HTN Awards 2023: Major Project Go Live

Here we take a look at all of the entries for the Health Tech Awards 2023 category of ‘Major Project Go Live’.

Nottingham University Hospitals and Nervecentre

Overview: During May and June 2023, Nottingham University Hospitals (NUH) worked with Nervecentre to deploy their EPMA solution across their hospitals.

Why? The EPMA deployment was part of a wider frontline digitisation partnership with Nervecentre to improve safety, efficiency and sustainability from paperless working, and provide real-time insight into prescribing activities.

What happened? The solution was deployed across NUH hospitals, over 101 wards and 1390 beds. 99.93 percent of medicines prescribed on EPMA were administered bedside using mobile devices in the first week. 14,488 Nervecentre-enabled iPhones and iPads were used extensively throughout the working day to record observations, track fluid balance and view test results, for sepsis alerts, task management, messaging, clinical noting, and bed management. Since the EPMA go-live, these mobile devices are also used to administer medications and to access patients’ medication records at any time of the day from any location. Pharmacists and pharmacy technicians built the prescribing configurations, and it was ensured everyone had the hardware and access rights they needed. The focus of each go-live was transcribing the inpatients’ paper drug charts into Nervecentre. Once a ward’s charts had been transcribed, it became an ‘EPMA ward’ that would then use Nervecentre, supported by floorwalkers. Five days after the QMC go-live started, a total of 157,130 prescriptions had been completed across both hospitals. In the first five days of use at QMC, there were 54,640 drug administration’s using EPMA. The figures are similar at City, with 54,420 medicines administered, of which 99.93 percent were completed on nurses’ iPhones and iPads.

Looking ahead. NUH hopes to continue to collaborate with Nervecentre to continue the good work completed thus far in the roll-out, and to learn lessons from this implementation for other trusts to take forward.

Worcestershire Acute Hospitals NHS Trust and Altera Digital Health

Overview: Deploying an EPR in six months: Worcestershire Acute Hospitals NHS Foundation Trust’s digital transformation journey.

Why? Worcestershire Acute Hospitals NHS Trust was designated “Group 0” under the frontline digitisation programme, and clinicians’ time was being used ineffectively, filling out manual forms and away from patients.

What happened? Taking a phased approach, the team chose to start with a pilot, using a tried-and-tested approach that resulted in a successful roll-out to all 56 inpatient wards. The project’s goals were to increase patient safety, provide clinicians more time, and improve treatment quality through digitising records. The trust created a strong training plan that was critical to the project’s success, ensuring that staff were adequately prepared for the go-live date. Users were supplied with a variety of training methods, including user guides, a dedicated website, 15-20-minute training tutorials, online help, and 24/7 floor walkers. During the pilot go-lives, a five-and-a-half-week command centre was also put in place, including a digital team, powered by clinical backup and floorwalkers to respond quickly to problems. In the initial phase, the technology reduced paper operations by 26 percent by decreasing repetition. Because of the geographical distance between each hospital location, decisions can be made remotely, eliminating the need for clinicians to travel between sites and review paper notes, saving clinicians significant time. The EPR is also helping increase safety for patient records as lost observations are less likely to occur and clinical teams are easily able to locate patient notes instantaneously. Records can be viewed by any clinician, resulting in safer care and improved clinical processes.

Looking ahead. The trust intends to implement electronic prescribing and medication delivery, as well as activate Sunrise EPR in its emergency departments.

Blackpool Teaching Hospital NHS FT and Nexus Patient Record (NPR)

Overview: System transformation through iterative in-house development, and planned integration with procured solutions to meet clinical and operational needs of users, enhancing user experience of care provision.

Why? To consolidate core applications including clinical hub, eReferrals, base and ward tracker, and eDischarge, into a singular system, allowing single sign-on, improved user interface, improved interoperability, and fully auditable Position Based Access Control (PBAC).

What happened? A roll-out plan was developed to cover Clinical Safety and Information Governance statutory requirements, testing scripts, communication plans, training materials (launched in-app), training sessions, migration and disaster recovery, Trust-wide bed configuration, and two go-live ‘dry-runs’. Training and deployment were further supported by two change facilitators from the Health Informatics Programme Team alongside clinical champions from each ward/service area across the organisation. In early June 2022, a version update to the Clinical Hub functionality was released within NPR, and this was followed by a ‘big-bang go-live’ deployment of the Patient Tracker Functionality and Bed management functionality in September 2022. NPR currently has 5805 users and is integrated with the trust’s EPMA, EDMS and the Lancashire Shared Care Record via patient context through single user sign-on. There have been seven NPR version updates since system go-live reflecting user enhancement requests and technical enhancements for system optimisation. Six months post-go live, a user survey was conducted to assess NPR’s mission statement against perceptions and experiences of users, finding 99 percent of respondents used NPR on a daily basis, and 88 percent felt that NPR was well embedded in daily clinical and operational practice within their area of work.

Looking ahead. Blackpool Teaching Hospital NHS FT and NPR hope to continue to roll-out enhancements based on user feedback and the emergence of added functionality including clinical noting.

Nottingham and Nottinghamshire Local Maternity and Neo-natal Service

Overview: A digital maternity information system replacement programme to provide the biggest improvement in maternity care across Nottinghamshire in over a decade.

Why? The need was identified for a better digital information system to create true alignment of care across the county, eradicate barriers for pregnant people to access the services they want, and to modernise into nation-leading digital-first centres of excellence in Maternity and Neo-natal care.

