EPR Series: Getting ready for EPR implementation, 10 success factors
The NHS met the government’s milestone of 90% of trusts having successfully implemented electronic patient records (EPRs) last year, with sights now set on the ambitious goal of full EPR adoption across all trusts by March 2025. To achieve this, it’s crucial to understand the key success factors that will enable this digital transformation – here I delve into the strategies and best practices that can make this vision a reality.
1. Strategy: Vision and Roadmapping
The foundation of a successful EPR implementation is a well-defined strategy that aligns with the NHS’s overarching goals of improving patient care and operational efficiency. An effective EPR system should not only streamline administrative processes but also enhance patient care and support the NHS’s digital transformation.
Setting Specific, Measurable, Achievable, Relevant, and Time-bound (SMART) objectives, such as reducing patient wait times by 20% within the first year post-implementation, provides a clear target for success. A meticulously mapped project scope, including key milestones across stakeholder engagement, vendor selection, and pilot testing, is essential to meet these objectives.
You should establish a comprehensive budget, accounting for software costs, hardware upgrades, staff training, and potential hidden costs such as for data migration. A 2022 EHR report pegs the per user per year figure at ~£1000. However, economies of scale are in play here, Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust set aside £450 million across both trusts for EPR implementation and running costs over 15 years for their 40,000 strong workforce, which is ~£750 per user per year.
2. Building a Multidisciplinary Team
A robust, multidisciplinary team is the engine that drives EPR implementation. Comprising representatives from clinical, operational, and digital backgrounds, this team must work cohesively to navigate the complexities of integrating a new system into the NHS framework. To ensure the project stays on schedule and within budget, the team will include a variety of roles, each with specific responsibilities:
- Project Manager oversees the overall execution
- Application Analyst focuses on data migration and cleansing
- Application Developer is tasked with system customisation
- QA Test Engineer ensures system testing and performance
- Clinician involvement is represented by a Clinician Advocate and Nurse Advocate, who provide insights on training, data, and testing from their respective fields
- Billing Advocate does the same for the billing department.
The composition of your implementation team will depend on the project scope, budget, and the needs of the trust.
3. Change Management Strategy
Change management is a critical component of EPR implementation, requiring careful planning and execution. First, a clinically-led steering group should be established to provide input and decision-making, creating a network of change champions to help embrace the cultural change across the organisation.
Assessing staff readiness through surveys and focus groups provides valuable insights into the organisation’s preparedness for change. A comprehensive communication plan, with tactics and channels to reach the right people, ensures everyone is kept informed and engaged throughout the transition.
Training programmes must be tailored to different roles within the NHS, with ongoing support structures in place to address any challenges post-implementation. There must be alignment between design change management teams to ensure the approach is standardised across the organisation and clinical workflows are not inhibited upon implementation.
4. Data and Governance
Data governance is a cornerstone of EPR implementation, ensuring that patient information is managed responsibly and in compliance with regulations such as the General Data Protection Regulation (GDPR) andNHS Digital standards. Addressing challenges with data models and sourcing requires a robust data quality framework with regular audits and cleansing to maintain the integrity of information migrated to the new system.
A clear governance structure that defines roles, responsibilities, and protocols for data access and security is essential to balance project and operational needs, ensuring trust and a conducive environment for change. Governance arrangements should be underpinned by a team with clinical and design expertise to manage the flow of EPR improvement. HR recruitment challenges, such as finding the necessary skills for the team, readiness owners, qualified trainers, super users, and at-the-elbow support for go-live, can impede progress.
5. Staff Training and Readiness
Staff preparation for the transition to a new EPR system begins with a thorough training needs analysis. This analysis identifies gaps in skills and knowledge, leading to the development of customised training programmes that cater to the varying levels of technical proficiency among staff. It is crucial to initiate training programmes well in advance of the system adoption to mitigate clinical risk. This proactive approach ensures that users are adequately prepared and confident in using the new system from day one.
