4 approaches to achieving digital maturity

5 technology success stories

Lessons from a Rubik’s Cube in solving health IT challenges

5 ways to continue clinical engagement beyond deployment

UK strategies for electronic patient record (EPR) success

Digital Transformation

2

DIGITAL TRANSFORMATION

4 approaches to achieving digital maturitySTEVE BRAIN

Rip and replace? Best of Breed? The risks and benefits of different EPR approaches

5 technology success storiesNHS Trusts share how they are using health IT to improve care and efficiency

IN THIS ISSUEDigital Transformation: UK strategies for electronic patient record (EPR) success

04 06

3

ALLSCRIPTS

Lessons from a Rubik’s Cube in solving health IT challengesDR MARTIN FARRIER

Complex problems require a new approach

5 ways to continue clinical engagement beyond deploymentDR ANNA BAYES

How to collaborate with clinicians for a successful EPR implementation

08 10

4

DIGITAL TRANSFORMATION

4 approaches to achieving digital maturitySTEVE BRAIN

Allscripts Vice President and Managing Director in the United Kingdom

There has been a national push toward digital maturity over the last several years, including an overarching objective to make the NHS paperless by 2020. Most people recognise the value of the information revolution, but financial and operational challenges are hampering Trusts’ ability to implement a digital maturity strategy.

Here are the most common approaches NHS Trusts take, along with risks and benefits to consider:

1) Rip and Replace

This is the implementation of a single end-to-end EPR, bringing a wealth of previously absent digital capability, whilst also replacing existing systems such as the PAS, LIMS etc. Most healthcare organisations that elect for this method do so because it’s believed that functionality is better within a single ecosystem, database and user interface. It also potentially enables clinical benefit to reach across the entire enterprise more quickly.

But this strategy poses challenges for our large, complex NHS Trusts. The biggest challenge? It requires huge, up-front investments of both time and money. Changing everything at once – implementing an EPR, changing your PAS and driving a clinical transformation program – is often too much for resource-constrained Trusts. One of these efforts is inevitably de-prioritized, putting adoption and overall success at risk.

Another significant limitation with the rip-and-replace approach is that it doesn’t acknowledge the reality that there will always be solutions that sit outside that single ecosystem. There must be a way to interface with dozens, maybe a hundred other key systems – such as departmental programs, payroll, devices, workforce management and more. An EPR must be able to work well with other technologies, to enable the collaboration and coordination health care requires.

About half of the UK’s National Health Service (NHS) Trusts claim to have an electronic patient record (EPR). However, of those who claim they do, 50% do not. What they have instead is a Patient Administration System (PAS) and point-clinical solutions, such as ePrescribing or order comms. This means that three out of four Trusts are not running as efficiently, effectively and safely as they could with a fully-functioning EPR.

2) Best of Breed

Once a Trust realises it cannot afford the rip-and-replace approach, it often decides to use a collection of products, known as Best of Breed (“BoB” sometimes disparagingly referred to as Bag of Bits). This path avoids major capital outlay and disruption in a single year and can move forward in incremental, manageable implementations.

It appears to be a quick fix for near-term problems, but unfortunately, organisations lose all economies of scale with Best of Breed. They will find themselves with additional long-term costs of having a larger in-house team to manage multiple vendors and technologies.

Perhaps most distressing is the best-of-breed approach inhibits an enterprise’s ability to create a comprehensive, end-to-end patient record. A disconnected, or loosely connected, collection of systems will ultimately lead to the detriment of data quality and clinical decision making. Today we are starting to see Trusts, who embarked on this path three to five years ago, shift strategy toward an integrated EPR, having concluded that BoB was a costly error.

5

ALLSCRIPTS

3) Self-Build

In this approach, the Trust’s IT team engineers its own EPR to be a tailored fit for the organisation’s needs. While this strategy is far less common today than it was 10 years ago, it does still hold appeal to some Trusts who are struggling to identify commercial solutions that meet their unique needs.

A comprehensive EPR solution is phenomenally expensive to build, and ultimately will not have the robust capabilities of EPRs that vendor organisations have spent decades and millions of pounds or dollars to create. Self-built options typically consume most of the budget to reach minimal functionality and never reach the advanced features of commercial offerings. The business case assumption that the product will someday generate revenue from other Trusts rarely comes to fruition.

