This is Part 2 of our 3 Part Project Spotlight featuring Calderdale & Huddersfield Foundation Trust (CHFT) in the United Kingdom. The HCI Group played an instrumental role in supporting this large Cerner implementation. Part 2 features CHFT Director of Nursing, Jackie Murphy and CHFT Consultant Pediatrician, Dr. Allistair Morris' perspective one of the most successful EPR Implementations to date in Europe.Bradford Teaching Hospitals and Calderdale and Huddersfield are working together to improve healthcare across the north of England through a new joint electronic patient record. Professor Clive Kay, Chief Executive at Bradford Teaching Hospitals, told Digital Health News the deployment represented “the largest deployment of an EPR system by Cerner in Europe to date – and we have been told it has been one of the most successful”.
The following is a full transcription of the video interview with CHFT Director of Nursing, Jackie Murphy and CHFT Consultant Pediatrician, Dr. Allistair Morris.
Please introduce yourselves and what was the clinical objective of the EPR programme?
Dr. Allistair Morris: I’m Dr. Allistair Morris and I’m a Consultant Pediatrician, and I’m Associate Medical Director at Calderdale and Huddersfield Foundation Trust. My role within the PR programme was the CCIO or Chief Clinical Information Officer for the organisation. The main goal was looking at patient safety benefit for the organisation for our patients in our community, so the vision early on was to look at establishing a full electronic patient record with a full suite of order coms, eprescribing, clinical documentation within the same system so there’s a single source of truth and we knew from evidence from HIMSS that once you're aiming towards an EMRAM Level 6 or above hospital, that’s when the real patient safety benefits came out for an EPR and that was our goal at the start of the project.
Jackie Murphy: I’m Jackie Murphy, I’m the Director of Nursing at Calderdale and Huddersfield Foundation Trust and I’ve got a portfolio for modernisation and transformation, and my role within the programme essentially I think was a leadership role around engagement, training, educating, change, getting the organisation ready for the electronic patient record, and I would say that our goal would be look at, for patient safety experience, but also efficiency and effectiveness as well, so looking at the whole broad suite of improving quality of care for patients.
Where would you say the Trust is on that journey?
Jackie Murphy: I’d describe very much now we’re that transitional phase of understanding a lot of our data, and I think a lot of what where we are now is having a better awareness of the things that we didn’t do well previously that we thought that we did so having data that tells us and gives us very specific, the very specifics really enables us to get underneath things to examine it further. I think at the moment what we need to do as well as an organisation is to energise ourselves to start to really utilise that as intelligence, and use that towards our quality improvement strategy, and to normalise all of that electronic patient record into how we do make that transformational change, but for colleagues that we work with and for patients. So, I think discovery is probably where we’re at, at the end of 2017.
Dr. Allistair Morris: This year we’ve achieved the Go-Live. I think adoption, I think we’ve got pretty confident that adoption has now taken place within the organisation. There’s very little paper around in the system. Virtually everybody is using the EPR to some degree, some a lot more. The questions that are coming to us as clinical leaders on the project now are around optimisation of the system and improvement of the system – when can it do this for me, when can I have that out of it, how do I get this information out of it, why don’t we change this to this way? So, they’re the areas that we’ve come in, and I think looking towards in 2018 is how do we look at optimising the system and spreading the system into areas that currently aren’t covered by the EPR on a single platform.
With the implementations that have taken place at CHFT and Bradford, what have been the top 3 success factors in making this level of success happen?
Jackie Murphy: I think and I speak from a CHFT perspective, predominantly – but I can see it both organisations. I think the executive sponsorship of the programme was really important, and I think the lead of our Chief Exec here that took the entire organisation, he really took it – the clinical element of it really seriously, and supported us to be able to deliver our role within that, so I think that’s probably one of the key success factors. I also think that the way that the programme was managed, was a key success factor, and I think the engagement was a real key success. And that across both organisations I think if you were to talk to colleagues at Bradford, I think what really helped them was learning the lessons of our implementation for them to do it more smoothly, and I think that that wouldn’t have been as successful but for the fact that it’s the same team, so you can talk about lessons learnt, and everybody can hear lessons learnt and think, “Well, that won’t happen to us,” but actually if you’ve walked it and lived it alongside somebody, you really take that part of it seriously.
