Salford best practice site visit: Rock stars, roadies and sexy data

Chief clinical information officers are the future rock stars of health, while chief information officers are their roadies.

Oh yes, and health data scientists have the sexiest job on the planet, members of the CCIO and Health CIO networks learned in Salford.

Lemmy show you the way

The ‘rock stars’ quote came from Rachel Dunscombe, the new CIO of Salford Royal NHS Foundation Trust, taking her cue from Dr Robert Wachter’s recent description of the status of CCIOs in the US. 

Wachter, the author of ‘The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age’, had visited Salford days earlier as part of his review of information technology in the NHS for health secretary Jeremy Hunt. 

 “I see my job as a CIO as [being] a roadie to the CCIO rock stars we need,” Dunscombe said, against a picture of Lemmy, the recently deceased Motorhead front-man.

Twenty years in the making

Dunscombe’s remarks were made at the impressively rebuilt Salford Royal Hospital during the latest in a series of best practice site visits organised by and for the CCIO and Health CIO networks.

Delegates from across the country got the chance to find out how Salford has become one of the leading electronic patient records sites, and is now at the heart of plans to integrate care across Greater Manchester.

Phil Bell, deputy CIO, described a twisting journey spanning 20 years in which Salford has worked with Eclipsys, iSoft, the National Programme for IT, CSC, and – for the past four years – Allscripts to develop its clinically rich EPR. 

Gareth Thomas, CCIO, told delegates about the benefits this has delivered: “Patient care improves with use of an EPR by supporting replicable, standardised care.”  He said that through its EPR Salford has been able to record reductions in pressure ulcers, cardiac arrests and cases of clostridium difficile.

Lessons to take away

Jym Bates, deputy CIO and a nurse by background, spoke of the hard-won lessons the trust has learned about the cultural challenges of driving EPR adoption. “It’s about enablement; and how we embed an EPR into clinical practice.  Remember that there can be different views,” he advised.  

He also stressed the need for champions or, as he put it: “People to wear the sandwich-boards.” “They are invaluable on reputation and they are the people who will assist on developing the EPR further,” he said; but they need support.

“Once you become a clinical champion it makes you both a saint and a pariah. You can be seen as having crossed to the dark side. [Clinical champions] need our support technically and managerially. They must be seen to affect change.”

With staff and services under such pressure, Bates added, it was important not to “forget your carrots”, and to “celebrate successes.”

He said that when Salford began implementing its EPR it had great top-level support; but was missing the carrots. “Nobody was enticing people to do the work from paper to electronic.”

To address this, he said the trust looked for specific benefits. For example, he said: “We looked at what you’d get with electronic documentation: [records] becoming easier to read, search, increasing [the] ease of clinical coding.

“Better coding meant that we could get correct income for what we were doing. We made sure we put extra cash back into the service, which gave increased impetus to using EPR.”

On the other hand, he said, it was important to be realistic. “Don’t make false promises, and don’t promise an EPR as a universal panacea”, he advised. “Don’t try to change all the world at once”; involve all the key players – not forgetting care assistants or administrators; “and admit defeats graciously; we don’t always get it right.”

Integrating an integrated care organisation 

The EPR is now in wide use across the trust, and is used for clinical noting, e-prescribing and protocol driven clinical decision support. This has given Salford one of the highest digital maturity scores in the country. 

But it is still planning to extend use of the platform. The next stage of EPR development will focus on: incorporating secure health messaging within the system; a patient portal; mobile care; access to the Salford Integrated Record; advanced prescribing in areas such as chemotherapy; and trauma care design.

Salford will become an integrated care organisation in April, when it takes over adult mental health services. So the need for an integrated care record system is pressing.

Bell said the current system, although used by some staff, had been designed primarily for research purposes and is hampered by requiring a separate log-in. “We’re now at final stages of procurement will have click through patient context.”

Emma Birchall, deputy CIO, information, said an integrated record will enable the creation of an integrated care organisation, and move the organisation from relying on a document-based tool to a task-based communications tool.

She added: “By 2017, key workers will instantly see the latest information held on my patient at the acute trust without a separate log-in.”

Contributing to DevoManc

Information sharing also fundamentally underpins the ambitious DevoManc agenda to pool £6 billion of health and care resources. 

Salford is one of the key players in the Datawell initiative, designed to create the country’s biggest regional health information exchange.

Garry Leeming, CIO of Greater Manchester Academic Health Science Network, explained: “The Data well HIE will enable us to connect different pockets of information.  “Lots of different data will be coming on board – so that it can be used by researchers, patients, doctors, commissioners and companies.”

One of first projects in to create a virtual pathology system, and trusts are planning to collaborate on sharing care pathways.

Salford and neighbouring Wrightington, Wigan and Leigh NHS Foundation Trust are two of three local trusts that have committed to create standardised pathways as part of DevoManc single shared data source. 

Their ability to do this is aided by the fact that Wrightington, Wigan and Leigh is just months away from going live with the same Allscripts EPR as Salford.

Steve Brain, the new UK managing director of Allscripts, said that while EPRs are important, they are just the foundation for joined up, coordinated health and care that engages patients, enables population health management, and opens the door to precision medicine.

“Today, EPR is just table stakes,” he said. “It’s the start of a journey.”