Kevin Jarrold has his work cut out being the chief information officer at two major London hospital trusts.
After implementing Cerner in his role at Imperial College Healthcare NHS Trust, Jarrold will now also be performing the same feat at Chelsea and Westminster Hospital NHS Foundation Trust, where he was appointed as joint CIO last October.
A familiar figure on the NHS IT scene from his previous role leading the National Programme for IT in London as the regional implementation director for the capital, Jarrold intends to expand the digital horizons of the two capital trusts through Imperial’s partnership with Google’s DeepMind, interoperability across the hospitals, and patient accessed records.
A rumoured GDE
One thing that was clear from the outset of the interview was that the topic of Imperial being picked as a global digital exemplar (GDE) was off the table. “We’re not allowed to talk about it, so that’s the bottom line”, a spokeswoman informed me firmly.
The reason for the testiness is due to a strange limbo that’s shrouded the small number of GDE trusts that have been announced but not formally confirmed by NHS England.
Speaking in London in February, NHS England CIO Will Smart said that 16 acute exemplars – four more than originally announced – would each be receiving up to £10 million in funding for their digital ambitions.
Cambridge University Hospitals NHS Foundation Trust has been named in its board paper as a GDE, but not confirmed. Similarly, Jarrold’s two trusts were named as a joint exemplar in Chelsea and Westminster’s January board papers.
However, with concerns growing over the non-appearance of the £100 million GDE funds, trusts appear unwilling to confirm or deny their own board paper reports.
Cerner going live at Chelsea and Westminster
Jarrold was able to expand, though, on the digital ambitions of both trusts, including the decision by Chelsea and Westminster to pick Cerner in October last year.
By choosing Cerner as its electronic patient record provider, it will share the same instance of the technology with Imperial, and the trust was able to negotiate a discount on the purchase. As a result of the NPfIT programme Cerner is also by far the most widely installed hospital EPR in London.
Jarrold said the plans are still being finalised, but West Middlesex University Hospital, part of Chelsea and Westminster, is due to go live in Spring 2018 and the Chelsea site in Autumn to Winter of the same year.
Big bang deployment
Jarrold says Chelsea and Westminster was “one of the original innovators” with its existing EPR, so there is already a rich clinical functionality in place. Chelsea and Westminster pioneered the use of EPRs in London with a system called IDX Lastword, subsequently bought by GE, but was left out of the mainstream when NPfIT chose Cerner for London.
But “the challenge is that where you’ve got a rich digital footprint already, you have to take all the functionality live at the same time”.
“If we’re not to take them back to paper, which we’re not going to do, there has to [be a] go live in a big bang.”
Unlike other organisations which can take months stabilising the patient administration system (PAS) before they move onto clinical functionality, Jarrold said that can’t happen in this case.
Lessons from Imperial
Imperial went live with Cerner PAS in May 2014, roughly one year later than planned, following a series of delays to ensure the system was ready and staff well prepared.
Jarrold said: “There are a lot of lessons that come out of Imperial in terms of the whole approach that we took to the roll out of clinical documentation.”
“What Imperial brings to the party is clinical content in that system that actually works.”
For instance, pilots revealed the value of deploying in inpatients first and that rather than putting doctors in a classroom, “the more effective way of doing it is to have somebody at their elbow at the point in time when they go live”.
Chelsea and Westminster will also be able to get the benefits from Imperial’s developing EPR, as “it’s on an improving trajectory, and they will intersect at a particular point”.
This is Chelsea and Westminster’s deployment
While Chelsea and Westminster have followed Imperial with Cerner, and with its choice of CIO, Jarrold is clear that this is the trust’s project, not Imperial’s.
“This isn’t something that’s being done to Chelsea and Westminster by Imperial”, Jarrold said. “The key to a successful deployment is it has to be owned by the operational managers and the clinicians in the organisation.”
Advantages of sharing Cerner
That being said, there are obvious advantages in two large neighbouring trusts whose patients and staff travel beyond organisational boundaries sharing an EPR.
“One attraction was the ability to share patient records, another attraction was there are a lot of clinicians that move between the organisations and they only have to learn the system once,” said Jarrold.
He also can see the “potential” in this model of nearby trusts buying the same instance of an EPR, as there are financial savings alongside alignment with the new models of care.
“When you’re looking at the way patients move between organisational boundaries and trying to manage care across those boundaries, then this approach absolutely supports and facilitates that.”
PKB’s Care and Information Exchange
Imperial is already undertaking an initiative to support regional working through the Care and Information Exchange, facilitated by patient-controlled personal health record Patients Know Best (PKB).
Rolled out in November 2016, it allows patients to choose who accesses their record across different sectors. It now has more than 900 active users with recruitment focused on those with long-term conditions.
Jarrold says what attracted the trust to PKB was there is “a really solid way of managing patient consent for access to the record”, with the record divided into mental health, social care, sexual health and general health.
Deepening the relationship with Google
Another initiative where patient consent is a sensitive issue is Imperial’s five-year partnership with DeepMind Health, Google’s artificial intelligence company, that was revealed December last year.
Jarrold said the “driver” behind the relationship “was a desire to develop an app [for] junior doctors to provide them with a task list at shift handover”.
This is part of the controversial ‘Streams’ app deployment and Jarrold says “what DeepMind are working with us on is this infrastructure that will enable this app to function”.
Streams caused a furore in the media when it was revealed that Royal Free London NHS Foundation Trust and the company had entered an agreement that allowed five years’ worth of patient data for 1.6 million people to be exchanged without patient knowledge.
The fall out is an ongoing Information Commissioner Office investigation, academic back lash and privacy groups up in arms. However, this has not stopped DeepMind entering into conversations with NHS trusts across the country.
The definition of “direct care”
The crux of the controversy was around the definition of “direct care” and how far outside of that remit the trust and DeepMind had gone.
Jarrold was clear to say the contract at Imperial is a data processing agreement, not an information sharing agreement.
“And the only things that we’ll allow them to process data for is direct patient care.”
While the data processing has not yet begun, Jarrold said “the arrangement we’re putting in place for them [DeepMind] is the same as the arrangement we have in place with loads of other IT suppliers where they process data on our behalf”.
Big plans for 2017
With both trusts under his wing, and with the run up to Cerner deployment in one and continued roll out in the other, 2017 will be a busy year for Jarrold and his team.
Jarrold’s focus is “on the fuller exploitation of what we’ve already got”, and regardless of whether Imperial fulfils its GDE expectations, both the trusts will be aiming high with their digital ambitions.
31 March 2017 @ 15:25
Efficiency in large organisation is now best achieved by cutting out the bureaucracy, replacing it with technology, so that strong leaders do not need to concern themselves with the measurement of KPIs and monitoring organisations can be confident that what they are seeing is a true representation of what is happening. Absolutely no disrespect but this technology will not come from the triumvirate of major disciplines within the NHS (i.e. Nurses, Doctors and General Managers, men or women), the NHS is now dependent on the IT suppliers to increase efficiency.
Mark K Jacob MD
31 March 2017 @ 12:05
Funny Neighboring hospitals using Cerner in the US often can not share patient data. In the US the focus of Cerner is clearly on compliance and less on patient care quality is physician satisfaction or efficiency.