live as we speak,” Marc added. “That will touch on the entire trust, even those areas that aren’t currently using Sunrise for patient care, because it will be our source of truth for allergy information. That will be a great way of leading into it, as they will be logging onto the system and getting used to it, but through a very soft approach.” The team is already seeing increased interest in upcoming go-lives as a result, he noted.
Marc also summarised some of the key learnings and takeaways from the trust’s phased approach to implementation. “During phase one, which was inpatients, it was brand-new to everybody, and we were moving from everything being on paper to everything being digitised. We took a lot away from that in terms of how best to deploy, so when it came to ED, it wasn’t quite as scary as it could have been.”
On the day of ED go-live, the team decided the best approach would be to implement a cut-off time of 10am whereby all new patients would be entered using the new system, Marc told us. “Within 24 hours that meant that every patient in the department was on Sunrise. That was a massive learning curve, and we’ll be able to take that learning forward to inform how we manage other phases like EPMA to help us make that as safe as we possibly can.”
“Reflecting on adult inpatient and ED in particular,” Jackie said, “I think we come to a lot of this in a project-managed approach, but these are very complex environments where we’re deploying complex systems looking to change the ways staff are working.” Understanding that environment and the needs of staff from the outset is integral, she considered, “and one of the things we identified early on in staff engagement was that we had a digital team running it, a project team who were very methodological in their approach; being put into rooms with ED clinicians who are used to fast-paced decision-making, there were clashes.”
Bringing Marc on board as an experienced clinician with leadership skills who also understood the team dynamics and knew what was involved on both sides was the turning point, Jackie continued. “That was absolutely our remedy for success, and had we not done that, I think we would have hit more challenges. Marc’s experience with go-live in ED was really important, and that also helped our training team.”
“We put those training teams in the middle of the ED in seminar rooms,” Marc reflected, “and although we’d looked at our approach to this and talked through the deployment for months, I had people coming to me and telling me they didn’t realise what it would be like on the ground, and now they understood why we had designed the system in the way we did. They saw why there wasn’t the time to go through three screens to get to a particular part of the product and why it was important for that to be readily available. Getting people in those environments to see how they work is essential.”
Key features of Altera’s Sunrise™ EPR
The modular approach offered by Altera was one of the main benefits it offered, which made it a good choice for Worcestershire, Jackie noted. “Then thinking about the culture of the organisation and the transformational journey we knew it would take us through, it was important for us to make sure that all staff were involved and informed along the way. Having safety and control in its deployment was another key thing that I think we looked for.” Ongoing support available from the Altera team was also an important element of the decision, she shared.
“For me, the configurability of the product is one of the greatest benefits it offers,” Marc added. “It’s not just a one-size-fits-all solution whereby it requires you to change the way you practise to fit with the system; it makes the system work for you.” Whilst there have been teething issues, which are to be expected, he went on, “having the ability to tailor it to the way we do things in our trust has helped massively with engagement and take-up, we’ve worked really closely with the Altera team and they’ve been fantastic.”
Jackie highlighted the benefits in terms of the “ability to document patient care in the right way, at the right time, which is understood by all, allows people to really look at the data and see what patient outcomes are needed. If you look at our colleagues in ED, they’re still on that journey, and we still need to get better at delivering that training element to be able to deliver all of the benefits and functionality available.”
Talking about how the Sunrise EPR enhances referrals, Jackie shared how the referral process is now automated, meaning referrals can be prioritised. “That’s something staff have fed back on, about how it’s really saving them time and improving quality – tissue viability is a great example of that.”
“You’re able to start investigations and treatment much earlier in a patient’s journey,” Marc agreed, “because their data is accessible to everybody, and tissue viability nurses, for example, can see all the documentation live, their CT results or investigations, without coming down to the ED.” This has had a positive effect on patient flow, he added. “The other thing is the tracking board – the amount of information you can have right in front of you and the way you can sort that using colours and symbols, is phenomenal. It’s a very flexible system, but it’s also very rich in data, which is really useful.”
On a practical level, simply not having to spend time searching for physical notes has been a benefit, Jackie considered. “We do need to do some work around capturing the timing of that, but it was huge, and there were so many cases where notes wouldn’t be where they should be, which is what our band seven shift leaders have been saying is one of the biggest benefits.”
Looking ahead, next steps include deploying EPMA from September onwards and looking at rolling out to more departments, Marc said. “Things like electronic bed management could also have an enormous benefit to virtually every single patient, and that and order comms are the two pieces I’m most excited about getting to, both from a functionality and a patient safety point of view.”
We’d like to thank Mark, Marc and Jackie for taking the time out to share these insights with us.
To learn more about Altera’s Sunrise EPR, please click here.
