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How to achieve credibility in NHS IT projects

Taunton and Somerset NHS Foundation Trust’s clinical lead for electronic patient records explains how clinical engagement has helped make EPR an open source success

Anyone who knows me will know I am not very good with computers. Which may make me seem a curious choice to lead clinical engagement in an important IT implementation for our trust. 

Two years ago I took a step back from clinical practice as a consultant physician at Taunton and Somerset NHS Foundation Trust to work as chief clinical information officer and clinical lead for the implementation of an open source electronic patient record (EPR) system across the wards and departments of the trust’s Musgrove Park hospital. It is fair to say that to date it has been a success, largely due to good clinical, nursing and wider staff engagement. 

It had been eight years since our previous system had been implemented, and we needed a new IT system that would support the work processes and patient flows in the NHS – the physiology of the hospital if you like. It would also need to improve the speed of access to medical records by eliminating the physical movement of paper notes.

Many doctors in the hospital, like everywhere, have an instinctive distrust of IT based on a long track record of poor IT implementations in the NHS. That’s where having a clinical lead who is clinically credible, but not tech-savvy comes in. They knew that if I thought the software was clinically fit for purpose and easy to use, then it most surely would be the same for them. 

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Clinicians were involved from the very beginning of our procurement process when we invited shortlisted suppliers to demonstrate their systems at an event with an open invitation for as many clinicians to attend as possible. Many came to score the systems, with their input contributing to the final choice of provider. 

First with open source 

We were the first NHS trust to opt for an open source EPR from IMS Maxims, where £45m of software development is freely available and open to further development through collaboration with the healthcare community and the supplier.

Our clinicians scored OpenMaxims highly. It was affordable through a new kind of contract for the NHS based on developing and maintaining the EPR, rather than paying for a software licence; and designing and implementing the EPR would be a collaborative venture. 

We started this partnership by involving clinicians in the work streams to define work processes and patient flows. Our IT department then worked with IMS Maxims developers to build what we think is a highly usable, open source patient administration system (PAS) that can work in any NHS hospital. 

By the time we had something to share with the wider clinical community, there was sufficient buy-in and interest from 600 doctors, nurses and administration staff who attended an open day four months before the go-live. During this time, we demonstrated how the new system would work, right down to the configuration of drop-down menus to meet the exact workflow needs of each team.  

In September 2015 we went live with OpenMaxims, replacing the PAS in A&E, theatres and outpatients, and the hospital’s 30 wards. In total, eight million records were migrated to the new EPR; remarkably, just seven needed to be manually loaded.

We can eliminate the need to move 100,000 paper notes a month around the county, saving around £1m a year
Chris Swinburn, Somerset and Taunton NHS Foundation Trust

We have now started phase two and have exciting plans to make our outpatient department paper-lite, enabling clinicians to view patient notes, order tests, make notes and book appointments regardless of their location. 

This means we can eliminate the need to move 100,000 paper notes a month around the county, saving around £1m a year. Further down the line, we plan to introduce e-prescribing, allowing us to link with external GP systems, and roll out a mobile app to help staff make use of the EPR system while on the move, providing them with patient and medical information at the point of care. 

Wider benefits 

Throughout this implementation, I made regular presentations to senior clinicians and at departmental meetings so everyone was kept fully abreast of what we were doing – and why. 

This meant senior doctors understood the anticipated efficiency and safety benefits for our patients, the hospital and the wider community. With this understanding came a high level of adoption of the new system. 

Clinicians have driven the development of the software now in use at our hospital, our main acute site. They understand what has been done, and why, and they are buying into it. 

We are also part of a wider community, ready to share our learning and the system we have helped build. Along with St Helens and Knowsley Teaching Hospitals NHS Trust, and Blackpool Teaching Hospitals NHS Foundation Trust, we have set up a community interest company to act as a custodian for the source code of the OpenMaxims software. 

Of course, as with any go-live, there were a few glitches, but the clinical buy-in has been remarkable and we are in a good position to continue to harness this enthusiasm as we go forwards with the next phase of our EPR journey. 

Chris Swinburn is the clinical lead for EPR at Taunton and Somerset NHS Foundation Trust.

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