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David Walliker is a healthcare digital leader with a significant brief. As CIO for both the Liverpool Women’s NHS Foundation Trust and the Royal Liverpool and Broadgreen University Hospitals NHS Trust, Walliker splits his time between the two organisations with the aim of delivering a digital transformation that provides lasting benefits to staff and patients.
Formerly national ICT manager at the Welsh Ambulance Services NHS Trust, Walliker joined Liverpool Women’s in April 2013, and assumed the CIO role at the Royal in January 2015. He is now running an IT-led change programme across both organisations, using the digitisation of paper records and electronic forms (e-forms) to deliver innovative healthcare to the people of Liverpool.
When Walliker joined the Women’s Hospital in 2013, the organisation was considering implementing a new electronic patient record (EPR) system. Although the aims were laudable, Walliker quickly realised that the trust would need to do more work on its digitisation strategy before introducing an EPR.
“If we’d moved forward then, we’d have been digitising poor processes and pathways,” he says. Instead, Walliker chose to work towards making the organisation digitally mature through 2013 and 2014. His first decision was to start digitising paper records and to introduce a supporting system of e-forms for NHS staff at the Women’s Hospital.
As he started to make headway in this area, Walliker says the IT team at the Royal was also trying to digitise paper records. But their progress had slowed – and Walliker was asked to help reignite the process.
“They had a gap in their leadership, so the executives at the Royal approached the Women’s Hospital and asked whether they’d be interested in a joint appointment – and that’s how I ended up working in both roles,” he says.
Working arrangements have varied since Walliker began his dual role in 2015. He currently works full time for the Royal and is loaned back two days a week to the Women’s Hospital.
“The idea of holding patient information on paper in a digital age is quite preposterous”
David Walliker, Liverpool Women’s & Royal Liverpool and Broadgreen University Hospitals NHS Trusts
Although the organisations are different, Walliker says the technical concerns he has to deal with are similar – and will be familiar to any NHS trust CIO. “It’s still about the challenge of digitising, creating an EPR, going paper-free and maintaining patient safety,” he says.
Walliker says his main achievement centres on the digitisation of paper records and the introduction of e-forms. Before the implementation of e-forms, nurses at the Liverpool Women’s who were responding to emergency phone calls relied on hand-written paper triage forms. The Royal, meanwhile, employed up to 200 people to look after its written medical records.
“When you think about it, the idea of holding patient information on paper in a digital age is quite preposterous,” says Walliker, who recognised that the reliance on paper was affecting operational efficiency. Governance surrounding paper records created further complications.
“Any information that is written down during a consultation has to be kept for legal reasons,” he says. “If a doctor has to make a note on something quickly, it has to be kept. I’ve seen medical records that include a paper towel – and then that towel has to be kept for 25 years. Paper is a very expensive and inefficient way to manage medical records.”
Selecting the right platform for change
Walliker knew an electronic alternative to paper was required. His approach to the challenge at each organisation varied in relation to the resources at hand. At the Royal, he has access to a set of six or seven “very talented developers”, who developed a system for e-forms using a document management platform known as the Patient Electronic Note System.
At the Women’s Hospital, Walliker did not have access to a dedicated software development team, neither did he have the resources to recruit such specialist staff. He needed to find a software platform to help develop new, electronic approaches. After an assessment process, he implemented Alfresco Process Services, an open business process management platform, to develop user-friendly tools to create custom e-forms.
The Women’s Hospital began exploring Alfresco technology in 2015. By the latter part of that year, Walliker says he had started to realise how staff at the trust might be able to use Alfresco Process Services to help replace an internal Microsoft SharePoint implementation and create a new basis for the delivery of electronic forms.
“SharePoint is an expensive licensed product that I don't think necessarily provides the value-add,” he says. “And then you’re locked into having to buy more licences because it’s a closed ecosystem. You also have to be wary of ending up in a circular debate that takes place with regard to who owns your intranet – is it the communications department, the HR department or the IT department?”
