How the unthinkable led to the unimaginable

When coronavirus arrived in the UK, The Dudley Group NHS Foundation Trust advanced its IT by “four years in four months” to support clinicians and patients. Chief information officer (CIO) Adam Thomas told a Digital Health webinar what it learned along the way.

The unthinkable happened in March, when we woke up to the reality of Covid-19. None of us should ever lose sight of the fact that there is an enormous, human cost to this disease that continues to this day.

But the unimaginable happened because in preparing to confront the consequences of the pandemic, we realised that a lot of things that had seemed like big issues were no longer major problems.

Take virtual access to outpatient clinics, for instance. About six months before Covid arrived, I was in a meeting about whether we could do this and still deliver good care. It was an aspiration in the NHS Long-Term plan, but in that meeting it felt like it was a long way off.

Then Covid-19 arrived, we rolled out the Attend Anywhere platform in four days, and that answered the question because we went from delivering 5% of outpatient appointments virtually to delivering 60% by video or phone call.

Challenges addressed

That’s just one example. In many ways, the challenges we addressed during those early weeks of the coronavirus crisis were challenges we had identified before Covid-19 arrived.

They included: providing better access to information for staff and patients, encouraging collaboration by moving from a transactional approach to a more flexible way of working, and integrating care across our pathways.

However, before Covid-19, we were struggling with this agenda. It wasn’t just virtual access to outpatients. We had been discussing longitudinal records and population health management to the point that I’d stopped talking about ‘interoperability.’

The word had become a turn-off for the board and for our clinicians. Then, the pandemic hit and for seven weeks we delivered digital improvements week on week.

Delivering at pace

So, we did a lot of work on Covid-19 testing and we created an SMS service so staff could get negative results in a matter of hours, which built a lot of confidence.

Meanwhile, we got people connected via laptops, signed them up to Microsoft Teams, and did a rapid piece of work on remote radiology so clinicians who needed access to images could have it.

We created a flexible working environment in which we could track productivity. We soon realised that NHS staff members were working far too hard at home, so we created a support model to address that and put in some continuous professional development so people working from home could stay up to date.

In our hospitals, we reconfigured our physical space and worked with Allscripts to make sure that our Sunrise electronic patient record was configured to support the triage and treatment of acutely unwell patients and that their Covid-19 statuses could be displayed on tracking boards.

And we accelerated a project to roll out our information sharing and population health management platform, the Allscripts dbMotion Solution. After all that talk about population health management, we had been working on a three- to six-month deployment programme to run this summer and suddenly we were able to deliver it in a matter of weeks.

We pulled medications information from the EMIS system that our GPs use into the platform, and we added laboratory and radiology information and documents from trust systems, so it was all accessible to clinicians at the touch of a ‘blue button’ in context, all within the EPR.

Facilitators for progress

The facilitators for progress were threefold. As an acute trust, we found ourselves operating in a changed funding structure. There was money available from the government and a streamlined approach for getting approval to spend it.

We had strong working relationships with suppliers, who were offering free access to their products, extra licences and enhanced support. And we had a strong, common goal, which supported teams and enabled us to drive forward projects like the dbMotion roll out.

Perhaps the most important aspect of this time was having a common goal. During the crisis, we were able to shift away from asking ‘what is the IT issue here’ to ‘what is the healthcare issue that IT can help to resolve’ and that created a ‘pull’ effect.

Learning lessons on what to stop, keep up and start

The question now is how to make this sustainable. If one of the reasons we have been able to make progress is that we have had a common purpose, then how do we keep up momentum day to day, when we don’t have a common enemy like Covid to provide one?

Our plan is to draw on the lessons that we learned during the pandemic, and to identify what we want to start, keep doing and stop. So, we are going to stop talking about ‘IT issues’ and we are going to stop talking tech jargon like ‘interoperability.’

We are going to stop trying to define the solution from the outset, only to find that it does not do what people wanted it to do. And we are going to stop making perfection the enemy of the good.

Instead, we are going to keep talking about operational and clinical needs and how technology can address them. And we are going to continue with agile development processes.

Aligned with that, we are going to be looking to maintain confidence at board level, so we can continue to use board-level leadership to guide the way the organisation moves forward in this space. But we are going to start developing a new cohort of clinical leaders who have stepped out of the organisation.

We also want to build patient and citizen advocacy, because while we weren’t always able to include all stakeholders as we moved at pace during Covid, the patient voice will be critical as we develop our local integrated care system.

To support that, we will be rolling out Allscripts Care Director. With this product, we can create care plans that professionals can share and act on across our pathways. We will use it to develop new digital services for patients and use the NHS App as a front-end, and build products behind them, so they get a consistent experience of any service that they use.

We will look to build even stronger relationships with suppliers, because our experience during Covid reinforced what I have always thought: we should be collegiate and collaborative. We should be working in partnership to share both risks and efficiency, quality and safety benefits.

No new normal

We should never forget the human cost of the unthinkable coronavirus pandemic, but we should also never forget that it allowed us to make previously unimaginable advances with technology. People are starting to talk about a ‘new normal,’ we do not want to go back to our ‘old normal.’

We need to review what happened and establish what worked and what didn’t so we can embed new ways of working. At the same time, we need to start looking at really exciting ideas, like AI in imaging, digital pathology and process automation where that makes sense.

I concluded a recent Digital Health webinar with a Brian Eno quote: “Repetition is a form of change.” It’s true, but it’s not the form of change that we can continue to accept. We need to adapt and move forward.