Cambridge University Hospitals NHS Foundation Trust (CUH) CIO Dr Zafar Chaudry had a tough job in front of him when he joined the organisation in September 2015. CUH was at the tail end of a problematic implementation of a new electronic patient record (EPR) project known as Epic.
Struggles to set up the system had played a big part in the Trust being put into special measures due to financial problems and being rated as "inadequate" by the Care Quality Commission (CQC).
Dr Chaudry was tasked with stabilising the project and driving adoption. He did this by optimising workflow through extensive remedial work, speaking directly with commissioners and holding their hands through system utilisation.
"We did a massive push in terms of year on year refresher training, and training at the point of care, and that helped in the adoption, and also making sure that all the tools were in place, that there was hardware available anywhere, anytime for you to access the system," Dr Chaudry told CIO UK.
The project was recovered and delivered within 12 months, which helped pull the hospital out of special measures and push its CQC rating up to "good".
CUH is the first hospital trust in the UK to adopt the system. It's now available to 13,000 users across two hospitals and gives 4,000 clinicians concurrent access to real-time patient data.
It's helped cut the time taken to prepare discharge medications in half, free up 4,500 orthopaedic clinic appointments by letting clinicians view x-rays digitally, and save almost £1 million annually by reducing adverse drug reactions.
A 'paper-lite' NHS?
CUH is one of the UK's largest healthcare Trusts. It runs the Addenbrooke's and Rosie hospitals, a biomedical research centre, and a range of specialist services across Cambridge and the southeast of England.
Thanks to Dr Chaudry's strategy, it is now also one of the country's most digital. The recovery of the Epic project helped CUH become just the third UK Trust to obtain a Stage 6 rating on the Electronic Medical Records Adoption Model (EMRAM) in 2015.
The success of Epic also earned CUH a place among "Health Care's Most Wired" hospitals. It's the first healthcare organisation outside of the US to be recognised on the American Hospital Association's (AHA) annual list.
EPR systems such as Epic are a key part of the vision of a paperless NHS that politicians have promised to deliver for 25 years.
Their continuing failure to achieve this has come as little surprise to medtech experts, many of whom believe electronic systems should complement paper records rather than replace them.
"I don't believe in paperless," says Dr Chaudry, who joined CUH after a three-year stint as a research director of global healthcare at Gartner. "People will still always need to print. And for business continuity, just in case the system does fail, you still need to be able to print.
"So I've always had the strategy that I'm working towards a paper-lite environment. And we're pretty close to that. We have 750,000 out patient appointments a year, and we don't pull a single record for those out patient appointments. It's all online, and on Epic."
CUH has also managed to reduce the number of printers at the Trust from more than 2,000 prior to implementing Epic to 438 today. Setting realistic goals that are sympathetic to staff needs has proved more powerful than grand promises.
The digital transformation of health and social care can improve treatment, maximise staff capacity and provide more flexibility to patients. But is ultimately an economic necessity.
"That's how health is shifting," says Dr Chaudry. "We're not going to be building more monolithic hospitals, because we just don't have the money. So, the question is, how do you conceive healthcare differently?
"And certainly, when we poll our patients, the millennials tend to tell us that they don't like healthcare anyway. So, they want to consume it in a different way, and that means they don't really want to come in, they just want to do it from their office."
CUH will further support this telehealth model through its migration to Microsoft Office 365 for Business.
The suite of software and services will give staff email access on their mobile device, extensive storage space in the clouds and productivity features such as real-time document collaboration.
It will also support virtual consultations with patients through platforms such as Skype for Business.
The partnership CUH has developed with Microsoft provides a model for how Dr Chaudry attracts the best technology available from a variety of vendors.
"Our conversation with Microsoft was very clear," he explains. "You put skin in the game, we put skin in the game, when we work together towards a common goal."
CUH gave Microsoft time with nurses, doctors, and other allied health professionals to understand what they thought and wanted to ensure that Microsoft provided an appropriate service for their needs.
"You've got to treat your vendor as a partner, but at the same time, you've got to push your vendors to bring real value," says Chaudry. "What I tend to do is say to them, 'If you think you can do it, prove it to me'. And the good ones absolutely do that."
CUH is also exploring how virtual reality could improve treatment in services such as physiotherapy.
“Physiotherapists will help people exercise when their rehabbing patients," says Dr Chaudry. "And then, when the patient goes home, the patient is supposed to repeat those exercises, and come back to the hospital, and show the physiotherapist that they've been doing those exercises. But the reality is, is you could actually do that in a virtual world, and measure that in a virtual world."
Securing the future
Cyber security is of paramount importance in the NHS, where leaks of patient information can cause major financial and reputational damage.
CUH limits the risks through a range of tools and practices, but education remains the most crucial component of its defences. As Dr Chaudry puts it, "your internal customer is usually your biggest culprit of losses of data".
The benefits of an enhanced understanding of IT extend throughout the organisation. Dr Chaudry reports directly to the medical director, who has a seat on a board that is heavily invested in digital developments at CUH.
Dr Chaudry's own experience as a medical doctor boosts their mutual understanding. Every month he gives the board an update on the progress his team is making.
"I think it's the CIO's responsibility - whether or not that person has a board seat - to win the hearts and minds of the board over," he says. "I spend lots of time working with board members, to keep them informed as to what we are doing within the department."
Dr Chaudry's own experience as a medical doctor boosts their mutual understanding. He uses time talking to nurses and doctors on the wards to ensure that the digital strategy is fulfiling the needs of staff on the frontline.
"Nurses are actually probably the best source of information any CIO can get," he says. "If you walk around the wards, and speak to the nurses, they will give you more information than you can ever get sitting in your office. They're quite vocal, and they're quite open."