Client Story
Clinical wrap approach delivers EPR benefits at unprecedented pace
Gloucestershire Hospitals NHS Foundation Trust uses the clinical wrap approach to deploy an electronic patient record (EPR) and achieve the highest levels of digital maturity within five years.
The trust, which provides a wide range of hospital services from Gloucestershire Royal Hospital, Cheltenham General Hospital and Stroud Maternity Hospital, contracted with Altera Digital Health (formerly Allscripts) for Sunrise™ Acute Care as a wrap around its existing third-party PAS (patient administration system) in March 2019. Implementation started in July 2019.
Beginning with two early adopter wards in late November, more than 60 nursing documents were completed in the software the first morning. By early December 2019, just two weeks later, Gloucestershire Royal Hospital went live with Sunrise in the remaining 22 adult inpatient wards.
Mark Hutchinson, the trust’s chief digital and information officer (CDIO), explains aspirations to reach HIMSS EMRAM Stage 6 within two years. He also explains how the clinical wrap is a quick and repeatable approach that other ambitious trusts can follow.
Gloucestershire Hospitals NHS Foundation Trust CDIO Mark Hutchinson describes his organisation’s starting point as “one of the least digitally mature in the NHS.” But that position will change rapidly over the next few years as the trust uses the Altera Digital Health clinical wrap approach to deploy the Sunrise electronic patient record.
“As of March 2019, most of our clinical records were still in brown paper folders holding sheets of notes,” he said. “As an organisation our long-term aim is to reach stage 7 on the HIMSS EMRAM maturity model. We want to become one of the most digitally advanced trusts in the country, providing the kind of high-quality care that our patients deserve and our staff aspire to deliver. This is just the start.”
Altera Digital Health clinical wrap
The trust will retain its existing PAS and add EPR functionality using Sunrise Acute Care
Rapid deployment
First go-live in less than 5 months, ambition to reach HIMSS EMRAM Stage 6 in two years
Replicable approach
Altera Digital Health deployment at a global digital exemplar, open architecture, and local configurability key factors in the trust’s choice
A strategy focused on clinical benefits
Gloucestershire Hospitals wanted to move quickly. Its first Sunrise go-live occurred in the same year as software contracting, and the trust aims to be at HIMSS Stage 6 two years after that, and Stage 7 within five years. This is one of the reasons that it decided to use a clinical wrap strategy.
The trust will retain its existing third-party PAS and wrap clinical functionality around it; delivering benefits to its clinicians much more quickly than if it re-started its digitisation from scratch.
“If you buy a PAS and an EPR as one system, you always have to deploy the PAS first, and that can take two years,” Hutchinson explains. “Instead of doing that, we are letting our PAS do its thing and use the Altera Digital Health clinical wrap solution to start helping our clinicians to improve care for patients as quickly as possible.
“A PAS allows you to see where patients are in a hospital, to manage your waiting lists, and to send information to the central bodies that request it. All of that is important, but the clinicals are where you get the patient benefit.”
"I am of the view that when money is constrained, making wise investments in systems that can be deployed quickly and that deliver demonstrable benefit for patients is absolutely something that other organisations should consider."
Mark Hutchinson
Glouchestershire Hospitals NHS Foundation Trust CIO
Choosing a proven system
Once it had decided on its strategy, the Trust was able to set out clear criteria for picking an EPR supplier. The three most important criteria:
- The system was working at another Trust that had taken a clinical wrap approach
- The system was delivering for a leading-edge Trust, preferably one picked by NHS England for the global digital exemplar programme
- The system could be configured for local clinical needs
Altera Digital Health easily met these criteria. A Sunrise clinical wrap is in place at leading English Trusts, including Wrightington Wigan and Leigh NHS Foundation Trust, which is hosting an experience centre to tell others about its achievements, and Salford Royal NHS Foundation Trust, which is a Global Digital Exemplar (GDE).
