Chief Nurse Informatics Officer at Oxford University Hospitals NHS Foundation Trust

The successful management of patients undergoing treatment in our health systems relies on making the most appropriate and timely information easily available to those charged with this patient and client care. Increasingly this function is being fulfilled by the supply of electronic systems, which provide the potential for the utilisation of key data at the point of treatment to facilitate care, prompt clinical intervention and highlight those patients potentially at risk of deterioration.

What drives the change?

Digital offers functionality, connectivity and information access opportunities and provides the prospect to shape clinical working, whilst also collecting key data to support operational strategy, guide efficiency and the best use of resources. The central goal is achieving improved data collection and reporting is seen as informing the need and use of clinical services, together with data on population health, allowing better planning of services.

What do you need to implement?

The choices range from a single system environment, best of breed comprising multiple specialist systems, but the goal should be for comprehensive systems integration to generate a single source of truth, which is documentation agnostic and reliably available when required. The goal should be for the appropriate display and contextualisation of patient data. This will allow clinicians to have oversight of patients requiring treatment and intervention, and what each individual patient needs to provide the best and most appropriate care. Whatever the solution, this will need to be backed up by a comprehensive and robust infrastructure, to ensure reliable access at the point of care.

Where do you start?

Key to this will be what you need to achieve, detailed mapping and understanding of the workflows will inform the functions required. The clinical services being provided and operational management of the patient cohort will inform both the clinical metrics required, both for essential care and mandated reporting, and the organisational performance metrics to allow oversight of the effective use of resources and provide information which may be used for billing or commissioning.

Detail is key. If there is no in-depth understanding of who you are, what you do and why you’re doing it, the system configuration, build and implementation will miss the mark.

Who is going to own it?

Engagement with users regarding this change process and the opportunities this presents will build trust and allow them to engage with it, helping them take ownership of the functionality. This process is essential for appropriate design and adoption, and to ensure the effectiveness of the solution. The drive for change and uptake must also be understood and enabled by senior management, so that they may drive compliance and engagement. Without this, the systems build and adoption will be sub-optimal, leading to holes in data and reporting which may result from inappropriate function or poor optimisation.

Who is going to lead it?

The opportunity of new functionality sometimes causes a wave of change, especially from those who are especially keen to take advantage to exploit what is on offer. But change fatigue and a glut of function, beyond the necessary, may leave many feeling overwhelmed and frustrated. Senior leadership must drive the need and give the context, clinical specialists should work with the technical team to create essential function, but understanding of professional identity will be essential to further shape the processes and workflows and allow support of organisational distinctiveness and purpose.

What are the safeguards?

Robust programme management processes are essential so that risks and issues present, in both the implementation and the maintenance phases, may be mitigated. For example, in the UK the Digital Clinical Safety Officer and their team may be tasked with overseeing key guidance for system build and adoption, and the Clinical Governance Team, will oversee issues of adoption and compliance.

The role of bodies like these cannot be overstated, as they will be key to providing assurance to patients and regulatory bodies about the robustness of safety processes.

How do you maintain the service and maintain quality?

Digital adoption will affect clinical and operational working and there is no way of avoiding changes to clinical and operational working. The move from paper or a legacy electronic system will always require a detailed review of how services are delivered and a robust plan for mapping and surfacing what changes to working processes are required and the opportunities these will offer.

Education and training for use of the system is essential and will come out of system operational design and build. This must continue beyond go-live, which is also true for operational and programme support, which will require a designated team of technical and clinical specialists.

Planning, build and go-live is only the start of the process, comprehensive oversight and support must continue for the life of the service.

How do you measure success?

Clinical governance and oversight of the quality of record keeping, together with staff satisfaction will provide perspective about where support and intervention is required, and key measures such as patient flow and incident reporting will provide core metrics. The programme may also benefit being measured against national and legislative reporting obligations and national initiatives, in the UK examples of these include the Maternity Services data Set and the What Good Looks Like framework.

What’s the bottom line?

 • Application; the choice of solution and the way it is implemented will dictate the scope of the project.

 • Integration will always be essential, both between different clinical systems and clinical workflows.

 • Operation; the organisation must own, support and strategize system use, to promote the generation of key operational data.

 • Implementation; comprehensive support of system development and use must carry on after the rollout has completed.