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It’s no secret that the NHS has been under extreme pressure as it copes with the Covid-19 coronavirus pandemic, but it has also led to the uptake of new technologies, with NHS organisations signing up to and deploying a range of systems to help care for their many patients and make life easier for clinicians.
When the pandemic began, many NHS organisations struggled to cope with the increase in patients – but it’s far from over. The country is now in the midst of the second wave of the pandemic, with added winter pressures on top.
Mark Hutchinson, chief digital and information officer (CDIO) at Gloucester Hospitals NHS Foundation Trust, said the second wave was “really quite different to the first”, particularly in terms of preparation in the hospital.
“The first time was very difficult,” he said. “All we knew was that we needed to stop as much as we could and focus on preparing our hospitals for a potentially huge number of patients.”
In the second wave, however, the challenge could be considered even greater, partly because it’s winter, and partly because all of the normal routes into care and elective care pathways and surgery are continuing.
“We’ve got a bigger challenge this time around,” said Hutchinson. “We have to be ready for whatever the second wave throws at us, while also doing everything we possibly can to ensure that all the treatment that people need for any other condition is still being provided in as timely a way as possible, so that creates a whole load of challenges.”
At the beginning of the first wave, the trust rapidly deployed several systems, including a virtual desktop solution – a project that was planned to take nine months, but completed in nine days. This means that, now, if staff are asked to work from home, they can do so easily.
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The trust had also planned to implement the second phase of its Sunrise electronic patient record system (EPR) from Allscripts.
“In March, just as things were getting busy from a Covid point of view, we went live with electronic observations,” he said, adding that it has helped greatly with the acute care response to recognise which patients need intervention, and doctors have been able to help remotely by logging in and seeing the relevant information in the system.
“And, of course, we spent huge amounts of time completing all sorts of submissions,” he said. “NHS England likes us to collect all sorts of bits of information.”
But having to collect all this information also led to the trust being able to understand how many patients were being supported on oxygen every day, something that was crucial in the midst of a pandemic. “That would have been a horrendous manual task before we went live with Sunrise EPR, but we can just press a button now,” he said.
Hutchinson believes the coronavirus response has shown that deploying technology doesn’t need to take as long as it previously has in the NHS. The pandemic meant it went from signing a contract to going live with the EPR in just five months.
“We went from the beginning of procurement to going live in less than 12 months. It doesn’t need to take two years like it did before the pandemic. And we certainly don’t need to go back to taking two years to buy something,” he said.
“There are a lot of things people did quickly at the beginning of this year. Because we had expedited ways of buying things, we took a different level of risk with regards to all sorts of things to make quick progress because there was a really present emergency in a tight timescale.
“The danger is that, for very good governance reasons, people resort to previously held ways of procuring and implemented systems. I think it’s our job as leaders to continue to make the argument for cutting those timescales.”
Using tech to improve efficiency
Further south in the country, at Royal Bournemouth and Christchurch Hospitals, part of University Hospitals Dorset NHS Foundation Trust, Becky Jupp, clinical director for the Stroke and Older Persons’ Medicine, said the main difference between the first wave of the pandemic and now is that they have the “benefit of some hindsight”.
“This experience means we are better able to keep as many non-Covid clinics open as possible, so there should be less disruption to the overall healthcare system here,” she said.
As in Gloucester, the pandemic has shown the trust the importance of technology. “The Covid-19 pandemic has massively increased the use of technology within the trust and investment in tech has gone up considerably,” said Jupp.
“There’s the obvious technology that has touched all industries – Zoom, Microsoft Teams, and so on – that helps us meet remotely wherever possible, and then we’ve also installed artificial intelligence for reading our CT, angiograms and brain CT scans for strokes,” she said.
However, one of the most helpful pieces of technology the trust has deployed is its Allocate electronic rostering system called HealthRoster. The trust had already been working with the system for a year before the pandemic, but coronavirus accelerated and highlighted the need for a formal system to ensure the right staff cover.
“This has enabled us to organise and manage new shift patterns and plan for staff sickness absence, too. Back in March, the trust needed to redeploy almost its entire staff to the Covid-19 wards to manage acute patient demand. In the early stages, it became clear that all of its 200 medical staff and 80 consultants would need to be rostered to meet the potential demand in the hospitals,” said Jupp.
