The NHS Long Term Plan commits to fully digitising acute, community and mental health providers by 2024, and introducing an Electronic Patient Record (EPR) system is an important milestone in any Trust’s digital transformation journey.
At an annual cost of between £500,000 and £1million to store and move paper records per NHS Trust, plus the need to rapidly implement clinical and operational solutions to support the response to COVID-19, the drive to move to EPR systems has never been greater. From a patient’s perspective, having an electronic record of care can mean a significantly improved experience; not only of hospital-based care, but also of the wider healthcare system. Despite this, nearly a quarter of NHS Trusts are still using paper to support the delivery of patient care.
Millions of pounds have been invested by Trusts aiming to transform the care patients receive by releasing time through numerous efficiencies, such as reduced time spent recording notes and preparing discharge summaries. Despite this, Trusts that have implemented these systems still face major difficulties.
We have seen first-hand the significant challenges and considerations that must be navigated when mobilising, implementing and embedding what is often one of the most significant digital transformations in a Trust’s history.
So, given these challenges, how can Trusts planning EPR, or complex digital implementations, increase the likelihood of successfully embedding the change and realising the benefits?
Based on our key learnings from supporting the successful implementation of EPRs and critical clinical systems as a set of recommendations for maximising benefits, we suggest that Trusts should treat the implementation as a complex change programme. This involves viewing the critical enablers to success through a holistic lens, rather than looking upon it as a set of technology solutions to be deployed.
Employ change management principles throughout the implementation
By approaching the implementation as a complex change programme and employing core change principles, adoption and uptake can be significantly improved. The need for a clear vision and aligned clinical leadership is critical, and, in our experience, identifying and engaging Chief Clinical Information Officers (CCIOs) and their nursing counterparts (CNIO) early has increased the success of EPR implementations. From leading the clinical change, to making key decisions, these experienced clinicians with a passion for digital can be accelerators for progress in the right direction and ensure change is led by the staff. This also empowers clinicians to adopt change at pace and enables them to adapt and flex to patient needs. This has been particularly noticeable when combined with an agile governance approach that allows for rapid decision making.
Similarly, our experience has highlighted the importance of identifying change ambassadors or representatives from each impacted area to form a Change Network - sharing information and troubleshooting issues. This has been particularly effective at engaging senior clinicians who may be resistant to change.
Engage all stakeholders early, and make it personal
The successful adoption of EPR systems often involves deep cultural change at multiple levels of the organisation. This means early engagement of staff groups at all levels – both clinical and non-clinical – and across all specialties, rather than just those that will be required to use the system. Time should be spent clearly articulating benefits to each group and alongside tailored and targeted training sessions. Ensuring that these create opportunities for iterative enhancements and continued learning is key to being able to harness the knowledge and experience of users to input into EPR design.
Similarly, by targeting user groups based on the communication channels that are actively used, success stories can be developed and shared that celebrate what can be achieved through new ways of working and tackle pockets of resistance, such as reaching a certain number of electronic observations. Be creative with the channels used; if staff regularly communicate with each other through social media then that can be a powerful tool to harness in promoting engagement and bringing to life the tangible benefits of the change being delivered. Engagement approaches should also adapt throughout the implementation, informed by the increased clarity of benefits (see next recommendation for more).
Avoid the pooling of different stakeholder groups or specialists together and assuming one approach will work for all. There will inevitably be a range of external stakeholders that will be affected by the transformation such as GPs or coroners so it is important to develop a targeted engagement approach for them.
Clearly define benefits and use cases
Benefits management has historically been a challenge for EPR implementations. As a result, it is often left bottom of the pile when priority calls need to be made on programme delivery. Reasons for this include: a lack of reliable baseline data, IT-led benefits planning and the inability to directly link back improvements to the EPR, e.g. a reduction in mortality rate.
A limited, precise set of benefits that are developed and owned by clinical champions will enable the identification of the highest-priority benefits which can then also be used as an engagement and communication tool. These can be articulated through stories and use cases, which not only make the change ‘real’ for staff, but also allow for assumptions to be tested.
Translate data into meaningful insight
A successful implementation will leverage clinical and operational expertise to identify the critical information requirements. EPR systems produce a wealth of raw data that requires interpretation and analysis to be truly useful and create meaningful insight. This is key for executive leadership, service leads and their supporting management to enable rapid, effective and data-driven decision making, which, in our experience, is often a gap.
Enablers such as role-specific tailored training on how to interpret EPR reports should be put in place to support teams, from ward to executive level, to provide the foundations needed for success. Data visualisation tools can also be employed to automate analysis and expedite understanding and insight.
It is widely accepted that EPR systems are a critical step in any Trust’s digital transformation journey. However, successful implementation and subsequent adoption levels will vary based on the ability to embrace change management principles, and place clinicians at the centre of the delivery. Rather than being approached with a purely technical mindset, implementations should be viewed holistically, engaging staff at the outset and providing support where it is needed most to deliver lasting change and drive continual improvements in patient care.
If you would like to know more about our experience supporting similar programmes or are about to embark on a similar transformation journey and want to learn from the experience of others – both the successes and the potential pitfalls and challenges – please do not hesitate to reach out to a member of the team.
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