A Decade of Digital Transformation

A Decade of Digital Client Profile The Dudley Group NHS Transformation Foundation Trust The Dudley Group accelerates its digital Dudley, United Kingdom journey during COVID-19 OVERVIEW • The Dudley Group NHS Foundation Case Study Trust is a National Health Service organisation, based in the West Midlands • Runs acute and community services for a population of 450,000 • Part of a developing integrated care system, working on new models of patient-centred care • Long-standing relationship with Allscripts, dating back to 2006

SITES • Russells Hall Hospital • Guest Outpatient Centre in Dudley • Corbett Outpatient Centre in nearby Stourbridge • Delivers community care from 40 centres in the Dudley Metropolitan Borough Council area and in patients’ homes

Since 2006, The Dudley Group NHS Foundation Trust has worked with Allscripts to deliver its Digital Trust programme, which is built around the integration of the Allscripts® patient administration system and Sunrise™ Acute Care to form a comprehensive electronic patient record system.

As part of a broader integrated care system, the trust is also using the Allscripts population health platform, the dbMotion™ Solution, to share information between acute clinicians and GPs.

Instead of stalling a major phase of the dbMotion roll out, the coronavirus outbreak gave it an additional impetus, as the trust needed to give its clinicians access to critical information to support the triage and treatment of patients with COVID-19.

The Dudley Group has just completed the implementation of e-prescribing for adult inpatients, and is planning further deployments, including the roll out of e-prescribing and Allscripts® Care Director. This will give it the digital platforms it needs to move forward as the NHS looks to “reset, not just recover.” About The Dudley Group NHS Foundation Trust and its relationship with Allscripts®

The trust

The Dudley Group NHS Foundation Trust, based in the heart of the Black Country in the West Midlands, provides hospital and adult community services for a population of nearly 450,000.

The trust’s acute care facility, Russells Hall Hospital, was first planned in the 1960s as a general hospital for Dudley but was redeveloped in the 2000s as the main acute and elective treatment centre for the area. The revamped Russells Hall Hospital was opened in 2005 and is cited as “among the most technologically advanced in the country.”

Relationship with Allscripts

The Dudley Group has a long-standing relationship with Allscripts dating back to 2006, when it implemented the Allscripts patient administration system.

The Allscripts PAS provides the functionality that supports all aspects of patient “Allscripts offers a very registration and appointment scheduling, patient administration, and bed management within the hospital. stable PAS platform that is very responsive to our The relationship was reinvigorated in 2016, when The Dudley Group announced needs. Allscripts has also that Allscripts solutions would sit at the heart of a ten-year, £32 million Digital Trust invested heavily in the programme. integration between the The trust wanted to retain the PAS and add clinical functionality. Following an open PAS and the Sunrise EPR tender, it announced that it would develop an EPR by deploying Sunrise™ Acute Care to deliver a streamlined as an integrated solution. process for key workflows.” Chief information officer Adam Thomas explained, “Allscripts offers a very stable Adam Thomas, Chief PAS platform that is very responsive to our needs. Allscripts has also invested heavily Information Officer in the integration between the PAS and the Sunrise EPR to deliver a streamlined process for key workflows.”

At the same time, recognising that new models of integrated care rely on information sharing between clinical settings, teams and patients, The Dudley Group announced that it would use the Allscripts population health platform, dbMotion, to support integrated care in the borough and more widely as part of an integrated care system.

Key go-lives

The trust went live with the first elements of Sunrise in May 2018, when it started its deployment with electronic observations and Sunrise™ Mobile. It also implemented a proof of concept project to share information with local GPs, using dbMotion.

As an early implementer, the trust worked with a handful of local practices to demonstrate the platform’s capacity to share information across the healthcare economy and to provide a foundation for further integration between the acute, primary care and other systems in the area.

The trust continued to extend its use of Sunrise in 2018, adding enhancements for NEWS2 scores and sepsis documentation. It then went live with the system in the emergency department (A&E) and rolled out order communications across the entire trust in 2019.

Case Study In 2020, it rolled out medical device integration, electronic prescribing and medicines Outcomes administration, a selection of assessment tools and further dashboards. • Reconfigured Sunrise EPR to tackle sepsis • Patient observations are recorded The Dudley Group’s success with in a standardised way and used to Allscripts Sunrise EPR calculate the NEWS2 score • Decision support tools enable staff to identify at-risk patients An award-winning project to tackle sepsis • Deaths from sepsis are now below the national average The trust decided to deploy the Sunrise EPR to make sure that staff members • Won ‘Best Use of Data’ in the Leading could record patient observations in a standardised way across all areas. It used the Healthcare Awards 2020 for its work e-observations functionality to help staff automatically calculate the National Early • Adapted its sepsis tools to track the Warning Score 2, known as NEWS2, which was developed by the Royal College of status of COVID-19 patients during the coronavirus emergency Physicians to identify patients at risk of deterioration.

