Achieving Clinical Credibility in NHS IT Projects

Opinion Article by Dr Chris Swinburn, Clinical Lead at Taunton and Somerset NHS Foundation Trust.
Anyone who knows me will know I am not very good with computers. Which makes me a curious choice to lead clinical engagement in an important IT implementation for our trust. Two years ago I took a step back from clinical practice as a consultant physician at Taunton and Somerset NHS Foundation Trust to work as chief clinical information officer and clinical lead for the implementation of an open source EPR across our hospital's wards and departments. It is fair to say that to date it has been a success that is largely due to good clinical, nursing and wider staff engagement.

It had been eight years since our previous system had been implemented and we needed a new IT system that would support the work processes and patient flows in the NHS - the physiology of the hospital if you like. It would also need to improve the speed of access to medical records by eliminating the physical movement of paper notes.

Many doctors here, like everywhere, have an instinctive distrust of IT based on a long track record of poor IT implementations in the NHS. That's where having a clinical lead who is clinically credible, but not tech savvy comes in. They knew that if I thought the software was clinically fit for purpose and easy to use, it most surely would be the same for them.

Clinicians were involved from the very beginning of our procurement process when we invited short listed suppliers to demonstrate their systems at an event with an open invitation for as many clinicians to attend as possible. Many came to score the systems, with their input contributing to the final choice of provider: IMS MAXIMS.

First with open source
We were the first NHS trust to opt for an open source EPR where £45 million of software development is freely available and open to further development through collaboration with the healthcare community and IMS MAXIMS. Our clinicians scored openMAXIMS - the IMS MAXIMS system - highly; it was affordable through a new kind of contract for the NHS based on developing and maintaining the EPR, rather than paying for a software licence; and designing and implementing the EPR would be a collaborative venture.

We started this partnership by involving clinicians in the work streams to define work processes and patient flows. Our IT department then worked with IMS MAXIMS developers to build what we think is a highly usable open source patient administration system (PAS) which can work in any NHS hospital.

By the time we had something to share with the wider clinical community, there was sufficient buy-in and interest from 600 doctors, nurses and administration staff who attended an open day four months before the go-live. During this time, we demonstrated how the new system would work, right down to the configuration of drop down menus to meet the exact workflow needs of each team.

In September 2015 we went live with openMAXIMS, replacing the PAS in A&E, theatres and outpatients and the hospital's 30 wards. In total, eight million records were migrated into the new EPR and remarkably only seven needed to be manually loaded. We have now started phase two and exciting plans to make our outpatient department paper-lite, enabling clinicians to view patient notes, order tests, make notes and book appointments regardless of their location.

This means we can eliminate the need to move 100,000 paper notes a month around the county, saving around £1m a year. Further down the line, we plan to introduce e-prescribing, allowing us to link with external GP systems, and roll-out a mobile app to help staff make use of the EPR system whilst on the move, providing them with patient and medical information at the point-of-care.

Wider benefits
Throughout this implementation, I made regular presentations to senior clinicians and at departmental meetings so everyone was kept fully abreast of what we were doing - and why.

This meant senior doctors understood the anticipated efficiency and safety benefits for our patients, the hospital and the wider community. With this understanding came a high level of adoption of the new system.

Clinicians have driven the development of the software now in use at our hospital, our main acute site. They understand what has been done, and why, and they are buying into it.

We are also part of a wider community, ready to share our learning and the system we have helped build. Along with St Helens and Knowsley Teaching Hospitals NHS Trust, and Blackpool Teaching Hospitals NHS Foundation Trust we have set up a community interest company to act as a custodian for the source code of the openMAXIMS software.

Of course like any go-live we have had a few glitches, but the clinical buy-in has been remarkable and we are in a good position to continue to harness this enthusiasm as we start to go forwards with the next phase of our EPR journey. Like the first phase, this is going to be a clinically led programme supported by IT and our partner, IMS MAXIMS.

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