The training approach should be scalable and flexible, to allow for the up to 15,000 staff needing to be trained on the new system. A blended and agile approach that incorporates virtual training elements helps accommodate the time pressures staff face. The effectiveness of e-learning programmes often varies, with a 25%-60% retention rate for information, highlighting the importance of developing training content that is engaging, interactive and allows learning at their own pace. Assessing staff readiness before and after training is essential for measuring the effectiveness of the training and ensuring that all users are competent and confident in using the new system.
6. Data Migration
Data migration presents a complex set of challenges, often stemming from the fragmented functionality of legacy systems. However, consolidating data into efficient new electronic systems can lead to a 10% reduction in data errors in the future.
The delicate nature of data migration requires meticulous planning to ensure continuity of care. GSTT had to delay EPR implementation for six months in 2023 as lengthy data migration was forecasted to impact the continuity of care. A phased migration plan minimises downtime, while data cleansing by clinical coders and IT staff ensures the accuracy and completeness of the patient information being transferred. Testing and validation of legacy data and new data inputs are critical for maintaining data integrity and ensuring a seamless transition.
Costs can spiral when trying to meet various IT requirements and manage multiple supplier contracts, even with new standards like Fast Healthcare Interoperability Resources (FHIR) aimed at easing interoperability. Trusts may encounter unforeseen issues at the go-live stage if they don’t involve a broad range of stakeholders in the planning process.
7. Testing
Rigorous testing is crucial for EPR implementation, acting as a system’s live environment rehearsal. Challenges like limited testing capacity and procurement delays need addressing through a comprehensive test plan that includes real-life scenarios for various NHS departments. User Acceptance Testing (UAT), involving end-users, is vital for identifying issues early and ensuring the system meets user needs, thus enhancing adoption. A robust testing strategy is key to reducing risk and ensuring a smooth EPR system transition, readying it for successful integration.
8. Communication
Communication is the thread that weaves together all stages of EPR implementation. A well-orchestrated communication strategy addresses the concerns and queries of stakeholders at every level of the NHS hierarchy and provides strong, clear messaging and directions to advice and support. Diverse channels such as the staff intranet, email bulletins, staff meetings, and dedicated EPR system forums – as well as emails, letters, website updates, and posters for patients – should be employed to disseminate information effectively. Moreover, establishing a feedback loop is essential for capturing the sentiments of the end-users and making necessary adjustments.
9. Go-live
The go-live phase marks a significant milestone in the EPR journey, where the system is put to the test in a live clinical setting. Depending on timelines, staff needs and resources, trusts have to choose between the “big bang” approach going live across multiple sites/departments at once or a phased approach, learning from each go-live before moving on to the next. This phase should be approached with meticulous planning, ensuring that all system components are functioning optimally. Staff and patient education campaigns are crucial to ensure that the transition to the new EPR system is smooth and that any teething problems are swiftly addressed.
10. Post Go-live Plan
The post go-live phase is not the end, but the beginning of the EPR system’s life cycle within the NHS. It is a period of reflection and refinement, where the system’s performance is scrutinised against the initial objectives. To effectively evaluate the EPR implementation, several methods can be employed depending on the project goals:
- Performing ROI calculations to assess profitability, while recording patient throughput can provide insights into the system’s efficiency
- Surveying patient satisfaction helps to gauge the quality of care delivered, and surveying physician satisfaction can reveal the degree of user adoption and the effectiveness of training.
- Analysing data error rates is crucial for assessing the quality of data input. Continuous monitoring and a structured approach to system optimisation are necessary to realise the full benefits of the EPR
- Decommissioning the legacy system is a complex process that must be managed carefully to ensure data integrity and continuity of care..
Getting started
It’s clear that careful planning, a dedicated team, and a patient-centric approach are the cornerstones of success. From understanding your needs to post go-live optimisation, each factor plays a pivotal role in ensuring a smooth transition to a digital healthcare environment. By adhering to these principles, NHS trusts can look forward to a future where EPRs enhance the quality of care, streamline operations, and empower healthcare professionals. The journey to EPR implementation is complex, but with these success factors as your guide, you can navigate the path to a more efficient and effective healthcare system.
HIC is more than just a consultancy. We provide organisations with the know-how and tools to adopt and implement digital solutions for the right reasons. For more information or a conversation on how we can support your ICS or trust with EPR discovery, adoption, and implementation, please contact us today.
