No trust is an island: digital maturity for health and care economies

Professor Graham Evans on how North Tees and Hartlepool NHS Foundation Trust has reached HIMSS 5 – and how he hopes to progress digital maturity across the North East and North Cumbria integrated care system

Professor Graham Evans told a meeting of Highland Marketing executives that more needs to be done to ensure the NHS achieves digital maturity

North Tees and Hartlepool NHS Foundation Trust has a tradition of IT innovation and, in 2015, it became the first trust in England to deploy the TrakCare electronic patient record from InterSystems.

The trust has also been doing important work on tracking as part of the Scan4Safety project and Professor Graham Evans, the trust’s chief information and technology officer, told the Highland Marketing advisory board that it was now at level 5 on the HIMSS EMRAM digital maturity model.

North Tees and Hartlepool is working to integrate the EPR with the Vocera communications system and to close the loop on e-prescribing and medicines administration, which has been shown to improve patient safety, and will put the trust on course for HIMSS 6.

No trust is an island

However, Professor Evans, who is also chief digital officer for the North East and North Cumbria integrated care system, argued that digital maturity across healthcare economies is just as important as digital maturity at individual trusts.

We can only be as successful as the system we work in, and the system we work in will only be as good as its weakest link, so we need to think about system success and digital maturity across the piece

In fact, he said it was essential if integrated care systems are going to make the impact that the NHS Long Term Plan wants them to have on joined-up working, population health management, and creating new digital services for patients.

“North Tees and Hartlepool is not an island,” he said.

“We can only be as successful as the system we work in, and the system we work in will only be as good as its weakest link, so we need to think about system success and digital maturity across the piece.”

Many systems, one goal

But this does not mean returning to the National Programme for IT days of trying to roll out one system across an entire region.

Some of the four integrated care partnerships that make up the North East and North Cumbria ICS have coalesced around different EPR systems. For example, Cerner is deployed in Newcastle, while Meditech is working in Sunderland.

And Professor Evans said he was fine with this, as long as they can all connect into the Great North Care Record (GNCR).

The GNCR is deploying a health information exchange from Cerner and has plans for a patient engagement platform that may be linked to the NHS App to act as a ‘digital front door’ for patients.

In fact, he argued, there are benefits to maintaining a market that is competitive enough to keep suppliers on their toes.

On the other hand, he suggested it would make sense for his trust to be able to help its neighbours if they adopt the same thinking and technology solutions.

This would spread best practice, which was an aim of the Global Digital Exemplar (GDE)programme, in which North Tees and Hartlepool is officially a ‘fast follower’.

It would also help to build health IT careers locally and make it easier for clinicians to move between healthcare settings.

Knocking heads together

As things stand, there are significant challenges to implementing this kind of cross-health and care economy approach.

The NHS Long Term Plan was published in January 2019, but England won’t have fully rolled-out integrated care systems until April 2021, and it is still unclear what legal basis they will operate on in the future.

To make a difference locally, we need a common API, a common integration approach, and some basic modules like A&E and e-prescribing

Even so, Professor Evans told Highland Marketing client director, Susan Venables, that “somebody has to say: ‘You have to do this’ and in the emerging health and care system that would be some kind of healthcare economy-wide organisation.

“I am not a fan of top-down management, but I think this is where the sustainability and transformation partnerships and integrated care systems can add value,” he added.

“They can say: ‘this is the right approach for a locality’.”

He also argued that it should be impossible for the CQC to rate an organisation as ‘outstanding’ if it was working in a struggling system; or had IT that would put it at the bottom of HIMSS EMRAM.

Stop aspiring, start digitising

And there must be a role for national IT bodies.

NHSX, the unit set up a year ago by health and social care secretary, Matt Hancock, to lead on policy, standards, and a host of other IT issues; has quietly let the GDE programme languish without announcing an alternative approach to digitising the acute sector.

But the NHS operational planning and contracting guidance for 2020-21 indicates that there may be some kind of ‘digital aspirant’ programme for struggling trusts.

So the bones of a programme to fund trusts to reach a set level of digital maturity and then support neighbours in the same health and care economy to do the same may be starting to become visible.

Andrena Logue, consultant at Experiential HealthTech, argued that for this approach to work, national organisations might need to specify the modules that a digital aspirant should deploy.

Professor Evans added: “To make a difference locally, we need a common API, a common integration approach, and some basic modules like A&E and e-prescribing.

“We rolled out e-prescribing in nine months, start to finish, and it has made a huge difference. Nurses say it is the best thing we have done. If we could deploy that elsewhere, it would make a big difference across the patch.”

A part for vendors

Other factors will need to be in place to secure success are the right leadership, clinical engagement and a focus on what Professor Evans calls ‘the basics’ – sound infrastructure and good devices.

You have to get the point where your technology is doing a lot of the basic stuff, your staff are doing the really high-value stuff, and patients and citizens have some skin in the game

Logue asked whether, in that case, vendors also had a responsibility to say that an organisation was not ready to deploy or optimise its use of their system.

Professor Evans, who has often praised InterSystems’ partnership with his own trust, said suppliers were an overlooked part of the picture, but looped back to the point that digital maturity is not just about EPRs and not just about trusts.

“The EPR is the core, but it is the ‘sprinkles’ that make it interesting,” he said.

“The communications solution, the BI, the shared care record, the patient solutions.”

Time for new maturity models?

Different bodies are starting to think about these issues: NHSX has indicated that it would like to revisit the NHS digital maturity index, while HIMSS has created a continuity of care maturity model that addresses some healthcare economy issues; albeit from a relatively-limited interoperability perspective.

One way or another, Professor Evans agreed that having a roadmap is key.

“If you are digitally immature and you move from one PAS or EPR to another the benefits are small,” he said.

“But, if you go from paper to digital, the benefit is huge; and then you have to keep going.

“You have to get the point where your technology is doing a lot of the basic stuff, your staff are doing the really high-value stuff, and patients and citizens have some skin in the game.

“And, to do that, you need to be clear about why you are making that investment.”

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