“The Allocate system helped us plan for this, as well as create ‘what if’ scenarios, such as staff self-isolating or being off sick. The system gave staff visibility of all shifts via a mobile app, rather than traditional paper-based and spreadsheet rostering systems, which unfortunately just don’t cut it in this complex situation.”
Jupp added that the attitudes and perception towards technology have changed during the pandemic, and the reaction to an e-roster has been “extremely positive”.
“The pandemic has forced us to think and plan as one big team for the greater good, and the technology we’ve employed has enabled this,” she said.
“The technology has enabled us to keep our staff safe, so meetings from home are now possible, video consultations, where appropriate, are now possible, as well as keep as many non-Covid clinics open as possible by having that visibility of resource. We don’t really know what’s to come, and there will undoubtedly be challenges, but I’m confident that we will look after our patients and serve our population really well.”
Advancing IT at pace
In the West Midlands, the Dudley Group NHS Foundation Trust has also greatly increased its use of technology. Its CIO, Adam Thomas, said during a webinar that the pandemic had made the trust realise that “a lot of things that had seemed like big issues were no longer major problems”.
“Take virtual access to outpatient clinics, for instance. About six months before Covid arrived, I was in a meeting about whether we could do this and still deliver good care. It was an aspiration in the NHS Long-Term Plan, but in that meeting it felt like it was a long way off,” he said.
“Then Covid-19 arrived, we rolled out the Attend Anywhere platform in four days, and that answered the question because we went from delivering 5% of outpatient appointments virtually to delivering 60% by video or phone call.”
While staff were connected via laptops and Microsoft Teams, and remote radiology, allowing them to work from home if needed, in the hospitals, the trust reconfigured the physical space and worked with supplier Allscripts to ensure the EPR was configured to support triage and treatment of very unwell patients, and that Covid-19 statuses could be displayed on tracking boards.
“We accelerated a project to roll out our information sharing and population health management platform, the Allscripts dbMotion solution. After all that talk about population health management, we had been working on a three- to six-month deployment programme to run this summer and suddenly we were able to deliver it in a matter of weeks,” he said.
“We pulled medication information from the EMIS system that our GPs use into the platform, and we added laboratory and radiology information and documents from trust systems, so it was all accessible to clinicians at the touch of a ‘blue button’ in context, all within the EPR.”
Stopping tech jargon
One of the key lessons the trust has learned from the pandemic, said Thomas, was to stop with tech jargon, and to stop trying to “define the solution from the outset, only to find that it does not do what people wanted it to do”.
“Instead, we are going to keep talking about operational and clinical needs and how technology can address them. And we are going to continue with agile development processes,” he said.
“Aligned with that, we are going to be looking to maintain confidence at board level, so we can continue to use board-level leadership to guide the way the organisation moves forward in this space. But we are going to start developing a new cohort of clinical leaders who have stepped out of the organisation.
“We also want to build patient and citizen advocacy, because while we weren’t always able to include all stakeholders as we moved at pace during Covid, the patient voice will be critical as we develop our local integrated care system.”
A CSU perspective
It’s not just NHS trusts that have had to deal with the pandemic. Arden and Greater East Midlands (GEM) Commissioning Support Unit (CSU) supports clinical commissioning groups and local GPs with technology, among other things.
Within the CSU, the pandemic meant staff had to work from home, and 95% of staff are still working from home, according to Nigel Cullumbine, IT executive director.
Nigel Cullumbine, Arden and GEM CSU
“Of all the terrible things that Covid is, what it did do is accelerate the digital journey,” he said. “It proved overnight globally how relatively easy it is to work from home. We put an awful lot of energy in the early weeks into remote access solutions, VPNs and also thousands of additional laptops were deployed to either CCG customers or, more importantly, to GPs for clinicians to work from home and do those remote clinics,” said Cullumbine.
“Our user base is already very well provisioned going into a second wave or going into winter,” he added.
During the pandemic, the CSU has also worked on a Windows 10 refresh, ensuring healthcare sites in the region could use the latest technology. The project, which included upgrading existing devices and procuring new equipment, has taken 12 months but was completed during the pandemic.
“We had to pause very slowly on a couple of our Windows 10 roll-out programmes for some economies we serve. But we’re pretty much near to completion for our customers now,” said Cullumbine.