Four London trusts set out to create a collaborative partnership to improve care for the region’s 2.4 million residents. A key part of the vision relied on using a single, combined Electronic Health Record, one which would create the largest single instance of Oracle Health’s solution in the UK.
The London North West University Healthcare NHS Trust (LNWH) and The Hillingdon Hospitals NHS Foundation Trust (THH) needed a trusted data migration partner to ensure their move to the existing Oracle Health instance happened on time, to budget and most importantly, safely. They chose Stalis.
LNWH serves a diverse population of more than one million people in north west London and beyond, and includes three hospitals: Central Middlesex in Brent, Ealing Hospital in Ealing, and Northwick Park in Harrow. Neighbouring THH delivers services for 350,000 people living in Hillingdon, Ealing and Harrow and also into Buckinghamshire and Hertfordshire and is home to two hospitals, Hillingdon and Mount Vernon. As the region increasingly moves to a more integrated model of service delivery, patients often receive care from sites across the entire area.
To support this move to more coordinated services, and enhance patient care, LNWH and THH embarked on an ambitious project to move to an existing shared instance of Oracle Health Millennium used by Imperial College Healthcare NHS Trust (ICHT) and Chelsea and Westminster Hospital NHS Foundation Trust (C&W). This collaboration marks the first time that four English trusts have come together on one domain, covering 12 facilities as part of the North West London Integrated Care System (ICS), serving a population of 2.4 million.
The project required the migration of more than 7 million records from legacy systems across both trusts into the existing Oracle Health domain and merging the Master Patient Index (MPI) registrations from both LNWH and THH into the shared ICHT/C&W MPI. The objective was to establish a single, unified MPI, with minimal duplicate patient registrations, and ensure patient safety was not compromised. The complexity of the task stemmed from handling data from two separate legacy PAS systems and integrating them into an already operational Oracle Health system at ICHT and C&W where 700,000 patient records within the 7 million to be migrated already existed.
Robbie Cline, Joint Chief Information Officer for LNWH and THH, explained: “Balancing data from different sources without compromising the accuracy of demographic details posed a significant challenge for us. For the project to be a success, we knew we needed external support.”
LNWH and THH decided to collaborate with Stalis, a trusted data migration partner with a solid track record. Robbie continued: “It was really important to choose a partner that we were confident understood the complexities of this project, alongside having extensive experience of migrating within Oracle Health and managing NHS data. So, Stalis were the obvious choice.”
Robbie explained that it can be tempting for trusts to try to manage the data migration in- house. “This is something I have done at a previous Trust, and it is not an approach I would recommend. For a project of this size, we knew we needed specialist support. Stalis has the system and data expertise, as well as the required tools that a Trust would never have. Their particular focus on data quality was another key reason why we chose them.”
Emma Jackson, Professional Services Director at Stalis, explained the approach taken. “Data migration is always complex, but this project had additional challenges and unknowns, given this was the first time four trusts had decided to use a single domain and one which was already in use by two of them. We split the project into workstreams, firstly merging LNWH into the existing ICHT and C&W Oracle Health domain and then subsequently merging THH into the new, three Trust combined domain.”
The programme approach was to complete three joint trial loads and one dress rehearsal and go live per Trust. Both trusts utilised the Stalis toolset to give full visibility of data quality and transformational issues across the timeline, ensuring the success of each data load could be predicted ahead of actual loading and that no data loads were wasted.
A joint collaborative approach between Stalis and the Trust was taken, completing volumetric comparisons between the transformed data and the Trust legacy systems to ensure no data was lost. These comparisons included all datasets and key indicators, such as the Referral To Treatment (RTT) patient treatment list (PTL) for example. One of the most common issues with EPR data migrations which are not completed correctly is the impact on RTT, and reporting, several months post go live. Poor quality migration can cause over or under inflation of a Trust’s PTL. The Stalis toolset, and approach, completes checks and balances against the Trust reporting KPI’s to minimise this risk.
Moving to a shared domain presented several benefits for the trusts involved. Robbie explained: “The COVID-19 pandemic demonstrated that we needed to move to a more joined up way of working which would help optimise use of our resources. Sharing our physical and clinical resources by, for example, an elective orthopaedic centre at one site that all hospitals use for elective care, provides a more efficient way of working. This results in reduced waiting times, which means better clinical outcomes for our patients.”
The new Oracle Health EPR enables clinicians to gain access to a unified view of a patient's medical history, treatment plans, and diagnostic results. Healthcare professionals across all four acute trusts within the North West London Integrated Care System (ICS) can make more informed decisions and provide higher-quality care due to this shared clinical view. But in order to reap these benefits, LNWH and THH had the arduous task of merging the MPI registrations into ICHT and C&W.
Stalis worked closely with the LNWH and THH team to fully understand their requirements and inform their decisions regarding how much data to move to the new domain and what data to archive. Robbie explained: “When approaching a data migration project, there is a tendency for staff to want to migrate all of the data just in case. With the volumes of data that we are talking about, this would have significant time and cost implications. Stalis were very good at helping us to understand the implications of the decisions that we were making.”