Managing healthcare processes electronically
Walliker started to think about how the intranet could be replaced with a more integrated service that used Alfresco tools and e-forms. “The intranet is full of useful – and useless – information and I’ve never come across an organisation where it is effectively managed,” he says.
“It becomes like a data dump, with policies that are out of date. We are still working on that area. But while we were looking at the Alfresco suite, we realised at the Women’s Hospital that we could use the technology to build some of our e-forms.”
The e-forms system that Walliker and his team have introduced allows staff at the Women’s Hospital to capture data from each patient touchpoint electronically and to eradicate legacy working methods.
“Get rid of the paper and you remove the problem – paper is a very expensive way to manage old records,” says Walliker, who adds that healthcare CIOs must look to embrace digital technology. “We want to spend our money on nursing, not moving paper around the hospital.”
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The positive effects of digitisation are also being felt at the Royal, which was selected as one of NHS England’s Global Digital Exemplars (GDEs). GDEs are examples of organisations that are delivering exceptional care, efficiently, through the use of world-class digital technology and information. Exemplars share their experiences to enable other hospitals to follow in their footsteps as quickly and effectively as possible.
Digital progress at the Royal centres on two key areas. The first is electronic sepsis (e-sepsis), where the trust’s development team wrote its own algorithms to pull data from electronic health records and help identify higher risk of infection.
“You have to identify sepsis quickly and you have to give patients antibiotics within an hour,” says Walliker. “The nurses do their observations digitally, our algorithms identify patients at risk of sepsis, we monitor their illness and they are then given medication if it’s required. In effect, we have digitised the whole way we manage sepsis within the hospital.”
Research suggests the process has already helped to save as many as 200 lives, says Walliker. Such is the power of this approach that the Royal was identified as a best-practice case study in the recently published NHS Long Term Plan, which presents a strategy for improving the quality of patient care and health outcomes. The trust also received an NHS70 Parliamentary Award for its digital strategy as part of last year’s NHS 70th birthday celebrations.
Reducing risk in patient care
But achievements relating to digital transformation at the Royal do not just concern crucial work in the control of sepsis. One of the other key projects covers risk assessment, says Walliker. These assessments, which were previously done on paper, are now fulfilled digitally.
The previous paper-based way of working presented a number of problems, he says. With a paper record, only one person can have their hands on the information at any one time. Also, patients can be transferred around the hospital and between specialist units in Liverpool, and when these movements occur, paper records can be lost.
As the Royal has digitised its patient records, it has also been able to create an electronic approach to risk assessment. Once again, the results from digitising previously legacy processes have brought major benefits in a number of areas, helping to boost operational effectiveness and potentially saving patient lives.
“We have seen a 3,000% decrease in the number of falls,” says Walliker. “The hospital has also seen a 52% reduction in the number of cardiac arrests happening on site. Digitisation makes existing processes work much more smoothly – it’s not really about introducing something new, it’s about making tracking and tracing easier.”
Embracing creative approaches
Walliker looks back proudly on the changes he has made and the platform he has helped to build for further healthcare innovation. He believes that, after a number of false starts, including the problematic National Programme for IT, the new digital approach to NHS IT could finally offer a better way to deliver care to patients.
A number of best-practice lessons have emerged from Walliker’s efforts. Digitisation of paper records and the introduction of e-forms must be prioritised. Healthcare CIOs should also aim for integration. And along with their supplier partners, digital leaders must work towards openness by using application programming interfaces (APIs) and creative thinking.
“What we’ve learnt is that you can’t put all your data in monolithic, closed ecosystems and then expect to embrace the work of innovative small firms and digital startups because they simply can’t get access to the information,” says Walliker. “We need to have open APIs and systems that talk to each other.
“We have seven hospitals in this city and you could potentially be a patient of all those hospitals. Unless all seven of us are using the same system, how do we take that information and put it into one larger piece for the population of Liverpool? I think that is the challenge that remains.”