When Lincolnshire Partnership NHS Foundation Trust (LPFT) was given notice that its electronic patient record was going to be retired, it needed to move fast. To simplify data migration, while still giving clinicians access to vital documents, it procured and implemented a new EPR alongside a CareXML® archive from Stalis.
LPFT provides specialist health and social care services for people with a learning disability and/or mental health issues, for a population of around 730,000 people. It operates from 56 sites and employs around 2,000 people.
Like many mental health trusts, it has a history of paper-lite working. But in 2017, it was told by its electronic patient record supplier, Silverlink, that its Maracis EPR was going to be retired.
Carolyn Holmes, the trust’s head of informatics, says it “was the right time” to move away from what had become a legacy product – “but we had to do that a lot more quickly than we might have wanted to do.”
Can’t migrate everything, can’t lose access to anything
With just a year to procure and implement a new system, the trust talked to its neighbours; one of which, Rotherham, Doncaster and South Humber NHS Foundation Trust, was working with Stalis on a data archive.
With the support of Silverlink, LPFT decided its best way forward would be to pick-up on this work: to procure a new EPR; to migrate a limited amount of data into it; and to create a data archive to give its clinicians access to documents that were not going to be transferred.
“We did not want to take all the information we had in our old system into our new system,” Holmes explains. “We knew we did not have the time to do that safely, and we wanted to do it well. However, once we had agreed a data migration strategy, we realised there was a lot of data that we did not need to migrate into the new system, but we did not want to lose.
“We spoke to Stalis and they were very positive and proactive. Servelec won the tender for the EPR and Stalis worked alongside their delivery timeline so that when we went live with RiO we could also go live with the data archive.”
Well structured, delivered in context
The data archive was built using Stalis’ CareXML data management suite; an open data repository for both structured and non-structured information that supports a web-based, integrated care record with custom-views of the information it contains.
Angela Georgieva, product solutions architect and project manager at Stalis, explains that a lot of work went into making sure that the documents in the archive were structured consistently, even though they were being drawn from what were, as it turned out, three different instances of the Maracis system.
“There were more than 70 forms that had to be replicated in the archive, many of which had 50 or more questions on them,” Georgieva says. “Some of those had to be translated manually into the database, because the way that one version of Maracis logged the response would be different to the way another version did it.”
The project team also worked with clinicians to understand how the documents should be ordered, so they could obtain the information they wanted quickly. “It was not as simple as taking information from one database to another,” Georgieva adds. “We understood that this was operational data, with a big impact on how clinicians work.”
The trust’s clinicians also wanted an almost seamless link between RiO and the archive. The different suppliers worked with the trust’s IT provider, Arden and GEM Commissioning Support Unit and Servelec, to create a link that could port over the user’s credentials, so they could view documents in patient context.
Sophisticated access protocols were also required, because some of the information in some of the forms is so sensitive that access is restricted to specific teams. “We could not just put-in role-based access, we had to say ‘this group can or cannot see this specific piece of information’. That is not a normal requirement for an archive,’” Georgieva says.
A tight timescale, met
Despite the complexity, the whole project was delivered to its tight timescale. Work started in April 2018 and was completed by the start of September, in time for Silverlink to retire Maracis at the end of the month. Holmes says the archive is now in day to day use, alongside the new EPR.
“The key benefit is that clinicians have access to the entire data archive,” she says. “They have patient demographics and appointments in RiO. But if they want to see previous risk assessments, or letters, or notes on the treatment that has been given, they are all in the archive. That is information that clinicians need day in, day out.
“Also, from a business perspective, under the general data protection regulation, GDPR, we have to be able to show that we are maintaining the archive, and this approach has given us that assurance.”
A model for other trusts to follow
Asked whether she would advise other trusts that need to switch EPR or to consolidate their document stores to take a similar approach, Holmes is unequivocal. “Definitely,” she says. “Any trust that is paper-lite and reliant on IT systems might do this.
“We have a lot of legacy systems, and instead of getting people to log into them separately our longer-term strategy is to take the data from all of them and to put it in one place. That way, we will be able to respond easily to subject access requests and our clinicians will be able to see all the information they might need, even if it was collected many years ago.”