UK: Transforming Care: How We Implemented A Hospital-Wide Electronic Patient Record System

Last Updated: 8 November 2015
Article by Karen Taylor

Most Read Contributor in UK, August 2017

It was a crisp equinox morning in March, when an elaborate and inquisitive project team gathered in a huge auditorium at a 500 bed community hospital in the US. The team members (comprised of physicians and clinicians from the hospital, Deloitte employees, and the electronic patient record (EPR) vendor), had gathered to 'kick-off' a big-bang EPR system implementation project.

It was the beginning of a 15 month journey; by the end of which the team, which were initially little more than acquaintances, appeared more like a big family. Strong alliances emerged and there was no place to hide from the politics. Hair was pulled, egos shattered, and challenges faced and overcome, all for a common cause, the delivery of a technology solution that would support the highest quality of care while maintaining patient safety. As UK health providers anticipate the challenges and rewards of undertaking similar transformational projects, this week's blog highlights some of the key moments of the IT implementation journey from the perspective of one of our colleagues who was at the heart of this challenging project.

The hospital in question had identified an urgent need for a complete overhaul of its existing technology systems, processes and organisational structures. An undertaking that was definitely not for the faint hearted. Knowing, as we did, that no technology change in a hospital can be successful unless there is a clinical imperative and clinical buy in, we took confidence from the fact that it had the full support of a dynamic board and an engaged and enthusiastic executive team that would lead the transformation. Importantly, it had key stakeholder buy-in and, for the most part, engaged and enthusiastic employees – a key success factor for any large scale implementation project, especially an EPR transformational initiative.

In order to realise its full potential, the project required the organisation to undergo fundamental changes to achieve its mission-critical objectives. These changes included specific improvements to systems and processes for patient care and safety, requiring a restructuring of care delivery pathways. The most important requirement, however, was the need for changes to the organisation's culture.

The first step in the journey was the formation of cross-functional teams and a requirements gathering phase. This involved a month of multiple workshop sessions to evaluate existing and future workflows and identify consistent and inconsistent processes. All were brought to the table, discussed and a way forward agreed upon.

The next step was the proof of concept, where the vendor showcased their basic understanding of the requirements and "transformation champions" provided feedback. A powerful activity that should never be underestimated. This task was repeated periodically with the key stakeholders helping to carve a path for success.

The proof of concept phase was followed by the design and build phase, where the teams worked in their specific areas and started to build the design, according to agreed requirements. The success of this phase is largely dependent on the team's skillset, composition and experience. This is also the phase where the percentage completion deadlines start to emerge and the reality of the task at hand starts to sink in, increasing the pressure on the project team.

As the design phase starts to taper, testing and training kick in. And this is when the intensity of the pressure really starts to build. This is the time of truth, when strength prevails. The analysts found themselves juggling not one or two, but five tracks or more. There was 'outstanding build' to be addressed, testing to be conducted, training workflows to be updated, further workgroups to attend, and multiple stakeholders to be managed. Meanwhile other related/impacted projects also had to be managed. Despite the involvement of multiple team members, the integrated nature of the implementation meant that individual analysts often found themselves wearing a number of different hats when representing their team.

As testing and training geared up, the organisation beyond the core project team ramped up their activities as well and the involvement of other personnel across the organisation increased. There was an increase in the frequency, scope and coverage of communications and the preparations that would be needed became evident to anyone walking down the hospital corridors. Marketing and branding initiatives were launched, both internally for employees and externally for patients and associates. Change was in the air and everyone became increasingly curious and enthusiastic, but understandably cautious.

Four months prior to 'launch' day, a meeting similar to the kick-off meeting was held in the hospital auditorium. This time, however, attendees were no longer inquisitive but precocious, presenting with pride, the progress they had achieved to that point. These periodic check points ramped up, with meetings held at three months, two months and 30 days prior 'D' day. There was exhaustive go-live planning and numerous schedules to complete. There was also a training frenzy to ensure all end users were trained and new roles created to make sure that everyone could access the system.
Technical dress rehearsals were conducted and completed. Back-up plans and business continuity plans were established. Additional support for the end users was brought in for the final days before go-live and after. Day one, week one, and 30 day pre-launch plans were established and communicated. A 24/7 command center was set up to support end user requests and calls. All the final "t's were crossed and i's dotted". Suddenly, there was the calm before the storm, as the cut-over team went into action and started to follow the cut-over plan by decommissioning the old system and interfacing with the new EPR system.

One year and three months after that first kick-off meeting, in the early hours of Saturday morning, the project director announced, "We are live". There was clapping and cheering, handshakes and hugs, along with a few moist eyes. The hospital along with its 20 out-patient clinics was live, operating on their new hospital-wide EPR system. Throughout the whole process, as the frenetic implementation activity ramped up, the hospital continued with business as usual. Indeed, during the actual "cut-over" stage, four babies were born and were charted on paper and later entered into the brand new EPR system.

Indeed every process across the hospital was transformed, without the hospital missing a beat. For clinicians the changes were palpable, "I can review patients notes from anywhere in the hospital and I can get a view of where every patient is at any one time, even on my mobile devices". For the Deloitte team it was a long, challenging, yet ultimately rewarding journey involving hard-work and commitment and the development of productive relationships with numerous stakeholders to achieve what seemed, at the outset, like a daunting task. The reward, for all of us, is knowing that we all played our part in facilitating that first, critical step, in the care transformation journey.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

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