It also built in a sepsis tool that prompts staff members to complete sepsis documentation for patients at risk, based on clinical data already entered, and guides them through appropriate assessment, investigations and treatment.

In addition, escalation, de-escalation and exceptionality tools have been configured to ensure individualised care needs are appropriately met.

In parallel, the trust created sepsis dashboards to give senior clinicians and the trust sepsis team an overview of the entire hospital population, to identify deteriorating patients, ensure appropriate care and enable earlier intervention, where required.

Bill Dainty, the resuscitation and deteriorating patient lead, explained, “They have seen individual teams ‘own’ their data and look for ways to constantly improve outcomes and shorten the time taken to commence treatment.

“By identifying the very sick earlier, we have been able to expedite treatment for many patients who might otherwise have experienced extended stays or poorer outcomes.”

The trust’s action on sepsis not only addressed improved patient outcomes and quality standards. Its work has also been recognised by a national award: in April 2020, the trust won the ‘Best Use of Data’ category in the Leading Healthcare Awards 2020.

Sunrise supports the trust’s COVID-19 response

The novel coronavirus arrived in the UK in late January 2020 and reached the Midlands a few weeks later. As part of its COVID-19 response, The Dudley Group made rapid changes to its Sunrise EPR.

Patients with COVID-19 and at risk of sepsis were also identified on the tracking boards. Bill Dainty said, “These patients frequently represented those experiencing a concurrent bacterial infection and being able to identify these patients allowed earlier administration of antibiotics and a respiratory team review.”

Existing Sunrise functionality meant clinicians treating patients with COVID-19 had fast, easy access to relevant blood test and imaging results.

But the trust optimised documentation and created a critical care review document to record intensive care unit input and consultations consistently, with a clear plan of care and escalation points.

It also created new documentation to record “ceilings of care” to consistently capture the extent of treatment plans, through enhancements to its documentation for capturing and acting on “do not resuscitate” instructions.

Dudley Group NHS Foundation Trust Data feeds in Dudley’s Coronavirus expedites dbMotion activity implementation of dbMotion: dbMotion is a population health platform that aggregates information from multiple systems to create a single view of a patient’s data. Unlike other information sharing • Local GP data (patient demographics, encounters, medications, allergies and products, it appears to clinicians as a “blue box” in the top corner of the EPR that problems) they use every day. • Labs The “blue box” alerts them automatically if there is information available from other • Radiology Sunrise documents sources about the patient whose record they are viewing – without needing to leave (respiratory assessment, respiratory assessment consultant review, sepsis their workflow or log into a separate system and then search for the patient. documentation) At the Dudley Group, clinicians can click to see additional information from two • e-observations data sources: the EMIS system used by GP practices in the area and other systems in use • Third-party system documents (discharge summaries from pharmacy, within the trust. Further data will be added. ICU, ICU Nursing and ED) GP data feeds Planned data feeds: Following the initial proof of concept, the trust worked with Allscripts on the technical • Do not attempt CPR integration required to expose discrete data from all GP practices using EMIS to • Respect frailty assessment hospital clinicians. But multiple, conflicting priorities meant activation was delayed. • Additional GP information (vitals) In March 2020, as the trust responded to the coronavirus outbreak, it decided to • Sunrise health issues (allergies and diagnoses – medications will be accelerate a three- to six-month rollout project planned for summer 2020, starting available following a recent Sunrise with the information most useful for the triage and treatment of COVID-19 patients. e-prescribing implementation. This included a patient’s GP medical history and medications data.

Trust data feeds

The trust also moved to give clinicians access to data from its own systems through dbMotion, so they did not need to log out of Sunrise and into multiple systems to search for it.

For example, it activated access to the past discharge summaries that are held in a third-party document management system, to give clinicians access to further details about previous visits.

The next step will be to enable clinicians to import discrete data from dbMotion to their Sunrise EPR, using a feature called Send to My EHR. This will enable users to select the data they want to incorporate and cut the time and risks involved in transcribing information from one system to another.

Working at pace

The trust was able to move fast on dbMotion because it had a delivery project team in place with a strong working relationship with the Allscripts UK delivery team.

Project lead Simon Richards said, “We had been working on a rollout plan and suddenly everything was different…We cleared a whole phase of the project in just a few weeks that would otherwise have taken until the end of the summer.

“That has put us in a much better position to deliver on our plans for a longitudinal care record and to support population health. dbMotion is a key tool for us now.”

