As the National Health Service attempts to advance efforts to improve operational efficiency and patient outcomes through technology, Maidstone and Tunbridge Wells (MTW) NHS Trust is making inroads into improving its digital maturity.
The trust launched its 10-year digital transformation strategy in 2020, which will see it transition from a heavy reliance on paper patient records and multiple legacy systems with limited interoperability and capability, into main hospital sites providing digitally seamless patient care. Central to the plan is the introduction of an electronic patient records (EPR) system.
According to the IT leadership at the trust, the original approach was to adopt “best of breed” technology to support clinical care when the digital transformation strategy kicked off, but the EPR roll-out has “significantly shifted” MTW’s journey towards digital.
“We have only just really started our digital transformation journey, but have made some massive leaps in the last six months,” says Jane Saunders, EPR programme director at Maidstone and Tunbridge Wells NHS Trust. Saunders says the trust was already running a pilot of consultations under a virtual outpatient department approach, and had plans to run a virtual ward, but the Covid-19 pandemic meant its efforts had to be accelerated.
“We were therefore able to ramp up the number of virtual clinics we were running quite quickly, as we had the software and were able to put in to place a remote ward for Covid patients to be monitored at home,” she says, adding that MTW also had to roll out many more laptops than planned in a short space of time to enable more staff to work from home.
Before the pandemic began, MTW had been focusing for two years on the design of the EPR, which went live in summer 2021. The system, supplied by Allscripts, provides electronic record capability for areas such as the emergency department, order communications, paediatrics, outpatients and all in-patient ward areas.
Alongside the implementation, the trust also carried out integrations with other systems, such as e-notes, PACS (picture archiving and communication system) viewer and the Kent & Medway Care Records system, which can all be accessed via the MTW EPR. The IT team at MTW also completed a trust-wide Windows 10 upgrade.
Issues to address
According to Saunders, the main areas the trust sought to address with the EPR system included the ability to get rapid and simple access to information required, where and when needed, across clinical systems via portals. Reducing the time required for data entry to enable clinicians to focus on care was another core area of focus, as well as providing a single source of data with notifications to improve clinical outcomes and reducing reliance on paper.
Other objectives for the roll-out included enabling the introduction of artificial intelligence to speed up diagnosis and treatment, as well as improving data analysis and collection to improve operational performance and efficiency. Also, the trust wanted a system that could enable the implementation of single sign-on functionality for all staff. Other considerations included having infrastructure that supported ease of use and was kept up to date, while also having a system that allowed for patient engagement in their care.
“We have only just really started our digital transformation journey, but have made some massive leaps in the last six months”
Jane Saunders, Maidstone and Tunbridge Wells NHS Trust
Regarding the technical aspects of the roll-out, Saunders says the project was not entirely plain sailing. “During the programme, there were technical complexities that were caused by having to do an upgrade of the EPR software during the design phase,” she says. “We completed the necessary business cases and progressed investment as per procurement guidelines, which meant we had to be agile in our approach to planning the overarching programme to keep it on track.”
To handle the intricacies of the project, the team also had to work at arm’s length with suppliers during design and implementation as staff and vendors shifted to remote working because of the pandemic. There was also a requirement to develop custom code to interface with MTW’s laboratory information management system, which did not have an HL7 interface – the set of standards, formats and definitions for exchanging and developing electronic health records – capability.
“This required a team of dedicated experts on all sides to progress,” says Saunders.
Success factors
Despite some hurdles along the way – including the complicating factor of having to make progress amid the pandemic – MTW has managed to roll out the centrepiece of its digital transformation successfully. According to Saunders, the good working relationship with the EPR supplier was crucial to that result, as the company had rolled out the system elsewhere in the UK. “We were also provided with the same experts throughout, despite Covid, which also provided consistency,” she adds.
The trust had also placed the EPR roll-out as a top priority about four months before the expected go-live date, which meant resources went towards ensuring areas were well supported, and that the IT team continued to evaluate and amend its roll-out plan during the summer, as more areas went live with the new system.
The highlight in terms of benefits the EPR has delivered to MTW so far is the ability for staff to quickly access the information they require, where and when needed. “They particularly like the ability to access a multitude of clinical systems from within the EPR,” says Saunders. “For many staff, the system has simplified processes and released time to care – for example, it has reduced duplication of data collected, as well as reduced handwriting on blood sample bottles.”
Also, the system has tracking boards that provide a vast array of information, notifying staff when results are available and helping to improve clinical outcomes and patient safety.
Future roadmap
Going forward, MTW will optimise the EPR system and extend and develop the documentation that is currently available. It plans to implement the EPMA (Electronic Prescribing and Medicines Administration) module to the Allscripts EPR system, developing interfaces with medical devices for point of care and taking observations automatically, as well as creating further integrations with other systems used by the trust.
The roadmap for the next 12 months also includes adding a surgical care module to the EPR system, building interfaces with the trust’s radiology, endoscopy, cardiology and cancer IT systems, and well as integrations with medical devices to populate information automatically. Plans also include enabling capture of observations through mobile devices and developing a mechanism for requesting and reviewing medical photography via the EPR and PACS viewer. MTW will also pilot an e-consent system and a patient portal.
The trust’s “Paper Lite” programme will also be among the priorities. According to Saunders, this will increase the amount of paperwork scanned and made available within MTW’s e-notes system. “Our health records library staff are already noticing that the volume of paper records needing filing or pulling for clinical care has been reduced,” she points out.
Priorities for 2023 will include focusing on introducing an intensive therapy unit (ITU) EPR platform, and an anesthetic pre-assessment system that interfaces with wider EPR. Allscripts is also proposing to develop a maternity module, and merge its EPR and PAS systems into a single platform.
“Once the EPR is fully embedded and complete, we hope that our clinical staff will be able to access one system to get all the information they need, which can be collected as simply as possible and can be used to further enhance the care we provide,” says Saunders. “Alongside this, we wish to ensure our patients are supported to access their care digitally alongside national and regional plans.”