Announced in September 2016, the NHS’s Global Digital Exemplars (GDE) programme has seen more than a few changes happen across the industry in the past few months – these include the appointment of a new secretary of state for health and social care, the launch of a joint unit to drive digital transformation across the system (NHSX), and the publication of the Long Term Plan.
The spirit of the GDE initiative, on the other hand, remains unchanged: spreading best practice and innovation to ensure sustainable, high-quality care into the future.
Earlier this year, speaking at the 2019 European Collaboration Forum, our GDE clients shared the main stage to showcase just some of their most recent achievements as national exemplars.
In this edition of our Cerner blog, we delve into some of these achievements, key learnings, and best practice that can help other NHS Trusts as they undertake their own digital journeys.
Better health for everyone – Wirral University Teaching Hospital NHS Foundation Trust
Cerner and Wirral University Teaching Hospital NHS Foundation Trust (WUTH) have been partners for over a decade, since the Trust first invested in Cerner Millennium® to power their electronic health record (EHR).
Over the years, WUTH has steadily built a world-class reputation as a digital leader, which included being ranked among the world’s ‘Most Wired’ hospitals in 2018.
Wirral’s NHS and social care patch includes some of the most deprived neighbourhoods in the UK – as well as some of the most economically advantaged. People in the most affluent areas have a life expectancy that is 11 years greater than their neighbours in the poorest communities just a few miles away.
Healthy Wirral is a local partnership that was formed with the aim to address these health inequalities and improve wellbeing for everyone, by empowering patients and connecting the healthcare services they rely on.
Key to the successful realisation of this vision was the implementation of an information sharing platform, provided by Cerner’s health information exchange (HIE), which offers real-time access to a shared care record. This means clinicians in different care settings, including acute and primary care venues, can now have key patient information accessible at their fingertips. This fact alone is saving primary care staff the time equivalent of £1.5 million every year.
“Nobody is more than one or two clicks away from the entire GP record. That is so valuable when you’re sitting in front of a patient.”
Gerry O’Sullivan, chief medical information officer, Wirral University Teaching Hospital NHS Foundation Trust
From paper libraries to digital records – Imperial College Healthcare NHS Trust
Some 200 miles away in London, electronic patient records are also at the heart of the digital strategy for Imperial College Healthcare NHS Trust, which runs five acute hospitals. These include major centres for trauma, stroke, maternity care and ophthalmology, which together have over a million patient contacts annually.
The Trust is determined to become a paper-free organisation by the first quarter of 2021, and the progress the project has seen so far is already generating significant cost savings – £3.25 million over the past three years, to be more precise, which can then be invested back into improving care.
"With health records libraries being phased out, we are freeing up valuable central London floor space – space worth the equivalent of £400K per year, and some of it is already earmarked for a new ward."
Linda Watts, GDE programme manager and head of health records, Imperial College Healthcare NHS Trust
[Read the full story: Imperial’s multi-site journey to become paper free]
On top of implementing an integrated EHR, Imperial is continuously striving to make the most out of the platform – as such, they’ve implemented a range of other solutions that have the potential to transform the way they deliver care and provide a better working experience for their staff.
Cerner VitalsLink® is one of such solutions. The tool allows care staff to capture patients’ vital signs and observations directly into the EHR, reducing documentation time and releasing 1.5 minutes for every set of observations taken.
Perhaps the most ambitious of their goals has been to integrate systems with their fast follower in the GDE journey, Chelsea and Westminster Hospital NHS Foundation Trust, and work is well underway to bring this partner onto a shared Cerner domain by the end of 2019. Once completed, the milestone is set to bring numerous benefits to both organisations.
Improving standards of care – Royal Free London NHS Foundation Trust
In the neighbouring patch, The Royal Free London NHS Foundation Trust (RFL) is determined to deliver world-class care and to develop local expertise across their three hospitals and satellite sites. Some of their GDE goals include:
- the reduction of unwarranted clinical variation through the digitisation of care pathways, and
- opening the most digitally advanced hospital in the NHS at Chase Farm.
