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