LNWH and THH both migrated 12-months of historic A&E, inpatient and outpatient data, with the remaining historical records moving to Stalis’ Careview integrated clinical data archive. Careview is accessible, in context, from the EPR, so non-migrated data is quickly available to authorised users, when needed. Robbie said: “The additional archive was an important part of the project, as it reassures clinicians that, should they need it, they can view the historical data from within the EPR.”
Drawing on their extensive experience working with other trusts, Stalis supported LNWH and THH, taking a hands-on approach to ensure the project was a success.
The Stalis team guided both trusts throughout the migration process, explaining technical steps and providing pragmatic solutions to issues to achieve the desired outcomes. Expert advice and guidance from an experienced data partner is key to overcoming common challenges. These include understanding and catering for the differences between legacy PAS system and EPR system concepts, for example, how to migrate future booked appointments correctly.
For LNWH and THH the concept of patients waiting for an inpatient appointment on their existing patient administration systems did not indicate the level of detail required to migrate these patients to the inpatient waiting list within Oracle Health. As such, Stalis advised that rules were agreed and applied to the data to ensure that the correct orders were placed for these patients.
For Robbie, having Stalis support on the project was invaluable. “Their attention to detail is fantastic. They would remind us of issues that we needed to keep abreast of or potential risks that needed to be addressed. We had a KPI dashboard to manage the data quality and cleansing work. Part of data migration is to ensure that the data you are transferring is usable, so we were committed to ensuring that any data quality issues were addressed from the outset. The Stalis tools ran nightly for both LNWH and THH, collecting daily changes from their patient administration systems and transforming the data for the migration, meaning that any corrective measures for data quality or data mapping could be seen on a daily basis. We were constantly running trial data loads to check for errors and correct them so that when it came to go-live, there would be no surprises.”
Robbie continued: “With a project of this size, there were always going to be challenges along the way, but Emma [Jackson] and the Stalis team always had a solution for us. Whether it was a Trust workflow issue that was impacting the data or an issue with the data itself, they were able to find a resolution and we were able to hit our milestones.” Robbie was particularly grateful for the support of Stalis when the project stalled due to an issue with a third-party supplier. “We had an issue that was putting the project and our timelines at risk, with the potential to delay go-live. The Stalis team were excellent, helping to secure a solution even though it wasn’t strictly in their remit. They definitely went above and beyond, for the good of the project.”
LNWH planned its go-live for Oracle Health for August 20, 2023. Data migration activities started after taking Silverlink ICS offline at 5pm on August 18. Stalis provided the delta of changes to the MPI, AE, Inpatient, Outpatient, and Future Appointments datasets at 6.45am on August 19 with data loading continuing until August 20 at 11.40 am. The prolonged load window was due to the Trust's request to validate 10 records before commencing full load, a practice adopted from the Chelsea go-live experience.
Robbie said: “We undertook a great deal of testing to ensure that all of our records were ready for the data migration, but we still wanted to follow Chelsea’s approach to validate the records before the full load. When you take a system offline, you don’t want any surprises. If something went wrong it could set us back hours. This gave all of our staff the reassurance that when the data load went ahead, there wouldn’t be any unexpected issues.”
All datasets loaded exactly as predicted by the Stalis toolset from the 4.9 million records included in the migration. The Electronic Referral Service (ERS) was 100% success on the first load attempt, which was a fantastic achievement as ERS is one of the hardest and most time-consuming manual activities to complete.
Three months after the LNWH go-live, THH, as planned, began cutover to the single Oracle Health instance.
The Trust decided to go live within the Emergency Department on Friday 3 November at 7am, ahead of the EPR go live planned over the weekend. The THH Silverlink ICS went down on Friday 3 rd November at 5pm, Stalis began transformation at 7pm, all transformed data files were handed over the loading at 2am Saturday 4 th November and data loading completed by 7pm Saturday 4 th November.
25 hours from PAS shutdown to go-live of the new system, all data was loaded from a total of 2.5 million records with a remarkable 99.999% success rate achieved.
In addition, both LNWH and THH have also deployed the Stalis Careview Archive solution. Data from a total of 13 systems from across the two trusts has been safely stored, but remains accessible in Oracle Health via an in-context link.
By adopting a collaborative approach and leveraging the expertise of Stalis, LNWH and THH successfully completed the migration of electronic patient data from 2.5 million records, paving the way for enhanced patient care and streamlined services across the North West London Integrated Care System. Summing up, Robbie said: “For me, a true indication of the success of the project was the chemistry and shared celebrations that could be seen at go-live across all of the partners involved in the project - it was true partnership working.
This project sets a precedent for future collaborations among multiple trusts, furthering the collective ambition for a new era of integrated and patient-centric care in North West London and beyond”.