The latter was achieved in September 2018, when the newly rebuilt Chase Farm Hospital opened its doors. The hospital was designed to be digital from the ground up, and the benefits are already evident. Attending the outpatient department is a seamless experience, from the moment of self-check-in to the clinician’s entry in the digital record. To reaffirm this achievement, Chase Farm Hospital was awarded HIMSS Analytics EMRAM Stage 6 in June this year – just seven months after going live with their Millennium EHR.
To deliver the first of these goals, RFL has introduced an innovative, clinically-led approach, through the implementation of clinical practice groups (CPGs), initially involving the redesign of 44 care pathways across the Trust to reduce variance in care.
So far, 13 of these pathways have been redesigned and digitised, and are already up and running, says the Trust’s group chief digital officer, Glenn Winteringham. “We’ve had clinicians redesign the care pathways and they understand they need a digital platform to run those on, so we’ve had huge engagement,” he adds. A further seven pathways are planned to be live in the EHR by the end of 2019.
“We think that we will deliver savings of approximately half a million pounds on each through actually improving the patient experience and removing waste. That’s £20m that we can spend on our patients.”
Dr Chris Streather, chief medical director, Royal Free London group
RFL is also committed to digital transformation that goes far beyond the Trust’s facilities. RFL is part of the North London Partners group, a partnership of 13 organisations across five London boroughs working together to connect care information, share records, and apply advanced intelligence to proactively manage the health and wellbeing of the local population.
From bedside to Tyneside – Newcastle upon Tyne Hospitals NHS Foundation Trust
One of the largest and most complex organisations in the NHS, Newcastle upon Tyne Hospitals NHS Foundation Trust’s switchboard receives a quarter of a million calls every month. About a third of patients travel in from outside the city, seeking care at its ‘outstanding’ facilities, as they have been rated by the Care Quality Commission (CQC). These include acute hospitals, a major children’s hospital, surgical training and robotics centres, and a transplantation service.
The Trust embarked on its GDE journey for several reasons, recognising that optimal use of technology and data across this vast organisation is vital to enhance:
- Patient safety
- Patient experience
- Research and audit
- Organisational efficiency
- Financial savings
That list is deliberately ranked from top to bottom, with patient safety coming as the top priority and financial savings recognised as being important, but coming after the other four aims. It sums up “the order in which we look at things across the organisation, and that’s important,” says Graham King, the Trust’s chief information officer.
For patients on the wards, the GDE work is already making a difference to that first objective. Using a set of tools that integrate flawlessly with their Millennium EHR, the IT team at Newcastle has developed an electronic whiteboard that allows staff to identify high-risk patients at a glance and act quickly, therefore increasing patient safety and the possibility of better outcomes.
Technology is also reaching far beyond the hospital walls to guard the health of mothers and babies, through remote fetal imaging. This service is invaluable for patients living in rural areas, who may find it a challenge embarking on a three or even four-hour journey to come to the hospital for a 15-minute scan.
“We’re looking at how we drive the whole programme across the North East… When it comes to neighbouring GDE organisations, we’ve all got converging desires that direct us to the same point across the region.”
Graham King, chief information officer, Newcastle upon Tyne Hospitals NHS Foundation Trust
More recently, the Trust led a region-wide agreement to further advance the Great North Care Record initiative, which will connect all 30 healthcare organisations across the North East and North Cumbria to allow safe information sharing at the point of care.
Beyond blueprints – Oxford University Hospitals NHS Foundation Trust
Cerner’s strong relationship with Oxford University Hospitals NHS Foundation Trust (OUH) goes back to 2011, when the Trust first introduced their EHR, also powered by Cerner Millennium. The system is now running at scale across all of the Trust’s four main sites.
Usage of the EHR has been going “up and up and up” over the years by several measures, OUH’s CCIO, Paul Altmann, explains, “showing the depth and scale of the uptake.”
