#CCIO

Moving from why to how:CCIOs and the power of collaboration #CCIO

Dr Colin Brown CCIO, University Hospitals of Morecambe Bay NHS Foundation #CCIO

Leadership support requirements during a significant system implementation #CCIO

Dr Colin Brown CCIO University Hospitals of Morecambe Bay Kings Fund - 26th November 2013 Leadership Support through a System Implementation

Single Patient Record Agenda Dr Colin Brown – Nov 13 INSERT AN IMAGE / IMAGES INTO HERE

Shape of a System Implementation A Process – Not a Single Go-Live Event

Leadership Support through a System Implementation • Describe Morecambe Bay journey • Lorenzo EPR as a core component of our Single Patient Record strategy • Interoperability / Portal Capability • Leadership • Clinical Engagement • Change Management

Morecambe Bay Locality

Morecambe Bay Locality • 1000 square miles • 320,000 residents (400,000 activity base) • 98% GP registered • 95% of all patient activity at local Trust • 3 Hospital sites (2 Acute) with 900 beds and 2 community treatment centres • 12M visitors to the lakes each year (2 x Scotland)

Background Leadership 1990’s to 2007 • Longstanding Single Patient Record Vision • Head of Health Informatics since 1992 • Generational change in consultants • Strong Executive leadership • Full visibility at Trust Board level (3 successive TB’s) • Organisational transformational project (NOT IT) Step 3: Develop a change vision Simplifies many decisions Inspires / motivates Coordinates actions Imaginable, desirable, feasible, focused, flexible, Communicable

Multiple Journey My Start 1996 2013 Labour Government Treatment and Cancer Access Targets Reduce to 2 Acute Sites FT Status Dr Foster High Mortality Trust Breach of FT Authorisation Bettercaretogether MBHT 3 Way Trust Merger Patient Records in the 21st Century Step 1: Create a sense of Urgency 50% fail – underestimate how hard it is to make people change Overestimate success Lack patience ver

Lorenzo Regional Care Management • Go-Live in June 2010 • Clinical Documentation (forms, notes and letters) • Care Management (PAS function) • ADT’s, Access Planning, OP management • Resulting • PACS viewing • Sequential capability • TTO prescribing (Nov 11) • Advanced Bed Management (Nov 11) • Emergency Care (Jun / Nov 12) • Test Requests (Sept 13)

Transrectal ultrasound biopsy of prostate clinic using clinical note and CDC forms

single Patient Record (sPR)

0 500 1000 1500 2000 2500 3000 3500 4000 Immediate Discharge Summaries Created in Lorenzo Jan 2011 - Sept 2012 single Patient Record (sPR) Step 6: Generate Short-term wins Long term change needs short –term wins within 14-26 months Visible and clear wins Reward change agents Reduce credibility of cynics and resistors Convert neutrals to weak supporters, then to strong supporters

R&R: Inc. External Report

R&R External Report (Gastroscopy)

GP Summary Care Record

Clinical Problem Recording

EPR Implementation Process • High-level Project life cycle Project Initiation and Deploy Go-Live and early life support 3000 users introduced to a new system Well run Project with good governance and controls Stability by November 2010 Adoption System and SOP familiarisation UHMB Trust Board sign off Jan 2011 Acceptance Process and content becomes irresistible

Patient Records in the 21st Century Risk Management Crossing the system transfer void • Good Communications • Good Governance • Good Project Management • Proactive management of the risk envelope – Don’t attempt too much, keep it manageable and credible – Change process before cut over or after not on the day – Engineer break points, Emergency Department? – Keep the big in big bang as small as possible – Keep the data migration as tight as possible – Look for a good day

Process of Clinical Engagement Informatics-led to Clinically engaged to Clinically-led Informatics Go Live Newly appointed Clinical Lead for Informatics IDS go live TTO go live EC go live New Clinical Directors in post Establish CCIO Clinical priority setting Step 2: Create a guiding coalition Position power Expertise Credibility Leadership

Clinical Engagement 1 • Hearts and minds, hearts and minds • Good communications • Small wins • Infection Control Team • Surgeons CPD • Reward supporters • Hardwire systematic change through “red line” steps

Clinical Engagement 2 • Mandated red line steps • Possess a smartcard (March 2011) • View NP referral letters on screen (June 2012) • “Training Workshops” - 228 of 230 consultants (Sept to Nov 2012) • Adopt IDS as sole discharge communication with GP’s - Dec 2012 (83 % within 24 hours) • “Paperlite” outpatient project (April 13 to June 14) Step 4: Communicate the vision for buy-in Most companies underestimate communications by factor of 10 Stalls transformation Comm’s – vivid, simple, repeatable, invitational Leaders – “Walk the Talk”

Requirements Work Package & Plan – sign off Sign off train, Start Finish 5 weeks Content built Dry run Pilot * Technical enablement of diagnostics ** Train technician/clinician 7 weeks Treatment Function - High Level Plan “Paperlite” Outpatients Project Step 8: Make it stick – Incorporate change into new culture Change norms of shared values and behaviour Inertia can be maintained by longstanding staff, need to overcome Prove new way is better than old Success is visible and communicated May lose some people in process Reinforce new norms / values with incentives and rewards Reinforce new culture with every new employee

Morecambe Bay Future EPR Developments -1 • Complete Paperlite Outpatient Project June 2014 • Inpatient Paperlite Care – Rollout Test Requesting – In Patient Prescribing and Meds Admin (IPPMA) – Documentation (inpatient and ED) – Observations – ICP’s – Theatres Step 5: Empowering broad-based action Reduce layers of management Align to customer (user and patient) needs Devolve responsibility Excellent communications Remove troublesome supervisors, honesty, change or remove

Morecambe Bay Single Patient Record Development • Interoperability • GP Systems – Documents, Messages, Reciprocal Summary Views • Medical Devices • Community Services , Social Services (Strata) • Connect up an e-Health Economy • Local Trusts (Blackpool, Preston, Blackburn) • Support whole patient pathways • Empower Patients view and interact with records Step 7: Never letting up Consolidate gains / produce more change Maintain critical momentum Drive new behaviours and practice into embedded culture Needs concerted effort, new projects, new people recruited, Do not declare victory Leaders steer for the long term

Morecambe Bay Single Patient Record Development • Has Morecambe Bay been successful ? Not yet (goals keep changing) Healthcare is evolutionary It is all part of a journey