As the executive chief digital information officer at Gloucestershire Hospitals NHS Foundation Trust, Mark Hutchinson helped lead the Covid-19 internal incident response team. He reflects on a hectic few weeks in which the trust rolled out remote working, proceeded with a planned EPR go-live, and still kept an eye on its long-term IT strategy.

When I arrived at Gloucestershire Hospitals in October 2018, I think it’s fair to say that it was one of the most digitally immature trusts in the NHS. It was recovering from a difficult patient administration system (PAS) implementation and most care was managed using paper records.

It was clear that we needed to find a way forward that would re-engage our clinicians. So, rather than spend two years scoping, procuring and then implementing another PAS, we decided to go with Allscripts Sunrise as a “clinical wrap” around the system we had.

Once the contract was signed, we were able to move quickly. We ran a pilot of nursing documentation last November, and rolled it out across our acute hospitals in Gloucester and Cheltenham by the end of the year.

That really helped us over the winter. Gloucester Royal Hospital is a ten-storey block, and our bed managers had to visit every floor just to determine our bed status. Now, that information is on our tracking boards where everybody can see it.

Covid-19 arrives, 2,000 staff shift to remote working

At the beginning of March, we were in the midst of go-live planning for the next crucial part of our EPR jigsaw – implementing electronic observations across all adult inpatient wards in our two acute hospitals. We also had the biggest event of the year happening on our doorstep, with 180,000 people coming to Gloucestershire for the Cheltenham Festival. And that’s when Covid-19 planning hit us, and it was time to prepare.

I was asked to lead the trust’s Covid-19 internal incident response team. Staff from all parts of the hospital came together to make sure we could monitor staffing levels, PPE kit levels, pathology turnaround times, oxygen status, bed occupancy, and all the other issues introduced by the crisis.

Meanwhile, my own fantastic digital team scrambled to deliver a huge amount of change in very short order. We focused on remote working and on giving people access to the EPR using their own devices.

Technically, we brought forward a planned virtual desktop infrastructure project. Instead of running it over nine months, we were ready to roll out in two days and over the next nine weeks, managed to get more than 2,000 staff working online and our outpatient clinics running virtually.

We also gave GPs access to the EPR so they could see information about their patients, whether they were admitted with Covid-19 and make plans to support their discharge.

Holding our nerve to go live with e-observations

With all this going on, we decided to push ahead with e-observations. We needed the additional visibility that it could give us, with automatic NEWS2 scoring enabling us to identify and respond to deteriorating patients, fast. What we didn’t realise at the time was how essential the oxygen status information would be to our local and national response.

Allscripts supported us by setting up a virtual go-live office, which gave us access to their global support teams by videoconference call if we needed it. A floor-walking app enabled us to address problems each day. As our chief executive put it in a tweet, we “held our nerve”, went live, and got the benefits we hoped for – plus a few others.

In the middle of the crisis, the government asked for hospitals to report on the oxygen status of patients and whether they were on a continuous positive airway pressure (CPAP) machine or a ventilator. Previously, the only way we could have found that out would have been to phone all the wards and ask for the information. With the EPR in place, all we had to do was push a button and it was there.

Everything we do now must work for us in five-years’ time

The incident response team stood down after eight-weeks and, for the moment, the trust is returning to something like normal. Throughout this period, one of the things that we have been determined to do is to make sure that everything we do will work for us in five-years’ time.

We took a deliberate decision not to spend thousands of pounds on laptops at the start of the outbreak that we would be committed to supporting in the future.

Instead, we implemented remote working by giving staff secure access to the EPR on their own devices, and it’s been a bit of a game changer. We have consultants who probably didn’t know that some of this functionality enabled them to run virtual ward rounds from home.

We moved ahead with e-observations because we knew it would be a vital tool for managing our hospitals during the pandemic. Our studies have shown that it is saving time for staff and improving care for all patients.

Nurses are saving the equivalent of two hours on a 12-hour shift because they are spending less time on non-productive activities, like looking for notes or drafting them at the nurses’ station. There has been a reduction in falls, because falls assessments are being carried out at the bedside.

We gave GPs access to the EPR to support patients with Covid-19, but we also did it because it is the right thing to do. It will support integrated care going forward.

Riding the storm, planning the next steps

When I arrived at Gloucestershire Hospitals, I said I wanted to turn it from an IT laggard into an IT leader. Our ambition was to get from less than Level 1 on the HIMSS EMRAM maturity model to Level 5 in two years and the top of the scale in five.

Our next steps will be to roll out order communications and test results, first for pathology and then for imaging, before going for a full e-prescribing implementation next year. Covid-19 hasn’t held us up because we have pushed on and because we have made sure that everything we’ve done has longevity.

We’ve known our own mind, followed our strategy, and used it to ride the storm.