4) Hybrid

There is an approach the combines strengths of the previous three, whilst reducing the risks represented there. Trusts can achieve speed to clinical value by implementing a core EPR for better patient data and clinical decision support. If that EPR is truly open and interoperable, they can modernize their PAS and other departmental solutions later, freeing up enough resource to successfully handle a clinical transformation.

Placing a priority on the clinical transformation provides the basic functions every clinical team should have, such as evidence-based care plans, automation, order entry and decision support tools.

This model avoids cost pitfalls buried within other approaches, and it builds a more sound case for total cost of ownership.

Ultimately, Trusts will take a variety of paths to reach digital maturity. I joined Allscripts because I truly believe we have the best strategy and portfolio to help NHS Trusts with this process. And not just for today—Allscripts is pushing to new edges of technology in population health and precision medicine to provide ever more effective treatment.

6

DIGITAL TRANSFORMATION

TECHNOLOGY SUCCESS STORIES5

7

ALLSCRIPTS

Reducing pressure ulcersLIVERPOOL HEART AND CHEST HOSPITAL NHS FOUNDATION TRUST (LHCH)

The Trust developed a comprehensive campaign to help prevent hospital-acquired pressure ulcers and improve patient outcomes. As part of this programme, the organisation configured guidelines in Allscripts Sunrise™ for evidence-based workflows and alerts to increase compliance with best practices.

These focused efforts enabled a 63% reduction in pressure ulcers (grade 2 and above) in one year, including an 88% reduction in pressure ulcers related to medical devices. The critical care unit surpassed 100 days “pressure ulcer free” for the first time in many years.

Collaborating for successful deploymentWRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST (WWL)

More than 300 clinical and non-clinical staff worked together for 18 months prepare for the big-bang go-live across five WWL sites. New capabilities include capturing and viewing electronic information, e-prescribing, medication administration, and placing diagnostic radiology and pathology orders. Teams uploaded 32.5 million documents from previous systems before going live.

Documenting DNR decisions and treatment escalation plansKING’S COLLEGE NHS FOUNDATION TRUST

The Trust created a process for clinicians to complete ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) forms and a more comprehensive treatment escalation plan (TEP) form to formalise consistent documentation of these important decisions for every adult patient admitted.

This project started with paper-based forms, moved to an initial electronic tool, then to Allscripts Sunrise™. Percentage of monthly admissions with documentation of CPR status increased from 18% (on paper) to 60%-70% on the first EPR and up to nearly 100% with Allscripts Sunrise. (Read in a BMJ Open Quality journal article)

Earning top marks in the industryLIVERPOOL HEART AND CHEST HOSPITAL NHS FOUNDATION TRUST (LHCH)

In just a few short years, LHCH has become 99.9% paperless, been ranked Third in Cheshire and Merseyside for digital maturity, and was rated “Outstanding” by the Care Quality Commission, which was the first time a specialty Trust earned this rating.

LHCH is currently top in the country in the Care Quality Commission’s National Inpatient Survey, which is the ninth time LHCH has earned this distinction in the last 12 years. It has also achieved HIMSS EMRAM Stage 5. (Read more here)

Improving medication safety with electronic prescribingPRINCESS ROYAL UNIVERSITY HOSPITAL (PRUH)

Within six months, PRUH went from paper to a digitised record with Allscripts Sunrise™. The next phase of the rollout was to deploy Electronic Prescribing and Medication Administration (EPMA), ward by ward, starting in January 2018. The organisation anticipates it will save time once fully adopted.

Because PRUH was a “greenfield” site within King’s College Hospital NHS Foundation Trust, it has proven a manageable site to introduce optimised functionality and refine workflows before these are introduced in sites with a longer EPR history, such as Denmark Hill.

Read more about these success stories.

8

DIGITAL TRANSFORMATION

We have all become used to simple problems. Like a jigsaw puzzle, they all follow the same rules and we can solve them using the logic that we learnt previously. Complex problems are less comfortable. They require a new set of skills. It’s like moving to a 3D puzzle from a traditional flat one. But if we adapt what we know and try some new skills, we will be able to solve the problem.

I was 14 when I was given a Rubik’s Cube. In 1980 the cube didn’t come with a solution. Google didn’t exist. I would invest hundreds of hours trying to solve the cube. The first thing you learn is that you wished you hadn’t muddled the cube up. In its initial state, any sequence of movements has a consequence that can be understood. In a muddled state the same is not possible.

I shared the cube with my friends. We began to work together. There were tasks that emerged. The most crucial was unexpected. We needed a method of writing down what we did so it could be repeated. We invented a language of cube experimentation. Moving in set patterns would allow us to move a piece from one place to another. Ultimately, we would solve the cube, but more importantly we had a way of writing it down so that others could copy.

