Data, Quality, People & Process.
Dame Fiona Caldicott’s review of data security, consent and opt-outs, acknowledges the potential for data to transform the way health and care is delivered, but it also clearly identifies concerns – both inside, and outside the NHS – as to how this data is stored, managed and accessed.
It is a truism that a clinician having access to the right information at the right time – without impediment – will make better decisions. In the past, with this firmly in mind, IT systems have been procured and implemented, with varying degrees of success.
In May 2016, at West Suffolk, we pushed the button on a massive transfer of our patient administration system and referral to treatment (RTT) data from our existing legacy system to a new electronic patient record (EPR).
We all understood the risk of getting this wrong. Data supports our hospital staff in managing patients through their care pathways as safely and efficiently as possible. If we can’t track patients through pathways, we might miss them. Our ambition was to improve the quality of this data as we transferred it over. There was an expectation that we would get this right – from board level to the project team.
Define the scope
Moving to a new IT system is a little bit like moving home. You want to ensure that everything great about your old home is kept and transfers to the new one, and is roughly in the same place. Some boxes might be in the wrong rooms, but everything that is important and essential to you moves with you. It’s a simplistic comparison, but it’s apt.
At West Suffolk we were moving much more than a house, we were transferring a huge amount of sensitive data from over 250,000 of our patients seamlessly from our 20-year-old system to a new implementation.
This information needed to be packaged, processed and cleansed before it could be moved. Once moved, it needed to be immediately accessible for our clinicians and administrative staff, whenever and wherever they needed it. And we didn’t need clinicians to tell us that this had to be done with as little downtime or interruption as possible.
Accurate scoping helps to reduce threats. With a clear understanding of the challenge, plans can be drawn up, risks mitigated and fears allayed.
Ask the experts
Moving house is never as straightforward as you hope. You need to package up and protect your belongings, load and transfer them to the new place, unpack them and ensure they’re all there. Like most things, it’s often a lot easier if you use a professional – but in an effort to save money (or face) – many of us choose to go it alone.
The reason is because it’s always difficult – as individuals and as organisations – to recognise gaps in our knowledge and potential areas of weakness. It became clear when scoping the project that our in-house expertise needed to be augmented by that of specialists to boost our capacity and capability.
We worked with Stalis, a specialised data management partner, to complete specific tasks around the migration and cleansing of our data. Working with a partner helped bring structure, specialist tools and techniques as well as knowledge and expertise, all of which helped us to avoid common mistakes that could have dogged our implementation.
A culture of involvement
Central to the success of any change process is convincing those involved and affected by that change that the new system or process will be better than that it replaces. While our existing system may have been almost two decades old, it didn’t mean that staff were ready to change.
Beyond the technical considerations, we needed to persuade staff and clinicians that this wasn’t an IT project by the IT department, but an organisation-wide, clinically-led change project with improved patient care as the focus. We united around the shared belief that the safe transfer of essential data to a new system was going to help us improve patient care.
Central to this is the recognition that high-quality data contributes to high-quality care. The reason is that only by having unimpeded, quick and accurate patient information can we as clinicians truly make the best possible medical decisions on as part of our patient’s care.
The fragmented, ‘best-of-breed’ system approach the trust had previously adopted resulted in organisational information silos. There is no suggestion that this resulted in any issues, but having this all in one place was widely considered to be the way forward for the trust.
While the aspiration for such a system prevailed, the complexity of it, which included managing the data, remained something of a mystery to our clinicians. But they do appreciate that we didn’t screw it up.
In the end, our engagement with clinicians was about focusing on outcomes. We asked what they wanted, and used that as our basis for developing and implementing the system.
Delivering results
Earlier this year we got the keys to the front door and moved in – transferring a substantial amount of data between our systems, going live with the EPR and pulling the plug on the old one. It was a nervous time, but we were confident that our comprehensive data de-cluttering exercise would help to ensure only the necessary information transferred over.
Co-designing the new system allowed us to shoulder the burden from clinicians, reducing the anxieties and reassuring them their requirements would be reflected. Knowing that we understood this means that our clinicians do not need to focus on the system, but can concentrate on patients – which is what we all want and need them to do.
Dermot O’Riordan Chief Clinical Information Officer
West Suffolk NHS Foundation Trust
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