An Epic test

Carrie Armitage, director of the eHospital programme that Cambridge University Hospitals NHS Foundation Trust is running with its neighbour Papworth Hospital, expects the scheduled go-live of its electronic patient record system to be, well, ‘epic.’

Next October, the programme is planning a trust-wide, simultaneous explosion of the Epic system, including a full patient administration system, specialist modules, nursing and clinical observations and documentation, order communications, a specialist theatre system, pathology, radiology and e-prescribing.

To name just some of the planned features. It all seems very ambitious, and Armitage acknowledges that it might seem radical to do everything at once.

But she argues that the trust has had a “serious under-spend in IT in the last few years,” which means “we have very little that is worth preserving”, so why not just get on and do it all?

“Where we have a single electronic patient record, if we say ‘let’s just go live in outpatients first’, or ‘let’s wait to go live in maternity’, when patients move across the hospital, we have a problem. It’s difficult to know where to draw the line. So we’re just doing it all at once,” she says.

The Epic way or no way

Epic is a US company fabled for doing things “the Epic way” or no way. It is running a tight ship at Cambridge, taking full charge of the implementation plan, which includes taking staff out of their frontline jobs to do some serious, hard-core training.

“We’ve had more than a 100 people taken out of their frontline jobs to do training courses. After that, they have to do a project online and then submit the project to be marked,” Armitage says.

“Then they have to do an exam which is properly invigilated and has a 95% pass rate.Three strikes and you’re out. Epic runs a very prescriptive implementation.”

Epic insists that two full-time individuals from every department must be assigned to an implementation project, which means that clinical staff inevitably get involved.

Around 50% of the Cambridge staff who take the exam and become ‘Epic analysts’ will be clinical staff. They include 21 consultants, nurses, clinical scientists, radiographers and therapists.

Armitage says Epic wants to make sure the trust can configure the system itself and be able to work out its every little quirk. She is extraordinarily positive in her praise of the way the trust and the company are working together towards the implementation.

“Epic will say to us, ‘you need to have this done by next week’ and we tremble and say we’re not sure we can do it, but we just have to do it. They are incredibly supportive,” she says.

“I genuinely believe that there are lot of good clinical applications out there, but what’s different about Epic is the resources they’ve made us put in. If any trust put in the resource and effort and approached an implementation in this way, it would be successful.”

Big, and expensive

As soon as Cambridge issued its eHospital tender, it became seen as one of the marquee deployments of healthcare IT in England post-NPfIT.

Partly, that is because the programme is linked to a major hospital building project, which gives the trusts involved the chance to show what truly modern healthcare looks like. But partly it is just because of the huge sums of money involved.

The eHospital programme will see Cambridge and Papworth spending something in the region of £200m over the next ten years; although they will spend more with their infrastructure and hardware supplier, HP, than with Epic.

Even so, the fact that Cambridge became the first in the UK to choose the supplier from Verona in Wisconsin, USA, raised eyebrows and has guaranteed that interest in the deployment would remain intense.

Because of the large financial spend associated with the deal, the trust found its eHospital programme under review by Monitor.

The foundation trust regulator was concerned that its ‘poor financial performance’, would lead to difficulties. However, the trust has now received a green light and can go ahead with the implementation. Papworth will follow six months later.

“The difficult thing is convincing a trust board to do this; it’s a huge investment,” Armitage says. To keep lines of communication open, Epic sends monthly reports on the team’s progress to the trust’s chief executive, including scores, where a rating of 4 out of 5 is “satisfactory”.

Starting with the wires and boxes

Armitage says the HP infrastructure will underpin the EPR, and give people “fantastic clinical tools” with fast and mobile access to the system.

As part of its infrastructure refresh, the trust is implementing or extending its use of single sign-on, persistent sessions, wi-fi and mobile devices, and looking at a ‘bring your own device’ strategy.

“If you want someone to enter the clinical information as fast as they can, you have to provide that kind of access, which is why the infrastructure is important,” Armitage says.

“We wanted to be able to provide clinicians with the sort of access they use in the rest of their life. We do banking and shopping on our smartphones for instance. Many of our staff have iPads and smartphones and they expect to use that kind of technology for their work.”

She says that mobile working is hugely important to the trust and it will focus on implementing BYOD properly, with standard policies and procedures.

She says that NHS managers are often worried about BYOD and concerned that it will throw up new security concerns and issues around the handling of patient confidential data. But she also argues that BYOD is as much of a solution as it is a problem.

“I can’t stop stupidity,” she admits. “If people want to take records home I can’t stop them. But at least if it’s on a mobile device, with remote wiping and encryptions you can rescue that data.”

New demands

The infrastructure elements of the plan will be in place before the EPR go-live, so staff can already see work underway. That, combined with the Epic focus on training and getting everything right before go-live, seems to have created a huge buzz of excitement at the trust.

Armitage says people want the system to do everything, and are already asking for GP communication, social care commissioning, and patient access. She says her team have had to calm people down, as “we can’t do everything at once.”

“The go-live is the start of the project. Once we’ve gone live, that’s when we start working to make it a fully automated hospital,” she says.

“We will go live with a basic system and then start building on the optimisation. An EPR’s not just for Christmas, it’s for life.”

All eyes on Cambridge

The ‘Epic way’ is way out of the NHS’ usual comfort zone. Armitage says she’s aware that it’s a model that suits Cambridge, but that might not suit everyone.

“We have a reputation for being arrogant, but we do know that there are a lot of ways to do it,” she says. “Everyone is watching to see if this works. I really hope and genuinely believe it will be great.

“It’s a very different approach. It will be very interesting for the NHS’ point of view to see a new way of implementing an EPR and infrastructure.”

Carrie Armitage will be speaking about the eHospital programme at EHI Live 2013, as part The Big EPR Debate stream. EHI Live 2013 is a two day conference and exhibition at the NEC in Birmingham on 5-6 November. This year, the conference is free for all visitors, and registration is open now.