Recovery of struggling EPR Implementation as Part of National Frontline Digitisation Programme

July 2022 - March 2023

Background

The Frontline Digitisation programme (FDP) plays a core role in achieving the health and care sector’s vision of creating a digitally enabled system for all, ensuring that information is safe and is able to flow through to where it is needed, creating shared records of care that enables the integration of services and supports the digital tools and service transformations that will allow social and economic benefits to be realised.

The Frontline Digitisation programme objectives are:

Ensuring systems and providers have the necessary foundational digital capabilities to deliver increased safety, efficiency and quality of care and support further innovation
Ensuring organisations successfully implement and exploit digital capability and value for money can be demonstrated from central investment
Ensures supplier marketplace delivers innovative, value for money products that comply with agreed standards
That Frontline Digitisation policy objectives of Long-Term Plan achieved.

Problem

During the Autumn / Winter 22/23 phase of the national programme, Xylem was approached to provide support to an ICS/ICB following a failed go live of an Electronic Patient Record (EPR) and needed a turnaround programme manager to review and understand the risks and impacts this was having on the programme, patients and trust reputation.

Working as part of a blended team with the local CSU, NHSE, NHS Digital and the Frontline Digitisation Team our Associate Partner set about providing a detailed review covering several strategic concerns regarding the EPR roadmap and delivery, the financial impact this failed delivery was having on the trust, the missing technical aspects which was impacting not only the build but the training and engagement of the clinical colleagues, operational impact was seen with the lack of system usage being seen.

The key risks identified were:

Failed delivery of the programmes technical aspects to ensure a clear scope of works was produced to work alongside the deliverables, therefore a go live was commissioned with the system build incomplete
Lack of Training and Engagement, with the inability to provide exact number of the staff trained, therefore staff had no confidence in system knowledge,
No clear evidence of the As Is and To Be processes therefore pathways not understood and factored into the clinical working practice, this resulted in the process taking more time in the digital format than by using paper, hence the disengagement of staff from using the system. This was classed as a “20” risk which is considered catastrophic and needed a high priority focus to resolve quickly and remove hybrid working
Failure to fully understand the “outcoming” process for the clinician which has resulted in not only lost patients but lost revenue. The financial and clinical risk again a high priority as patients were missing appointments. The lack of staff using the Outcome process in both digital and paper format created an additional risk with the inability to track all documents.
Disjointed working practices, with trust system experts ignored throughout the programme and therefore aspects of reporting have been missed, thus impacting the trusts reputation to deliver national reporting.

Action

In collaboration our Associate Partner agreed mitigations for each of these risks and developed an approach to underpin the programme which supported the business to use the system in the interim. This included:

Overall development of a new programme plan to support all aspects and improve governance of tracking all activities, including all Task and Finish groups, Risk meeting, Clinical safety meetings.
Develop a technical plan with all outstanding items factored in with their individual RAG rating, high priority and high risks were actioned first and workarounds put in place for anything not yet built but equally impacting users.
Site project managers recruited to support the Engagement and Training of staff on a service-by-service basis to ensure all staff have the confidence to use the system for their service needs, this also supported the reporting in each area as the risks were resolved
Business Analyst supported the As IS and To BE process mapping to ensure Clinical Forms being produced are Fit for Purpose and promoted the digital improvements with time efficiencies being seen
Reporting specialist recruited to underpin not only programme risks but the business-as-usual failings which had resulted in the ongoing erosion of the correct reporting and mapping of data. Therefore, an extensive piece of work has supported the trust to improve all aspects and build solid foundations supporting future programme behaviours and deliverables
Our Associate Partner also supported with the funding which had been provided to ensure the accountability of spend was clear and an accurate 3-year roadmap built to evidence growth of the system and digital vision for the trust

Impact

The programme was completed, and the trust transitioned to BAU with the EPR in a functioning state with recommendations to support ongoing improvements. In addition, since the works have concluded our Associate Partner has supported a Lesson Learnt plan which is further identifying the journey of this EPR and the outcomes, reporting back to the Trust and also the wider NHSE teams.

Feedback for our Associate Partner

“You provided vital recovery, stabilisation and optimisation support, following the client’s go-live with Cerner last year (which did not go well). Your expertise and guidance have been fundamental in turning things around, all whilst facing very challenging behaviours and culture in both trusts”

– CSU SRO

“I’d also like to thank you on behalf of the ICS digital team for your hard work, professionalism, support, care and commitment supporting this programme and the ICA since last July. You have provided invaluable insights and support, a much-needed breadth and depth of EPR expertise and shared a wide range of useful advice, knowledge, processes, tools and contacts with both our trusts, programme teams, ICS, regional and FD partners.”

– NHSE SRO

COLLABORATE • CONNECT • CREATE • CO-DELIVER

COLLABORATE
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CONNECT
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CREATE
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CO-DELIVER

COLLABORATE • CONNECT • CREATE • CO-DELIVER

Collaborate for Success Connect for Growth Create for the Future Co Deliver for Impact

Collaborate

Collaborate to discover the problem

Connect

Connect to design the solution

Create

Create the action to move forward

Co-Deliver

Co-deliver to design the solution