In recent weeks there have been a number of announcements from NHS trusts and ICSs about their digital transformation plans. Most notably, Norfolk and Waveney ICS, is rolling out the MEDITECH EPR solution across its three acute trusts, with plans for a March 2025 go-live. Having been dubbed a ‘digital desert’ in the media, the implementation of the enterprise system is set to make the ICS the first in the country to have a single, shared EPR.
It’s a significant step forward in NHS England’s transformation agenda and has the potential to pave the way for other healthcare systems. However, big bang rollouts are multifaceted and complex and can be hampered by delays, poor adoption, and varied levels of benefits realisation, if not managed effectively. These risks will only be multiplied at an ICS level, when the implementation is planned across multiple trusts rather than a single site.
Having worked on multi-site digital transformation projects in the NHS and across the globe – helping systems implement shared instances of MEDITECH and other solutions such as Epic and Oracle Cerner – we consider some of the most critical factors for success to be implementation planning, governance, and decision making.
Pre-implementation work and the development of a robust decision-making process are often overlooked, particularly as these require experience and skills which unfortunately aren’t always available in the NHS. As is well documented, the NHS is facing challenges with recruiting and retaining qualified staff, and this includes strategists, advisors, project leaders, and experts who can support a robust and rapid EPR implementation.
Plus, all too often, the outsourced external resources being offered to the NHS involve contractors who might understand the theory but do not always have the tailored execution expertise needed in situ.
Whereas, by working with a specialist implementation partner it’s possible to have immediate access to the necessary knowledge. Plus, the extensive insight into lessons learned from other big bang and multi-site implementations.
Redefining pre-implementation and governance
In our experience, the most successful deployments take a slightly different approach to the more standard model used in the NHS, and it’s one that we consider to be imperative for shared-site rollouts.
It involves:
- Setting time aside to bring together key decision makers from each department/site to develop guiding principles that address the technical, financial and clinical issues, as well as considering the overall patient experience. Whilst elements of this happen in the NHS, it isn’t common to incorporate all these factors, yet it helps ground the critical decisions that will be made throughout the implementation. Admittedly, this can be a challenging process due to differing priorities, and a third-party facilitator is advisable to help achieve the desired consensus.
- Completing an assessment of current state readiness and reviewing change readiness aligned with the goals and outcomes of the programme. We find that clinical readiness isn’t considered in the same way as operational and technical readiness, and this can cause challenges later down the line
- Linked to this point, we’d advise prioritising mentoring the leadership team on how to effectively develop and execute a programme that will benefit patients and clinicians and be widely adopted by end users
- Ensuring training, activation planning, and sustainability planning are included in the programme plan with dedicated funding and assigned resourcing. Unfortunately these elements can be the first to be squeezed if there are financial pressures on the project, but they’re essential and need to be baked in and protected from the outset.
- Developing and executing a shared governance model with clear descriptions of the roles of each structure and how decisions will be made and escalated.
- And having a third-party facilitator to support clinical standardisation activities and group consensus. It has sometimes been the case in the NHS that the benefits of shared standardisation from deploying an EPR across several sites haven’t been capitalised on from an operational, clinical or financial perspective. Achieving consensus in this context is always going to be hard, and it’s why third-party involvement can help avoid any conscious/unconscious bias and expedite decisions.
A new way of thinking on EPR implementation
Based on the projects we have been involved in, the benefits and return on investment from a shared EPR across an ICS will be fundamentally aligned with the programme’s ability to navigate the hard work of developing and adhering to a centralised and standardised build of the system.
ICSs such as Norfolk and Waveney, who are initiating their plans for digitally enabled clinical transformation, have the opportunity to think differently about the approach to its EPR implementation. Not only for the benefit of the patients in their locality, but to pave the way for other ICSs to follow as they progress the convergence agenda in the coming years. The time is now to redefine pre-implementation and governance.
By Alison MacDonald, Global Lead for EPR Implementation