Dr. Allistair Morris: I think some of the clinical side of the system, the real strength for the project was actually the clinical agreement we got across the Trusts. Most of the time we didn’t struggle to get agreement on the build around the clinical side, both from the clinicians, the nurses, the doctors, the AHPs, in both Trusts worked the same at the end of the day, and they agreed how the build should look, so the build is very generic across both Trusts, we both did the same things, and I think that’s been a real strength for the project and that enabled, that sort of alignment and engagement of the front-end staff in the build and the final testing and then the go live after that.
Were you engaged with the CEO during the project?
Dr. Allistair Morris: Absolutely, I don’t think without our CEO and the Exec Board that went along with that we could have done the project that we did. It would have been a project over there by the EPR team, whereas actually it was bringing it into hospital business.
What extra steps did you take to engage the physician community?
Dr. Allistair Morris: A variety of things we did for engagement. We had our simulation centres that were set up for clinicians, nurses and doctors, to come down and use the EPR, the sort of play domain within the more inpatient environment between beds and things. I did one to one sessions with over 70% of our consultants which at least gave them a window into the EPR, and continuing to do that and looking at master classes for the consultants now, they’ve got so much skill, but now they want – they don’t feel they can develop it any more, I’m doing classes rather than one to ones at the moment and just being there as a listening ear and hearing what they say and taking what they say seriously and putting that back into the programme.
How do you think this EPR has impacted clinicians at this Trust?
Dr. Allistair Morris: I think from a medical point of view, I think it’s had a wide variety of impact. I think there are some positives in there and there are still some areas we need to do further work on. I think in the inpatient setting the EPR really is coming into its own, having that whole patient record there, the whole information results, e-prescribing, clinical documentation, the amount of documentation and the amount that people are typing into the system is impressive, you know, it’s not just a brief clinical note, it is a, you know, sometimes quite an in-depth clinical note that’s going in there. So, all that information is available, although the number of Datix we’ve had around prescribing against allergic patients has virtually disappeared. Since we put the EPR in, there’s very few allergic patients receiving medications to which they’re allergic to. We’re starting to see that process now we’re beginning to populate the record with information from admission to admission, it’s really, it’s more coming into its own now. I think the areas we struggle around are within our outpatient areas where time is bit more pressured, and then the fact that have still a multiple of legacy systems that either need replacing or bringing into the main EPR so that all the information is in one place.
Outside of medicine how would you say we have impacted clinicians?
Jackie Murphy: I think in terms of nurses – inpatient nurses, our nurses on inpatient wards, I think they’ve adapted to it really, really well. I think that their initial introduction by using the nurse centre technology was a really big step actually that it got them used to using technology in healthcare. So, that really helped as part of an engagement. And actually, now they’re at a point where they’ve got used to documenting most of the care into an electronic patient record, and they’re looking all the time now to how to improve it and how to make it better, and that optimisation side of things, maybe that enthusiasm need to be harnessed somewhat. I think for colleagues that work either remotely, so things like clinical nurse specialists, AHPs, physiotherapists, occupational therapists, our infection control team, they benefit for being able to see a patient record from a distance and be able to prescribe and offer advice. They speak volumes about and are really are enthusiastic about how that’s changed their working lives, and enhanced patient care.
Dr. Allistair Morris: Another bit on the back of that is actually the junior doctor group, I surveyed a group of junior doctors that were with us during go live, they went through all the trials and tribulations of go live, and then in August they all moved back to paper because a lot of them went to other Trusts, some of them went to Bradford who went live in September, so they went sort of paper, electric, paper, electric, and so I surveyed them once they’d left the Trust and said, “Well, which do you prefer, an EPR or paper?” and over 50% were very much EPR, another 30% were more EPR than paper, and about 20% were still with a bit of paper but only slightly paper over EPR, so they could see the benefits of prescribing from a distance, of seeing the patient record from a distance, that everything was there, it was readable, it was legible, they could really see the benefits of it.
What lessons have you learnt from this experience?
Jackie Murphy: For me I think the lesson learnt would be that we did a really, really successful implementation and I think we probably didn’t concentrate hard enough on the post-implementation phase.
Dr. Allistair Morris: Yeah, I think I would agree with you on that. I think very much a lot of people said this to us prior to, you know, different conferences that It’s the start of a journey, it’s not the … the go live isn’t the end, it is absolutely the start.