GDE trusts light the way for NHS digital transformation at UK e-Health Week
[London, UK] When digital doctor Bob Wachter laid the foundations for what would become NHS England’s Global Digital Exemplar (GDE) programme, he noted that learning from the most digitally mature healthcare organisations was essential in helping to get the rest of the country get up to speed.
At UK e-Health Week 2018, GDE trusts and digital health pioneers from the US, Scotland and India shared that learning in a series of compelling presentations that, it is hoped, will inform how many others approach the journey to digital transformation.
Putting the user first
Working with users was vital. With end user feedback an important part of the evaluation process planned for the GDE programme, it was positive to see this highlighted by participating trusts.
At Berkshire Healthcare NHS Foundation Trust, for example, the foundations for the successful implementation of its e-prescribing project were built on end user and clinical engagement, and understanding their workflows. As a result, staff are now more accepting of change, and more willing to engage with technology.
A similar approach was taken in University Hospital Southampton NHS Foundation Trust, where CIO Adrian Byrne shared how implementing technology such as electronic whiteboards required changes in seemingly minor working practices, such as how staff organise their task lists.
“There is often something down in the detail that makes things difficult to do, and you have to solve the problem before you get started,” he said.
At Luton & Dunstable University Hospital NHS Foundation Trust, all staff worked together to optimise patient flow to help meet four hour wait in A&E targets. This is now supported through an operations centre where technology and data gives the trust full visibility and control over capacity and demand.
What happens when you do not work with end users was laid out by US nursing informatics lead Nicole Martinez in the Allscripts session. A failure to engage staff in an electronic patient record project contributed to a work stoppage. Now a user council is in place which sets out the digital direction for the hospital.
Giving powerful tech to the people
Some trusts are putting the power of technology directly into the hands of frontline staff
Staff at Oxford University Hospitals NHS Foundation Trust have been given iPads and are using out-of-the-box functionality and the apps store to save time and help with the care they deliver, such as by using an app to more efficiently order surgical stockings. The message was to “get your staff to use the technology and see the benefits”.
At Wirral University Teaching Hospital, staff were given iPads alongside laptops and computers on trollies to make it as simple as possible to engage with technology. By over-supplying such hardware, and taking the time to think how to translate paper-based to digital processes, the trust now has a digitally-empowered staff using electronic in-patient notes that fit around clinical workflow.
Letting people try out new technology was also in evidence at Salford Royal NHS Trust. Dell EMC introduced digital director Rachel Dunscombe, who said one of the key success factors at the trust was the use of a physical space. The trust’s ‘experience centre’, delivered with the support of Allscripts, enables clinicians to try out new technology and to engage with the digital team. “It has been very transformational,” she said. “Our clinicians are doing great things.”
This was clear from the work described by Salford consultant Niamh Collins. Working with users to develop the technology in the right way has helped increase diagnosis rates for delirium and reduce readmission rates.
Powerful tech needs powerful infrastructure. The HCI Group session saw Tech Mahindra share its end to end digital workplace service. This could deliver significant savings in hardware, software and services through a smarter approach to end user computing.
Using data as a strategic asset
Harnessing the data was also vital for many, with many in support of the belief that data saves lives.
Emma Wright of the Northern Care Alliance shared how he multi-skilled team was applying data science to numerous projects, including one that helps identify patients at risk of deterioration with more accuracy than current national early warning scores.
Cambridge University Hospitals is well-known for its pioneering work on digitisation, and data is central to that work. With the support of Qualcomm Life, it was implementing multi-device integration so that equipment data could be combined with patient data to deliver care and efficiency benefits, including a £2.6m annual equivalent saving in staff time.
Access to citizen data will be crucial. Scotland is working with Cambio to deploy clinical decision support across integrated care systems. Scottish GP and CDS lead Paul Miller proclaimed: “We need our data. It is not our vendors’ data, it is our data. We want it back.”
What a vendor can do with data was on show from Health Catalyst, whose data operating system is powering 500 hospitals. Data is showing clinicians how they can improve the care they deliver. HIMSS chief medical officer Charles Alessi chaired this session, and noted: “This shows the power of data for the system, and the individual.”
The positive impact of using data was reinforced by consultant nurse Sarah Stanley of the Royal Free London NHS Foundation Trust. The trust plans to use data to better predict and manage acute kidney injury and sepsis. She said: “I’m desperate to do more of this, as I think we are causing harm by not doing it.”
James Bird, chief nurse information officer of Imperial College Healthcare NHS Trust, shared how the trust was data to reduce variation and support clinical audit. “A lot of this is fixing the basics,” he said. “But we need to get this right.”
Learning from others
Part of getting it right involves learning from others. As part of their funding agreement, GDE sites are committed to developing blueprints for digital transformation that they will share across the NHS.
Four GDE sites have been involved in a pilot for the blueprinting programme. Luton and Dunstable and Cambridge, together with Royal Liverpool and Broadgreen University Hospitals NHS Trust and University Hospitals Birmingham NHS Foundation Trust, are developing blueprints that look to help others achieve similar levels of digital maturity.
Birmingham shared the experiences of developing its own blueprint for digital, or rather digitally-enabled clinical transformation. Good governance through strong clinical leadership was essential, as was managing expectations.
“You cannot implement an EPR in your initial phases and expect to save money. This will come later by improving patient outcomes and reducing length of stay,” said Deborah McKee, head of clinical systems development.
Installing an EPR was “only the start of the journey”, said Richard Griffiths, CCIO of the Clatterbridge Cancer Centre NHS Foundation Trust. By using its Meditech EPR, the trust has now gone from moving patient records in suitcases, to one where it can now share information electronically across care settings.
The cancer specialist trust is a fast follower for GDE Alder Hey Children’s Hospital. Both are Meditech customers, and they are working with the supplier to adapt the technology to meet their common needs. At Alder Hey, this means implementing digitised pathways, and delivering enhanced patient experiences.
Across all projects and presentations, people, process and technology have come together to help drive digital maturity.
Joining the movement
The blueprints being developed now, as well as the supporting learning networks, plan to share the success of the GDEs across the health service. It is of vital importance; NHS England is looking to use that success as a bargaining chip in further funding negotiations with Treasury.
“We have seen how these things are spreadable,” said Salford Royal CIO Gareth Thomas. “They can be blueprinted, but it takes a lot of time.”
Wachter did say it would take time, and said NHS IT needed further investment. If the lessons shared by the GDE programme can help speed adoption of digital health across other parts of the NHS, then this time will be well spent, and show it merits the further investment needs. No pressure then.
Get in touch and involved with the blueprinting programme, contact England.firstname.lastname@example.org