Digital records are often the backbone of a healthcare organisation’s digitisation. Here, three suppliers take you through the ways in which their products can support your EPR journey: Nervecentre, Imprivata and CCube Solutions. In addition, the health tech community share their views and lessons learned on business cases.
Nervecentre’s next generation EPR platform has been designed with – and for – clinicians to support ICSs, trusts, and hospitals as they tackle their most resonant challenges; patient safety and flow. Modern mobile technology gives clinical and operational teams across acute settings the real-time information they need to deliver safer, faster, and higher-quality care – all in one place.
A seamless and continual experience for faster, easier, and safer care – all in one place.
Adoption is everything
Nervecentre is the intuitive EPR that clinicians love to use.
Loved by clinicians, Nervecentre is the UK’s most usable EPR. Your biggest risk when selecting an EPR is clinicians choosing not to use it. Poor clinician adoption leads to unfulfilled safety benefits and failing to meet your financial business case. Nervecentre is loved by clinicians, not tolerated. That’s why it’s your lowest risk choice of EPR. But don’t take our word for it.
In 2022, The NHS Transformation Directorate commissioned the first national acute EPR Usability Survey to understand how effectively clinical IT systems support frontline healthcare professionals across the NHS. The survey focused on acute care clinicians, with 147 trusts surveyed and 4,852 total responses.
The results have shown that Nervecentre’s Next Generation EPR is used in four of the top eight trusts with the highest net usability score and has performed consistently higher than the NHS average in:
Nervecentre’s success reflects its clinician-designed system, rapid response time, the breadth of its functionality, and collaborative partnerships with trusts.
It’s time to aim higher
Because the NHS deserves better.
Nervecentre was founded in 2010 to reimagine healthcare software – to create digital solutions that would genuinely help clinicians do their jobs well. Existing systems were cumbersome and got in the way of care. The NHS deserved better. We had the vision to build a new breed of intuitive, mobile-first software that would put a real-time EPR in clinicians’ hands at the patient’s bedside and make it easier for them to treat their patients faster and safer than ever before. The vision hasn’t changed. Twelve years on, our passion is to immerse clinical, operational and administrative teams in a personal and positive EPR experience; to build, deploy, and support intuitive software that people love to use rather than tolerate – all based on modern technology that has the highest levels of scalability and availability.
We partner with ICSs, trusts and hospitals to progress digital maturity, whether you’re striving for HIMSS level 7 or levelling up. We’ll work together to implement ICS level digital solutions that help you achieve your goals – and realise your clinical, operational, and financial benefits at the earliest opportunity.
Today, Nervecentre’s EPR platform is at the heart of many NHS trust digital transformation strategies. Clinicians in over 100 hospitals depend on Nervecentre software, and two of the ten largest acute hospitals in England have chosen Nervecentre to support them on their EPR journey.
We posed a question to a number of digital-focused NHS professionals: Is there anything that you think is usually or often missed from EPR business cases, and what would your key lesson(s) around that be?
To begin, we heard from Tamara Everington, chief clinical information officer at Hampshire Hospitals NHS Foundation Trust.
“If I’m honest, I don’t think we are good at business cases in the NHS in general,” Tamara said. “Cases are often thrown together in short order to fix an immediate gap in current practice or respond to a cash drop. Some attention is given to describing the context but we often build cases based on the problems we see today rather than taking time to reflect on what might be needed as healthcare naturally evolves. To ensure our case progresses, we tend to wildly overstate the benefits and fail to take into account hidden costs, impacts and what we can sustainably afford. It is rare that we take time to say, ‘OK, if we are going to start doing this new thing, what are we going to stop doing because we have limited resources’. Because business cases are often requested in tight timeframes, it is common to see that end users have not been involved in considerations.
“Too often new EPR digital solutions are considered in isolation – this is like buying a beautiful new cooker which does great things, but doesn’t fit in the kitchen you actually have. You then end up having to demolish the rest of the kitchen to accommodate your new toy and spend a deal of time living in chaos. That doesn’t feel great.
“The alternative approach is to invest time in building your business case working directly with end users to understand what gets in the way of them doing their job well and what they need from a future system. Don’t think about it the other way round and prioritise data over human factors. Ultimately, if the new solution works for your end users, the data coming out the back end will be reliable in real time and your business will be supported to run more effectively. This means better personal care for all in need.”