In addition, Sunrise is built so that healthcare organisations can deploy the
functionality they want, in the order they want it. “I often say Altera Digital Health (Allscripts) is a bit like a Lego set. Or sometimes I compare it with Meccano,” Hutchinson said. “It allows you to build a system around your pathways.
“That local configurability is important because engaging clinicians is important. If you are going to engage clinicians, then you need to be able to sit down and codesign systems with them. We wanted a system that we could configure, on site, for our patient flows and for our patients. With Sunrise, we have that.”
Rapid deployment
The trust began its Sunrise deployment with nursing documentation. It also ensured that clinicians had access to images from its picture archiving and communications system, radiology and pathology results, and all historic discharge summaries at golive; and access to data from Gloucestershire’s shared care record, Joining Up Your Information (JUYI).
Subsequent go-lives will focus on paperless outpatients, order communications for radiology and pathology and e-prescribing.
Starting a big EPR deployment by rolling out functionality for nurses is relatively unusual in the UK, but Hutchinson points out that nurses are a key staff group.
“Nurses collect a lot of information, so if we engage with them it will help us as an organisation to find out what is happening to our patients,” he says. “At the moment, if we want to find out what is happening to a particular patient on a particular ward, we have to phone the ward and find somebody to ask.
“If we have access to that information electronically, then our patient flow team and our discharge planners can access it at the click of a button. That will support the management of the hospital and allow discharge planning to be started, as it should be started, when a patient is admitted.”
Mark Hutchinson
Glouchestershire Hospitals NHS Foundation Trust CIO
In addition, he points out, e-observations deliver almost immediate benefits for patients if they are combined with assessments, alerts and pathways to pick up and treat specific conditions. By working with Altera Digital Health, Gloucestershire Hospitals will have access to work that other English Trusts have completed in these areas.
For example, Wrightington, Wigan and Leigh created an acute kidney injury
proforma in Sunrise that triggers an alert to a nurse practitioner who can provide rapid advice and support. Salford Royal has created a chronic renal failure pathway to monitor and support patients who may need dialysis or a transplant.
Open architecture to support integrated care
A further consideration for the Trust in choosing Altera Digital Health was the
company’s commitment to building open systems that interoperate with others. They started with the JUYI shared care record that enables health and social care professionals across Gloucestershire to obtain up-to-date information about patients from other systems.
Creating large scale, shared care records that can be used to support integrated care, new digital services for patients, and data for population health management analysis is an important policy direction for the NHS in England, and one that Gloucestershire Hospitals must be able to support.
“We have chosen a system that takes an open approach to interoperability,”
Hutchinson says.
“It also means that we are getting a system that is built to deliver national priorities out of the box, without having to pay additionally for every connection that we want to make in the future.”
An approach for other trusts to follow
Gloucestershire Hospitals has big ambitions for its EPR. “Our intention is to make a really significant improvement in terms of releasing time to care,” Hutchinson says.
“For clinicians, that will mean less time with a pen and paper and more time working with the information they need at their fingertips; and that, in turn, will deliver a significant improvement in the reliability and safety of patient care.
“This is not an IT project, it is a safety and reliability of care project. Two weeks into go live we were already seeing results. Nursing staff spending more time at the bedside inputting into mobile laptops, means that the number of falls reduced on one ward from two every week, to zero since go live.”
Mark Hutchinson
Glouchestershire Hospitals NHS Foundation Trust CIO
The trust is also taking an approach that others could follow. The GDE programme is looking to deliver world class IT at 17 acute Trusts and seven mental health Trusts, and to support their fast followers and other Trusts that want to use their bestpractice blueprints.
Yet there are many organisations that have yet to benefit from the programme, and that need to make their own technology investments at a time when the NHS is facing severe financial, demand and workforce pressures.
The Altera Digital Health clinical wrap approach can support such trusts by enabling them to retain their PAS and other critical systems while adding the functionality they need at pace.
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