Despite being surrounded by neighbouring trusts using enterprise-wide electronic patient record (EPR) systems, The Royal Wolverhampton NHS Trust (RWT), has opted for a multi-system strategy. Simon Parton, Head of ICT systems and applications services, divisional lead for sustainability and trust RA Manager, explains why RWT has chosen this approach.
Having neighbours that have opted for enterprise-wide systems does make you think, but I then remind myself that, although we are all trusts with a core aim of providing quality care for our patients, that is where our similarities end. The way we work, our technical priorities, even our structures are very different, and so what works at one trust will not necessarily work at another.
Our trust is one of the largest acute and community providers in the West Midlands, providing care across three hospitals, over 20 community sites and ten integrated GP practices. Even within the trust, there are huge variables in workflows and the ways in which departments are run. So, implementing a rigid enterprise-wide EPR solution, which requires clinicians to adapt their ways of working to suit the technology, isn’t going to work for us.
When changing IT infrastructure, it’s not just the technical implementation that staff have to go through, it often requires change management and for the organisation to rework some of its workflows. Otherwise we risk just replacing manual with digital, when in fact we need to look into ways of using technology so that we can do things differently.
By opting for a blended, modular approach using multiple suppliers, the software solutions can be chosen to support our ways of working more easily because they’re responding to a specific need. Also, the software companies specialise in the type of system they are offering and they’ve got their experts who understand what our clinicians are saying when discussing requirements.
Delivering a blended strategy
At RWT, we work with a number of core suppliers including companies such as Silverlink Software, Teletracking and System C. In taking this approach, we are able to offer solutions that can relieve the clinicians’ pain-points and will actually help or improve their workflows. As a result, we didn’t have to sell the solutions, because the solutions sell themselves – and it worked.
Take Silverlink Software, for example, who provide our patient administration system (PAS). The solution is fundamental to how we admit patients and progress their journey through the healthcare system. During COVID it has helped us identify patients that were shielding – it’s processing and validating high volumes of data in real time every day. Using a specialist provider means we get the best solution for the task, and their HL7 and Spine compliance means we have the flexibility to bolt on specialist clinical solutions, as and when we need.
We spent a long time developing our own in-house EPR that is truly bespoke to our needs and the Silverlink PAS underpins that. We’ve developed a system that does exactly what we want it to do, which we feel has helped to encourage positive engagement with the technology by our clinical colleagues. This is compared to an enterprise-level system, which admittedly is already developed, but may be less flexible in its ability to adapt to certain ways of working.
However, with our multi-system approach, there are still compromises; having to manage multiple suppliers, rather than just one supplier for example, and it takes time to administer and manage those relationships. It can also be quite liberating because if there is a supplier that is not meeting your needs, you can change. You don’t have the same level of vendor lock-in, long-term commitment and financial investment. That’s not to suggest that changing is ever easy, but it’s potentially easier than with an enterprise system, where switching suppliers is not a decision you take lightly.
The other main concern, which I think prevents people from fully exploring the blended strategy is interoperability. System “a” doesn’t always want to talk to system “b”, and if they do, it can sometimes come with additional costs. But, if you build-in HL7 and FHIR requirements from the start and only work with suppliers with credible examples of offering this, the issue can be overcome. It’s all down to the architected plan – based on the service requirements and strategic approach of the trust – providing flexible, yet integrated solutions from a number of suppliers.
Choosing what’s best for the patient
That’s not to say that we are dismissive of enterprise-wide systems – or even to say that we wouldn’t use one in future. They are very good – that is why they sell, after all. But you go into that relationship knowing that there are compromises that you are going to have to make. With our in-house EPR, we haven’t had to compromise on the functionality – our clinicians have exactly what they need to care for their patients, and patient care is what is most important to us.