The Rubik’s Cube represents a wicked problem, and one that needed a new type of solution. It reminds me of the ultimate wicked problem: healthcare.

Medicine is getting more complex. Patients are on more medications. They are cared for by more people. Evidence grows at exponential rates. The information that one clinician needs to be able to provide best care is enormous. Worse than the quantity, however, is the rate at which it changes.

At an organisational level we have paper notes with paper prescribing. We now have two warehouses that store our paper notes. That costs money. Providing notes to care for patients becomes a logistical nightmare. Co-ordinating care across organisations is increasingly difficult.

This wicked problem will not be solved using the solutions we know. Better logistics, bigger warehouses or better training are the solutions we have tried. It’s time for IT systems to be allowed to manage data, implement care pathways, remove clinical variation and stop logistic problems. Doing

so however will require lots of people with lots of skills. We will need a new language and a new set of skills—just as my friends and I did with our Rubik’s Cube.

The story of the Rubik’s Cube and the Wicked Healthcare Problem struck a chord at Wrightington, Wigan and Leigh NHS Foundation Trust (WWL). The Cube became something of a symbol of what we were looking to achieve with a new Health Information System (HIS), which is Allscripts Sunrise™ platform.

Because while complex problems are less comfortable, we can adapt, work together and develop new skills to unravel any challenge. With this approach, no problem is too wicked to solve.

Lessons from a Rubik’s Cube in solving health IT challengesDR MARTIN FARRIER

WHITE PAPER

What will healthcare look like in the year 2030?

To tackle this question, Ed Smith, CBE, FCA, CPFA, (former) Chairman of NHS Improvement and Allscripts UK Medical Director Dr Anna Bayes interviewed experts about how they expect technology will shape the future of healthcare.

9

ALLSCRIPTS

10

DIGITAL TRANSFORMATION

Doctors face huge pressure to be efficient during patient consultations, often less than 10 minutes each. Navigating a new electronic patient record (EPR) system can strain that precious time and leave clinicians feeling frustrated.

Over the years, I’ve seen organisations take some successful approaches to alleviate this pressure by continued clinical engagement beyond deployment. Here are just a few examples:

1. Proactive super-users

The concept is to have identifiable experts ready to help beyond the initial go live. Some wear badges that encourage people to “Ask Me.” The key is to find proactive people who seek out users needing help and offer assistance

2. Ongoing, open house training options

Users have a threshold for how much information they can retain from their initial training. Beyond deployment, organisations should offer regular opportunities for clinicians to drop in to ask questions and learn or “re-learn” about new functionalities. Sometimes it works best to piggyback on existing meetings or training to demonstrate a “Top Tip.”

3. Optimisation as quantity of data grows

An organisation’s needs change over time, which is why an expert-led Optimisation Review is most effective after six to nine months of system use. For example, one of our clients successfully went live with a full EPR. But after several months of adding data, clinicians were having trouble finding the data most crucial to them. An expert review highlighted a number of key configuration opportunities to facilitate filtering and document search. After training on filtering and use of summary screens clinicians can now quickly find the most relevant information.

4. Transparent governance

Once clinicians actively use the system, there will inevitably be multiple requests for EPR enhancement. Most organisations have a clinical assessment team to prioritise optimisation efforts. Transparent processes, that anyone can participate in, build stronger clinical engagement.

5. Clinical Performance Manager (CPM) reports

These reports show which functionalities are being well used, and which ones are not. For example, they can identify when clinicians are still ordering certain tests individually instead of using an evidence-based, best-practice order set. CPM reports provide useful data for amending configuration and helping to pinpoint what will make data entry more efficient.

...

Clinical engagement can be challenging because the effort and payback is not always tangible, and it’s never finished. But organisations that make it a priority will be rewarded with stronger adoption, more comprehensive clinical transformation and better patient outcomes.

5 Ways to continue clinical engagement beyond deploymentDR ANNA BAYES, ALLSCRIPTS UK MEDICAL DIRECTOR

PODCAST

How important is usability?

User-centered health IT solutions relieve clinician burnout, which helps improve quality of care. Gareth Thomas (CIO, Salford Royal) and Ross Teague (Director of Development, Allscripts) discuss key principles that help create platforms that really work for clinicians.

11

ALLSCRIPTS

Copyright ©2018 Allscripts Healthcare Solutions, Inc.