“We’ve got about 12,500 staff, and over 11,520 unique users every month. That indicates virtually everyone is interacting with it.”
Paul Altmann, chief clinical information officer, Oxford University Hospitals NHS Foundation Trust
The team has also been implementing a voice recognition feature, and some clinicians are already dictating directly into the notes during consultations with the patient, then sending their documentation off straight away. This goes a long way to show the potential for improvement the system holds and its compatibility with other supporting technology that can significantly improve staff experience.
The Trust is now working on Cerner’s HealtheIntent® intelligence platform to advance population health management, and they recently launched Cerner’s HealtheLife℠ patient portal to transform the way patients care for themselves and how they interact with their care team.
System-level transformation – West Suffolk NHS Foundation Trust
In 2018, West Suffolk NHS Foundation Trust (WSFT) was recognised by the CQC as an outstanding healthcare provider. While this recognition represents a great achievement for the team and a gold standard for many NHS Trusts, WSFT still faces a variety of challenges that include a population that’s older than the national average, and individuals presenting different issues, such as frailty, co-morbidities, and rural isolation, that severely impact their health and wellbeing.
The launch of their Millennium-powered e-Care EHR in 2016 made information that’s critical for care more easily accessible and visible for clinical staff. Today, with patient information stored in one consistent place, clinicians and other members of staff are better equipped to improve patient safety and therefore the quality of the service they deliver.
The progress made by WSFT since the introduction of e-Care is supported by a significant reduction in adverse drug events causing moderate or major harm to patients, earlier identification of sepsis that has resulted in a 34% reduction in number of patients escalating to ITU, a 65% improvement on performance for handling complaints within the agreed timeline, and 53% fewer pharmacy interventions required.
Additionally, it has generated estimated savings of 15 minutes per shift for every healthcare professional; giving them back time to do what they do best: caring and serving their patients.
More recently, to help better manage demand, local organisations in the region started working more closely together to integrate health and social care services, and to keep local people as well as possible. Gathering, sharing and analysing the right information is the key to success in this transformation. A result of this local collaboration was the link between the Trust’s Millennium EHR and the EHR of fellow GDE, Cambridge University Hospitals NHS Foundation Trust – a link that was enabled by Cerner’s HIE technology.
The team is also in the process of joining up data from a number of organisations running different systems. Services provided by these organisations include acute care, community health, mental health, adult social care, GP, and ambulance services.
Early successes in this endeavour include their most recent link, also using Cerner’s HIE, with local GP venues running EMIS and TPP systems. This is enabling staff to make more knowledgeable and supported decisions based on their patients’ medical history and care journeys.
“It’s like moving from a labyrinth to a matrix. Finally, we can make important system-level decisions with really good quality, comprehensive information, which we didn’t have before.”
Dr Helena Jopling, consultant in public health, West Suffolk NHS Foundation Trust
The connection with TPP also represented a first-of-type interface using Fast Healthcare Interoperability Resources (FHIR) between Cerner and the GP systems provider, in line with NHS Digital’s GP Connect Programme and their aim to make clinical data available in a standard form, so it can be seamlessly accessed by clinicians to provide the right care at the right time.
Once all organisations are connected, the HIE will be supporting information sharing across the whole Suffolk and North East Essex integrated care system (ICS), which covers a population of one million individuals.
While great progress has been made, the Trust recognises that there is still a lot to do. “It’s early days, and we’re not there yet,” the Trust’s consultant in public health Helena Jopling says, “but we’ve got a clear line of sight to it.”
Better is never done
These accomplishments and the strong commitment of healthcare providers and their partner organisations across the country bring great hope of a smarter, better tomorrow for one England’s most valuable treasures, the NHS, and consequently, for all the individuals who benefit from its care. Yet, the road that lies ahead in this ongoing transformation journey is an extensive one – one that will require continuous collaboration between GDE and non-GDE Trusts as well as other parts of the system, and a pledge to a common ultimate goal: to enable individuals across England to live better, healthier, and longer lives.