HTN caught up with Adrian Harris, chief medical officer, digital and research, at Royal Devon University Healthcare NHS Foundation Trust, to find out more about the trust’s recently published five-year digital journey.
Adrian started out with a brief introduction: “I qualified 40 years ago as a doctor, and I’m an emergency physician, an A&E consultant, and also a sports physician working in professional sport, ” he said. “I became chief medical officer in 2015, and had digital in my portfolio from the very outset. We feel that having a clinician, and the most senior doctor at the trust, leading the digital agenda is very helpful – since September I have focused only on digital and transformation.”
Reflecting on Royal Devon’s digital journey from 2020 – 2025, Adrian reported having witnessed “enormous” progress around digital maturity, driven particularly by the trust’s adoption of Epic in 2020 during COVID. “Prior to that, we had one of the oldest PAS systems in the UK, and in general really disparate systems with poor integration,” he explained. “We implemented Epic at our East Devon sites in October 2020, and have since implemented at our North Devon sites, including North Devon District Hospital in Barnstaple, which is probably the most remote district general in the country.”
With a population of around 600,000 over a huge geographical area, the EPR has helped support work in the community, Adrian continued. “We have also used the MY CARE patient portal to empower patients, giving them access to their data and greater control over their health.”
Adrian also talked about his role as SRO for the OneDevon EPR programme, noting the same instance of Epic is due to go live in Torbay at the beginning of April and at University Hospitals Plymouth in late July. “By August, the whole of Devon, all 1.3 million people, will be on a truly horizontally-integrated single instance of an integrated EPR,” he advised, “so if we think about where we were in 2019 with our myriad of systems that didn’t talk to each other, multiple logins, no patient access; it’s a massive step change.”
The trust is also doing some work around AI, including the use of LLMs and Ambient Voice Technology (AVT), and with Agentic AI being used for note summarisation and discharge summarisation, according to Adrian. “We’re doing stuff with geolocation to ensure our community staff take the most efficient route between cases; we’re working on DNA prediction; and we were the first hospital trust to integrate AVT into an EPR in the UK.”
Bringing colleagues along on the digital journey
Ensuring the digital agenda was clinically-led was important when bringing people along on the journey, Adrian considered. “I have a lot of authority and agency with the clinical body, and I think that’s really important – I’m still a doctor working alongside them; I know what it’s like to be disadvantaged by needing to log in to multiple systems, toggling between multiple screens – I’ve experienced that frustration. We’re very focused on the user experience and end user acceptance testing.”
When making decisions such as selecting an EPR, user needs were also given greater weight than any other factor, Adrian told us, “and since implementation, we’ve been trying to catch up with the other functionality it can offer, particularly on an operational level”. The “magic bullets”, he went on, were listening carefully to clinical needs, running user acceptance testing, and having a clinician leading the programme. “With the OneDevon EPR programme, that’s very complex, and there are technical bits I don’t always understand, but once briefed, I can make useful decisions or contributions,” he added.
The EPR has helped with a number of Royal Devon’s digital aims, including supporting virtual working between the trust’s sites and creating “one virtual organisation”, Adrian said. “We’ve always been committed to delivering care as close to home as possible, and we were early adopters of virtual wards and wearable tech,” he noted. “We have a huge virtual ward and do an awful lot of work in the virtual ward space. We input more data from wearables into our EPR than any other Epic site in Europe, so that’s been immensely powerful in driving that left shift.”
Self-scheduling is just being enabled now to allow patients to schedule their own appointments through the patient portal, Adrian told us, “and that is part of our wider aim to have this truly horizontally-integrated system that is hugely beneficial to patients as they move between hospitals and staff; or to staff as they move between patients; and we can exploit the opportunity provided by scale”. Looking ahead, vertical integration will be much more of a focus, to integrate with primary care as well as community, he continued. “We’re primarily a SystmOne ecosystem in general practice, but I would like to integrate that, and we’re working on bringing those two elements closer together.”
Patient journeysÂ
Looking at how patient journeys have changed over the last five years, Adrian highlighted that the biggest shift has been around their empowerment, and their access to better, safer care as a result of the trust’s EPR, with noticeable improvements like a sizeable fall-off in medication safety issues since implementation. Patients are also now able to view their healthcare record and see results in almost real-time, and in some instances, can directly message their clinician or clinical team. “That’s about patients owning their own health,” Adrian explained, “and using MY CARE we offer many patients short notice appointments, letting patients on waiting lists know if there has been a cancellation at short notice, so that they can come in. That has seen a big reduction in our DNAs.”
The patient portal also allows patients to fill in questionnaires prior to their appointments, meaning that when attending a clinic, things like pain scores are already completed. “It’s so important to emphasise that empowerment,” Adrian said. “I’m a patient at my own hospital, and I use the portal all the time. I attended an elbow clinic the other day, and I’d had my discharge letter before I managed to walk back to my car – that’s fantastic.”
Adopting a “digital by default” approach
“We have two mantras – digital by default and Epic-first,” Adrian noted. “If we can build it in Epic, we will do it in Epic; if we can do it digitally, we will do it digitally. We try and weave that into everything we do, and make it cultural, and I think we’re winning.” Most members of staff now immediately think about whether or not things can be done digitally when looking to introduce something new, he continued, “and that’s been an iterative process over time as the EPR has been embedded and we’ve started utilising more of its functionality”.
Building on the work the trust is already doing with AI, Adrian shared how his team is currently looking at the opportunities to use AVT in a resuscitation environment, in MDTs, and in community nursing. “We’re also looking at how we can support the neighbourhoods agenda, and we’ve introduced an app called Compass Rose that is focused on the prevention agenda and community care. It has a focus on social determinants of health, and because of that, we’re now collecting really rich data in terms of what those look like, that will enable us to work with our primary care and ICB partners to do some of this work around identification of patients with additional need.” The responsibility is not only to reach clinicians out into neighbourhoods, but also to provide data that allows commissioners and GPs to identify those needing additional support and prevention, he added.
Plotting Royal Devon’s digital journey 2025 – 2030
Adrian shared a little bit about what he hopes Royal Devon’s digital journey for 2025 – 2030 will look like when looking back in five years’ time. “If I had been thinking about this two years ago, I’d have spoken very eloquently about digital empowerment, and that type of thing,” he said. “In reality, now, I think the world will have changed radically – the impact of AI will have completely changed the healthcare landscape, and we have to proceed very judiciously, with good governance, and take the population along with us.”
At the moment, there is anxiety around AI, where data is held, and its potential to take over, Adrian went on. “My guess, though, is that we’ll still be using a lot of human validation, but that a lot of the time-consuming processes will be done by machine. I am hopeful that will provide an opportunity for our clinicians to have more time to care, more time to have conversations, more time to provide compassion, and to really understand what matters to patients. I think that’s a great cause for optimism – it’s going to make us safer, we will be using more decision support software, using AI to spot patterns and risk, and identifying those types of things earlier.”
Revisiting his hopes to achieve greater integration with primary care, Adrian said: “One of the greatest risks in health is that patients tend to fall between the cracks existing between primary and secondary care, social care, and vice versa. If we can fully integrate primary, secondary, and social care, we will be a long way toward our ambition of delivering truly integrated care and driving the neighbourhood agenda. How far we will get along that road is difficult to predict, because what was true for AI six months ago is not true today, and I don’t think anybody can predict where we’ll be in a couple of years’ time.”
We’d like to thank Adrian for taking the time to share these insights with us.
