Digital clinical systems such as electronic patient records (EPR) are key to transforming how the NHS delivers its services - reducing inefficiencies and friction for both staff and patients. The NHS knows it needs to modernise and deliver digital services, yet the barriers to this are complex and challenging.
Our partnership with University Hospitals Derby and Burton NHS Trust (UHDB) was to conduct a user centred strategic review that would provide clarity and insight into the need, choices and impact of a separate EPR for a specialist department. We also highlighted key considerations and a roadmap for a successful implementation that could be sustainably maintained.
This six week review looked to understand the needs and context of the Ophthalmology team and the systems they use to put forward recommendations on the best suited EPR for the Ophthalmology team at UHDB. This included understanding the historical context around EPR implementation and the wider context of how UHDB operates to shape considerations for setting up implementation for an ophthalmology EPR at UHDB.
We set to work in a multidisciplinary team of user centred design and technology expertise and brought that together with clinical knowledge from experts and medical professionals. Our approach focussed on engaging key stakeholders and users that would either be impacted or would help deliver an EPR for Ophthalmology across the two sites of Royal Derby Hospital & Queens Hospital Burton at UHDB that ranged from doctors, nurses, digital and administration colleagues. This gave us a well rounded view of patient, staff, service, data and technical needs across primary, community and secondary care pathways. We supplemented this with functional comparisons of leading specialist and core EPR choices in the market.
We also spent time unpacking learnings from previous EPR implementation efforts to shape a coherent implementation approach that the digital and service teams could take forward to implement the chosen EPR.
What we learnt
Ophthalmology has specialist needs ranging from image driven fields, precise and large datasets, data that needs longitudinal representation and interoperability across multiple care pathways. Standard off-the-shelf core EPR systems rarely have that level of specialism and might not meet key functional requirements, with the paper trail often continuing.
We also made recommendations around integrating the specialist EPR for ophthalmology with other core systems, while highlighting the impact of this additional system on key users across departments, making it a viable solution.
Our analysis and recommendations were framed through the lens of improving patient outcomes through an EPR implementation. This also helped engage and align key stakeholders and different users across the system.
What we recommended
Procuring a specialist EPR would enable the Ophthalmology department to improve efficiency, collaboration and enable better patient outcomes by creating a connected and consistent patient experience across multiple patient pathways. This would also support better oversight and ensure faster auditing and reporting to feed into national ophthalmology datasets.
The senior leadership team had clarity and clear direction on which way to go with in-depth analysis and comprehensive due diligence done to support their decision making and next steps.
This was a challenging and complex engagement, with fatigue around an EPR implementation since this had been attempted and put on hold multiple times. While our approach and recommendations created alignment between the clinical and digital teams, our learnings were framed to inform an actionable implementation for Ophthalmology at UHDB.
We delivered a roadmap for implementation that took into account learnings from previous implementation attempts, challenges faced and aligned that with the team’s ambitions. This covered recommendations on the programme team, data integrations, usability testing, programme roll-out and its maintenance.
"We were really grateful for the work that was done by TPXimpact. From the kick off session, through the weekly reviews to the final product we really appreciated the time and effort they put in. The EPR is the cornerstone of modern healthcare delivery and we needed advice on the right approach. We could never have done what that team did. Their expertise, knowledge and ability to leverage external views made for an authoritative end product. We really appreciated the way they got alongside our internal teams to understand their needs. They also made clear recommendations that we could actually take forward."William Monaghan
Executive Chief Digital Information Officer, University Hospitals of Derby and Burton NHS Foundation Trust
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