Picking up on the theme of human factors, it’s all about getting the culture right for Chris Mason, chief information officer at Wirral University Teaching Hospital NHS Foundation Trust.
“I think an EPR business case will largely focus around the technologies – your hardware, your software, the EPR supplier and so on. What cannot be undervalued is the transformation change and the change agents in your organisations who make that difference,” Chris said.
“Sometimes it doesn’t matter how good the technology is. If you’ve not got the appetite for transformational change and people on the ground who are willing to embed that change and show people the way forward, describing what the future looks like, then I don’t think it makes any difference how good your system is functionality-wise. If you’ve not got the right environment to change people’s behaviours and the way they work going forward, then something really important is missing.
“Considerable attention should be paid to the business change element – you want to ensure that you’ve not only got the system to achieve your goals, you’ve also got the right workforce with the right skills in digital.”
Katie Trott, head of digital delivery and engagement for New Hospitals Programme at NHS England, reiterated Chris’s point around the importance of having people in place who can drive ongoing change.
“From experience, I would say that the most often overlooked aspect in an EPR business case is the permanent team who remain after go-live,” Katie said. “We consistently say to stakeholders that go-live is just the start and the EPR is a foundation. It should be used as a springboard for ongoing digital maturity that drives better patient care, better staff experience and improved data use.
“For the use and optimisation of EPRs to be effective, it’s essential that you have a permanent team of clinical digital experts and change advocates, along with those with sufficient technical knowledge, to drive improvements. Without them, true adoption will be slow to achieve.”
It is a sentiment shared by Andy Webster, chief clinical information officer at Leeds Teaching Hospitals NHS Trust.
“I would suggest that when building businesses cases, don’t underestimate the size of change and the workforce one needs to identify the change between the current state and the delivery of transformation to a future state,” Andy said. He noted a particular challenge: “This can both be hard in obtaining the finances, but also in terms of finding the right skills to deliver.”
It’s not just having the right workforce in place, but also ensuring that they have the resources to support the change, said Nick Venters, clinical information officer at Leeds and York Partnership NHS Foundation Trust.
“One omission from many health tech business cases is the clinical time required to make them a success,” Nick pointed out.
“Will staff be able to attend design workshops given all the other pressures on their time? Will removing staff for training be possible; and have you planned in case they cannot? Will your new technology free up time for administrators and managers by placing an additional burden on the front line? How will you spread adoption across an organisation which is already likely to be working at capacity. All of these questions should be considered at the business case stage.”
Matt Connor, chief information officer at Liverpool Women’s NHS Foundation Trust, agreed on the importance of organisational change and added a point around how buy-in is needed from colleagues across the organisation, not just digital staff.
“Business cases often focus on the more tangible aspects of the EPR investment, while cost consideration of the organisational change component is less defined,” Matt said. “Reinforcing the importance of organisational change activities should be clearly captured in the business case, it’s more difficult to bolt this on later. Securing organisational commitment and ownership outside of digital and data departments is essential as is managing expectations and ‘what’s in it for me’ benefits of the EPR programme.”
Dr Sunil Rathod, North & Mid ICB clinical digital lead at Hampshire and Isle of Wight Integrated Care Board, highlighted another key challenge: “The biggest issue with EPR business cases blind spots is around cross integration across platforms along the patient pathway.”
Chris Beadle, EPR project manager at Nottingham University Hospitals NHS Trust, commented on how businesses cases can sometimes lack detail or the necessary resourcing behind them.
“We have seen where EPR benefits can on occasion be partially overlooked. If we don’t have the full detail, due to the scale of work usually involved in a trust-wide EPR, or the resource to carry out the baselining exercise, we can find that operational pressures occur,” Chris said.
“The information lacking could be anything related to the above – for example, understanding how long it takes a user to access a specific piece of patient information with their current system, or understanding the cost of printing physical letters for a patient to take home. This then leads to the benefits analysis being carried out post-delivery of the project, which can impact the accuracy of the benefits realisation.”
Dr Penny Kechagioglou, chief clinical information officer and deputy chief medical officer at the University Hospitals Coventry and Warwickshire, noted a further two issues.
“Defining EPR financial benefits from a transformational lens and committing to waste reduction and lean process adoption with new EPR systems is often missed in EPR business cases,” Penny said. “To achieve that, there needs to be good knowledge of current state processes and an ambitious plan to transform services through digitisation. By doing so, more financial benefits can be identified and organisations can commit to transformation as early as the business case stage.”
