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Why UK EPR deployments should start in ED

To NHS Trusts planning a major electronic patient record deployment, the emergency department can look like a scary place to start. I understand that. EDs are busy areas and anything that disturbs their flow can — and will — impact a large number of patients in a short period of time.

This means ED is often placed at the end of big IT deployment projects. It’s tempting to start with a quieter area and to revisit ED when the rest of the trust is live. I think that’s the wrong way. Change should start with the ED, and in some ways, beginning in ED makes change management easier to implement.

Trust me, I’m an ED specialist

Why should you believe me? Well, trust me, I’m a doctor, an ED specialist interested in health tech since I was an accident & emergency department (A&E) trainee in the Bristol, England, in the 2000s building a website for fellow trainees.

This led me into five years of healthcare IT experience prior to moving to Swindon as a clinical fellow, where I became the IT lead in ED and took exactly the approach I’m advocating now.

When I arrived, the A&E department was anti-IT because it had a previous bad experience. But I thought the upgrade would work well for it, so I got people on board.

With A&E live, I moved on to become the clinical lead for IT for the whole organisation before returning to the supplier-side four years ago.

Start with the beginning of the data journey

I joined Allscripts in March, but I still work in ED every other weekend. So, I know ED and I’m not afraid of it. But why should trusts start an EPR deployment in ED? There are lots of reasons, but one of the most important is that it is where the data journey begins.

If you are looking to get clinicians to engage with an IT development, the big offer you can make to them is that you will reduce their workload by capturing data so they don’t have to ask patients the same questions repeatedly. In ED, the trust is in full control of the data. Also, ED is where patients tend to be sickest, so it is where information is needed most to treat them effectively and safely.

Success factors

Staff can argue that ED is not the place to start because it is not the place to experiment with new ideas.

I’ve found that if you ask: “Do you want other specialities designing these forms, or do you want to do it?” they come around pretty quickly. The key to getting this right is clinical engagement.

You need the clinical lead on board because they will engage and support others, and you need a good story about how things are going to get better that addresses the interests of various staff groups.

You need to be clear about the scope of the project because you need to do enough to deliver benefit without trying to do too much. And you need to demonstrate support. IT projects are change management projects and change management projects need additional resources. In ED, that means more staff.

Then, once you start, you have to build momentum. If teams pull out and resources drop once you are at business as usual, progress can stall, and cracks can appear.

ED is on board

Since I started working at Allscripts, I have seen Sunrise Acute Care working for EDs in the NHS. Salford Royal NHS Foundation Trust, our first UK customer and a global digital exemplar, uses Sunrise well in that setting, as does Wrightington, Wigan and Leigh NHS Foundation Trust, which went live more recently.

One of the features of the Allscripts clinical wrap strategy is that it enables trusts to focus on the functionality they need most. So, I have been talking to a potential EPR customer about starting in ED and the lead clinician, an ED consultant, has volunteered for his department to go first.

The trust is looking at a very rapid rollout, so if this happens, ED would be followed quickly by the rest of the hospital. But in terms of bringing people on board with the patient journey, I think it will work.

As a clinician who knows ED and knows IT, it is the logical place — not the scary place — to start.

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