Case Study Clinical benefits

The visibility of historical clinical data in dbMotion saved admitting doctors valuable time when assessing patients with dementia. For example, they could see whether patients were recorded on the dementia register, which gave them immediate confirmation as to whether their symptoms were new or historic.

Meanwhile, pharmacists noted how much quicker it was to validate patients’ home medications – a process that otherwise required logging into other systems and/or calling the GP practice or retail pharmacy.

Max Hodges, the trust’s chief clinical information officer, said, “Being able to find out quickly what medications the GP thought they were taking was enormously helpful. These benefits will continue post-COVID-19.” “Information is valuable, The CCIO noted that the information available through the EPR and dbMotion is and we have improved supporting clinicians who are delivering clinics remotely, and who might not be able the quality of information to access paper documentation from home. available for clinicians.” “Information is valuable, and we have improved the quality of information available Max Hodges, Chief Clinical for clinicians,” he said. “In time, we will be able to bring it into our Sunrise EPR, Information Officer using Send To My EHR, which will save more time for clinicians and reduce transcription error.”

In July, the Dudley Group was ‘highly commended’ for its work on dbMotion in the ‘working at pace’ category of the Health Tech Newspaper’s Health Tech Leaders Awards 2020.

The Dudley Group plans the future in partnership with Allscripts

The Dudley Group plans to extend its use of both Sunrise and dbMotion. It also plans to adopt additional Allscripts solutions to progress the national and local vision of a joined-up care system, in which clinical teams can more easily communicate with each other and with patients.

Sunrise e-prescribing and medical device integration

The trust is working on a project to implement electronic prescribing and medicines administration and has just gone live with a first-phase roll-out to adult inpatients.

This important project was delayed by the reconfiguration of hospital services in response to the coronavirus crisis but is progressing and should be complete by the end of 2020. In the meantime, the trust has begun to integrate its bedside medical devices with the EPR.

This work has been piloted in the coronary care unit and there are plans to go live in the ED resuscitation area, where patients are typically linked-up to multiple devices that monitor their pulse, blood pressure, heart rhythm, oxygen status and other vital signs.

The integration of medical devices with Sunrise will enable observation data to be automatically fed into Sunrise flowsheets to minimise the amount of time that nurses spend on documentation, while reducing possible transcription errors.

However, each data item will be acknowledged by trust staff before being committed to the record, to make sure that any changes in serial measurements are not missed.

Dudley Group NHS Foundation Trust Timeline: dbMotion information sharing

• 2006: The Dudley Group uses the The Dudley Group also plans to feed additional information into dbMotion from the Allscripts PAS IT systems used by its partners in the ICS. This includes the systems used by social • 2016: The Dudley Group signs with Allscripts for Sunrise and dbMotion care services, which in England are run by local authorities (councils). • 2018: First go-live with Sunrise Acute The trust is currently talking to its partners about operating models. When these are Care confirmed, it will make sure that dbMotion and other IT systems can support them. • May 2018: Proof of concept for dbMotion • September 2019: National funding Additional Allscripts deployments secured for dbMotion rollout and investment in population health To support new care models, the trust is also planning to deploy Allscripts Care analytics Director. Care Director enables organisations to create and share care plans across • March 2020: dbMotion project care settings, providing a unified view of a patients’ care for all multidisciplinary care accelerated to respond to coronavirus team members. crisis • Summer 2020: e-prescribing rollout Task-based workflows and messaging are used to structure care team activities for • Coming: Allscripts Care Director each patient lead and overseen by a care coordinator. Patients and caretakers also for integrated care coordination, form a part the care team and are assigned tasks to update, track and complete population-level analytics and remotely against the overall care plan. intelligence, and patient portal The trust also plans to use Allscripts patient engagement solution to enable the targeting of focused care to those patients requiring it most through increased interaction and monitoring in the community.

Reflecting on The Dudley Group’s digital journey

Speaking at the Digital Health Rewired conference two weeks before the UK COVID-19 lockdown, Adam Thomas reflected on his trust’s journey with Allscripts.

“We have an ageing population, living with a growing burden of chronic disease, exacerbated by health inequalities and our vision is to create a population health management solution to help to address them.

“We started [the first step, to deploy dbMotion] with a proof of concept with a small number of GPs who wanted to see the contact that their patients were having with our hospital. We were surprised that such a small amount of information could have the impact that it did, but it really helped.

“Now, we are looking to make more use of the platform; the information in dbMotion will mean that we can start to work on care coordination and to see people in the most appropriate setting.

“Our clinicians have been glowing in their compliments for what we have done during the outbreak, and now we are in a great position to move onto other things, in partnership with Allscripts.”

To learn more, visit uk.allscripts.com