Penny also picked up again on the issue of human factors: “Another aspect that is often missed in EPR business cases is accounting for the long term establishment of sustainable digital informatics teams. The short-term investment in clinical informaticians to drive EPR implementation does not match the long-term requirements for post go live EPR adoption and innovation. A clinically-led digital informatics team needs to be resourced for the whole duration of the programme including the post go live phase.”
CCube Solutions’ managing director Vijay Magon highlights the challenges around unstructured data and how technology can help transform healthcare records management.
The need for digital
The growing adoption of electronic patient record (EPR) systems is an important first step to improving access to health information, but far too many healthcare organisations believe that EPRs are all that’s necessary for digital-enabled clinical transformation.
While the shift from paper to digital has been ongoing for years, but embracing it is no longer an option – it has become an essential strategy.
Productivity, teamwork, and the patient experience are constantly at the top of every healthcare organisation’s priority list, but our research indicates that a high proportion of healthcare organisations believe that in the last 12 months, their hospital has been impacted by incorrect or missing data due to paper processes.
The problem: unstructured data
If we explore the landscape of patient information for context, we see two large groups: unstructured and structured.
As much as 80 percent of the information that exists on a patient is unstructured. It is largely found in paper form and electronic files and lives outside of the electronic patient record in a number of siloed systems and repositories. That means that this data is locked within the documents or files; and it is found in huge volumes, leading to enormous amounts of paper sitting in storage.
This creates additional problems in itself. Storing huge volumes of paper means that huge amounts of storage space is taken up; paper has to be retained, and in some cases, it has to be retained for a long period of time. Alongside taking up premium storage space, there are issues around retrieval and access, with time and costs associated with going into these paper libraries and finding a particular patient record by hand. Filing and refiling also leads to recurring costs, so the costs associated with storing this unstructured paper information will rise over time – this is the cost of doing nothing!
Then there are the risks with holding physical records; it is easier to lose a paper file than it is an electronic one, and it is also more difficult to restrict and audit access.
Ultimately, dependency on paper creates and exacerbates issues within care pathways and workflows. This unstructured information needs to be digitised and transported electronically, rather than relying on trolleys laden with paper.
Having said that, it’s not just about paper. Some 65 to 70 percent of new patient information is actually created electronically through a variety of IT systems in use within an organisation: EPR, clinical portals, primary and acute care systems, specialty systems, laboratory information management systems. In these systems, we might find Word documents, PDF files, photography, electronic forms, emails, spreadsheets.
Although it is electronic and not causing the same physical problems as paper records, the content within these files is still largely unstructured. It is disconnected from other sources of information and difficult and time-consuming for clinicians to find what they need – document silos.
Structured data: the solution
Structured information is data that sits within system databases and can be managed and searched through those databases. As it is accessible and organised, it can be used to deliver patient care in pathways and in patient administration systems, providing clinical decision support.
Structured data is absolutely necessary for digitally-enabled clinical transformation, so we need something that can capture the unstructured information described above and manage it – turning it into structured information that can be more useful.
Electronic document & records management software (EDRMS) technology has been around for nearly 50 years. Originally developed to help manage paper records, the technology has now developed so that it can assist with multimedia electronic files too. Unstructured information can be inputted into the EDRMS where it will be managed and stored. The technology can be configured to manage the files that are captured over a long period of time, supporting work around retention and destruction policies.
Once set up, the EDRMS provides a clinical view of the whole record contained within the platform, supporting clinicians by providing them with access to all the information that is available on a patient.
The model can be easily extended, too. There might be information sitting outside the EDRMS – for example, information contained on file shares. The technology can be integrated with the other systems such as the EPR or clinical portals to provide access to this.
Interfaces can be set up to ensure that the EDRMS provides a multi-document repository that can be accessed through some of the IT systems. The interfacing work has already been done; so a user can sit in a clinical portal or an EPR, select a patient through clicking a button, and instantly view what is held in the EDRMS without having to log in and out of applications.
That’s the goal we should all be aiming for – we need to create a true single source of patient information. It doesn’t mean that everything needs to be contained in one system – it means that information can be held on one system and fed to where it is needed, supporting data flow and staff and patient experience.
For more information on how CCube Solutions can help with EDRMS technology, please click here.