Implementing an EPR system which maximises existing digital innovation
This case study highlights the importance of mobility and interoperability in the journey to EPR, using the example of Calderdale and Huddersfield NHS Foundation Trust (CHFT).
A collaboration between Calderdale and Huddersfield NHS Foundation Trust (CHFT), Cerner and NIA innovation, Nervecentre, saw the introduction of an electronic patient record (EPR) system which worked with – rather than replaced – existing digital innovation already in place to improve patient outcomes.
The adoption of EPR systems is widely regarded as an essential step on the journey towards a more effective and efficient NHS.
The rationale is strong. By ensuring that patients’ medical records are securely available to the right clinicians at the right time, wherever they are, NHS organisations are better placed to achieve the Triple Aim of better health, better healthcare and lower cost.
CHFT’s 2016 five-year strategic plan included an objective to optimise information technology (IT) as part of a long-term modernisation programme to deliver clinical and operational sustainability. A key component of its digital strategy was the introduction of an EPR system that sits at the core of its systems and allows vital patient information to be shared with clinicians and providers across the care continuum. The Trust describes it as the single biggest transformation it has ever undertaken.
CHFT provides healthcare services to a population of almost half a million people in West Yorkshire. The Trust employs over 6000 staff across two hospitals – Calderdale Royal Hospital and Huddersfield Royal Infirmary – as well as various community sites and health centres.
Despite recognising the benefits of a full-scale EPR, CHFT knew that for its modernisation programme to work, it needed to ensure its EPR maximised existing digital innovation that was already helping it improve its patient outcomes.
In particular, clinicians were keen to maintain their use of Nervecentre – a mobile clinical workflow platform that allows them to collect, share and access patient information in real time, and escalate timely and appropriate care.
Strongly embraced by the Trust’s clinical teams, the solution has proved invaluable in monitoring patients’ vital signs, accelerating care and managing clinical workflow. Moreover, it has played an important role in helping CHFT identify deteriorating patients and improve its performance against mortality indicators.
The Trust was therefore determined that any future EPR should work with, rather than replace, Nervecentre.
Mandy Griffin, Associate Director of ICT at CHFT, cites mobility and utility as two of the major factors driving clinical advocacy for Nervecentre:
“Interoperability with our EPR was critical because our staff were wedded to Nervecentre. The impact it was having across the hospital was incredible. A key reason for us wanting to keep it – in addition to that escalation point, which goes directly to the clinician – was that it provides mobility. This means we can take care right to the patient’s bedside. But it also means that our staff are using technology that they’re already familiar with at home.
“Nervecentre has been instrumental in helping us identify deteriorating patients and get care to them quickly and effectively. Integrating that with our EPR solution was therefore incredibly important.”
Owen Williams, CEO of CHFT, said:
“Nervecentre helped us get a broad coalition of clinical colleagues to use technology to improve patient care. Its impact on our ability to provide high quality care in a timely fashion created such positive efficacy that, as the go-live for our EPR drew closer, an inevitable question arose: should we look to utilise the early warning equivalent within the Cerner [EPR] system or maintain our use of Nervecentre? Our challenge was simply to find an interoperable solution.”
The new EPR, from Cerner, went live in May 2017. Its introduction was the culmination of positive collaboration between CHFT, Cerner and Nervecentre to configure a solution that met the Trust’s clinical and operational needs.
Dr Alistair Morris, CCIO at CHFT, said:
“We worked with both suppliers to build an interface between the two systems that was clinically useful. We achieved this prior to go-live. It’s enabled us to give our staff the continuity of Nervecentre, which was embedded in the Trust, but also made sure that the EPR contains the whole information around the patient.
“We’ve retained that mobile functionality and developed a link between Nervecentre and the EPR that allows us to share information across both systems. This means we can keep the patient safe and our clinical teams informed.”
The deployment debunks a common misconception that the implementation of EPR means organisations must rip out their existing technologies and replace them with a single solution.
The clinical and operational benefits of interoperability are very quickly being realised and will only increase as the new approach embeds into CHFT’s culture. The early indications are hugely positive – not only in how the interoperable systems are helping the Trust leverage the power of information to improve care, but also in how smoothly the implementation process ran.
Jackie Murphy, Director of Nursing at CHFT, commented:
“The Cerner and Nervecentre solutions are working together incredibly well – better than we could ever have hoped. Nervecentre had become a key part of the transformation work we’ve been doing – and, in terms of its integration with Cerner, it’s worked very easily.”
The implementation of EPR is the biggest transformation CHFT has ever undertaken. Achieving interoperability with Nervecentre brought additional complexity, but proactive collaboration between the two technology providers and the Trust ensured that the deployment was ultimately a straightforward process.
As NHS trusts look to employ EPR systems, they’ll invariably face the dilemma of choosing a single solution or connecting systems to maintain the benefits of existing digital tools.
“In our experience, that choice should be clinically-driven,” says Owen Williams. “Our clinical colleagues are closest to the patient. If we’re to stay truly patient-centred, we must listen to them and ensure that digital decisions are based on what we hear. The outcomes of those initiatives should be evaluated in a similar manner.”