What happened? £1.7 million of Unified Tech Fund NHS England funding was secured to support the project, by demonstrating how it would save clinical time through increased efficiency of staff, reduction in data duplication, removal of delays in discharge and transfer and dozens of other adjustments to process and benefits of digitisation. Within a year, the team scoped, procured, process mapped, configured, tested and deployed BadgerNet. Recruiting a specialised digital team, including six digital clinicians, impact was limited on the service through a time of critical pressure at both trusts. Using data migration to enable a rapid deployment at the point of Go Live, all 12,000 patients across the two trusts were transitioned over four go live launches within four weeks. The result has been an overwhelming improvement to patient care, interoperability between NUH and SFH and staff satisfaction with Maternity digital systems. It became a pilot site for NHS login for Clevermed nationally. 87 percent have transitioned to using digital notes to access their own record. They are being seen faster in community, and love the digitised leaflet library. £390,000 a year has been saved by moving to a cheaper system and tens of thousands of pounds on printing, scanning and storing forests worth of paper.

Looking ahead. The system enables compliance with mandatory BSOTs guidelines for triage. Future developments are now possible include integrating eObservations and CTG charts which will further improve outcomes for staff.

Oxleas NHS FT and eMeds

Overview: Rolling out an ePrescribing system (re-branded in trust as eMeds), that interfaced with EPR to 23 wards over six months.

Why? To save admin time, and travel time, improve sustainability, and improve outcomes in terms of patient safety through eliminating re-writing drug charts.

What happened? Upon go live the team supported ward staff by offering a 24-7 on call service during the first 3 months, including weekends along with floor walking from 8am-11pm to ensure staff felt confident to use the new system. A comprehensive current state review took place pre-project to provide baseline data which allowed us to measure project success on admin time saving for nursing staff by introducing eMeds. This indicated a saving of 45 minutes per day on average for nursing staff; by the end of June, with all 23 wards live, this will be saving approximately 17 hours of nursing time a day across wards, increasing patient care significantly. The business case for eMeds was focussed on staff time saving and patient safety rather than money saving, however, the audit shows that this translates to a saving of over £75,000pa. eMeds saves out-of-hours doctors significant travel time, and for transfer of care across Oxleas hosted services paper use has reduced. Doctors no longer need to transcribe paper drug charts, saving approximately 425 hours per year. The prescription error rate when drug charts are re-written by doctors is 3.9 percent according to the EQUIP study from 2009, and introducing eMeds eliminates that risk.

Looking ahead. Success across the trust project means the next stages are to build up a business case for eMeds within Community Services.

Imprivata and The Royal Marsden NHS FT

Overview: The Royal Marsden NHS Foundation Trust has implemented Imprivata OneSign® to provide clinicians with fast access to patients records held in Epic.

Why? To overcome slow login times affecting user adoption and patient care, with Connect, Royal Marsden NHS FT’s new EPR solution.

What happened? Imprivata OneSign® Single Sign On (SSO) was rolled out to 1,700 clinicians across the Trust, used on kiosks, workstations and multiple user devices. The clinician simply taps the card reader for the workstation, kiosk or device to unlock it, the desktop unlocks and the Epic Connect application is loaded and logged in automatically. The clinician accesses the details they need, records their activity and taps their card to lock, and the desktop is locked again. Sensitive patient information is secured, and the clinician doesn’t need to remember complex login details. Licence utilisation for Imprivata is almost at full capacity at 94.8 percent, meaning that user adoption is high. During a seven-day period in which systems were monitored, there were 141,092 logins using Imprivata. During the same period, logins for multiple user devices were monitored and timed. The logins would have previously taken 627,250 seconds. Using the new Imprivata OneSign SSO for accelerated logins reduced the time to just 125,450 seconds.  The total time saving created was 501,800 seconds or 139 hours per week, the full time equivalent of three and a half extra Band 5 nurses, or an equivalent monetary saving of £100,251 per year.

Looking ahead. Imprivata and Royal Marsden hope to continue to work on improving the solution to further save clinician time.

NHS Shared Business Services Ledger Reconfiguration for NHSE/ICBs

Overview: After CCGs were abolished and ICBs were introduced, NHS SBS closed the existing 106 CCG financial ledgers, and created 42 new ones for the new ICBs, enabling ICB finance managers work from day one.

Why? To support the once-in-a-generation restructure of healthcare services for England, data templates from legacy ledgers, open transactions, and General Ledger journals needed to be transferred between the organisations.

What happened? Data was extracted, cleansed, imported and reconciled on a colossal scale. The automated transference of hundreds of thousands of old transactions from legacy organisations, was built into the new processes. 44 extra qualified staff were recruited, and NHS SBS managed to hold onto them even when the timeline was pushed back by three months, by combining redeployment and hours reductions. Over 680 weekly project calls and 170 project boards with ICB sponsors provided appropriate governance and maintained pace. NHS SBS added new functionality within the ICB chart of accounts, to facilitate more advanced reporting for NHSE and the ICBs. 1,100 data templates from legacy ledgers, 106,000 accounts payable, 5,000 accounts receivable open transactions, and over 400 general ledger journals were transferred between the organisations. NHS SBS also effectively delivered two year-ends in three months to clear cash balances as the legislation went live. The project was signed off by NHSE, alongside the 42 new ICBS. Learning from the project has informed plans for future technology investment to make NHS finances even more efficient and effective. NHS SBS also onboarded two new clients with 150,000 accounts payable transactions/year each, supported another large NHSE project, and six others all with year-end dependencies.

Looking ahead. NHS SBS will be looking to help inform the future of NHS finances under the new ICB system.