Delivering paperless electronic patient records

Brian James,

Chief Executive

The  Rotherham NHS Foundation Trust

The Rotherham NHS Foundation Trust• District General Hospital; 650 Beds• Population served c.320,000; 3,500 staff• CQC rated “Double-Excellent” (07/08, 08/09 and

provisionally for 09/10)• Monitor rated “Double-Green”• Amongst the lowest waiting times in the NHS• Amongst the lowest HCAI in the NHS• CHKS 40Top Hospital 2008/9 and 2009/10• Health Investor Magazine’s “FT of the year” 2009

Why we went outside the National Programme

• A burning platform? Originally due for replacement in 2004 (20 years old)

• No further development by McKesson - Notice of intent to withdraw from market in 2010 (now extended)

• No clarity around when Lorenzo phase 1 would be delivered or when all 4 phases would be completed

• Increasing concern as to whether it would be fit for purpose and ‘State of the Art’

• The anticipated financial position beyond 2011 (before the global financial meltdown!)

• Ambition to achieve a step-change in performance - improve quality and safety and to eliminate bureaucracy

The challenges we faced• Real concern that NPFIT products would not be fit for

“business”– Preceded FTs– Preceded introduction of market reforms– Preceded PbR– New technologies and innovations emerging that would not be included in the

NPFIT spec

• Real difficulties in engaging alternative suppliers within the National Programme

• Significant political opposition to us moving outside the National Programme

• The EPR market outside the National Programme was severely depleted

• The “Triple-Whammy” threat

Stage 1 - Preparing the way• Vision setting – EPR Strategic Outline Case

• Initial EPR scoping requirements

• Initial market assessment

• EPR option appraisal by front line staff (NPfIT / Non NPfIT)

• EPR Outline Business Case

The Vision (2007)• Paperless Patient Records, not just EPR• Fully integrated HISS environment• Clinician owned and led• Truly transformational – supporting major cultural change• Snomed throughout• Substantial improvements in quality

– Safety, Experience, Outcomes, Performance, Value

• Simple intuitive interfaces and ways of communicating with the system• A platform for a whole range of other technological innovations:– E.g. RFID/GPS/tracking of staff, patients and equipment

• Fully integrated pathways across the system• Spine compliant and able to interface seamlessly with GP systems• Delivered, installed and operational in 2010/11

IM&T Strategy

• Develop the IT infrastructure

• Implement EPR

• Implement Data Warehouse

• Develop industry standard Service Desk

• Support business as usual

Preparing the way (2007/8-2008/9)• £8M extra funding over two years

• Replace entire Network– 10Gb wired and– 10Gb wireless

• Two new Computer data centres with VM Ware Technology

• Desktop replacement programme to latest operating standards (2010)

Stage 2 – Procurement• OBS

• OJEU

• Short-listing

• Site Visits UK and USA – Executives and Doctors

• Procurement and contractual negotiation

• Full Business Case

• Final Contract negotiation

• Contract Award March 09

Financing the Strategy• Solid Business Case developed over one year

(despite weak evidence on ROI)• Hypothecation - All Specialties required to fund

the investment, equal to a 2.2% recurrent CIP• Capital sourced from NHS Bank• Repayment by surpluses generated through

increased efficiency• Tough approach to benefits realisation

Stage 3 - Implementation

• Contract let from 1/4/2009

• Phase 1 comprises 14 core and clinical systems and goes live later this year (current schedule is 30 October 2010)

• Phase 2 comprises 12 clinical systems and goes live in 2011/12

Major advances in RFT Deployment• Paperless across entire patient pathway• Snomed drives the clinical input across the entire patient

journey• Internal Service Improvement Teams drive redesigned

processes using lean principles:– Current State– Ideal State– Future State

• Use of third party (Dell/PEROT) to undertake configuration to support redesigned processes

• Sophisticated Project Management, governance, assurance and risk management processes

• Massive attention paid to benefits realisation

Why Meditech?

• World Class System

• Truly integrated solution

• Doctors liked it best

• Responsive and flexible supplier

• Competitive price

Our Experience so far• Initial problems in getting the suppliers to work well

together (Filetek, Meditech, PEROT)• The trust are having to drive Anglicisation and the

SNOMED development hard• Unrealistic expectation of Trust resources (and we

have had to significantly increase internal resources accordingly

• Suppliers want a much looser approach to project management and delivery

• Supplier commitment to succeed

Risks & Challenges• Unhelpful SHA• Complexity of programme management• Anglicisation of product• Securing a stable project plan• Recruitment of skilled staff with relevant experience• Training – skills, numbers, facilities, timing• Data Migration – deciding what to transfer to the new system• Managing to time and budget• Clinical engagement and ownership of the benefits• The clinical-user interface• Realising the benefits• Relationships with the suppliers• Process redesign & configuration consumes enormous HR