The Download: Inside an Epic implementation

One little-mentioned technology triumph during the pandemic has been the NHS’ ability to implement new electronic patient record systems across large trusts while grappling with all the extra challenges created by covid-19.

Several trusts, including Barnsley, Walsall, Leeds and York Partnership, and Kettering have deployed EPRs at this hugely difficult time, especially given the lack of face-to-face support available from software companies whose employees have largely worked remotely.

But one such implementation in particular, the Royal Devon and Exeter Foundation Trust’s recent deployment of Epic, caught The Download’s eye.

Although it is now more than six years since Epic famously ran into major problems during deployment at its first NHS trust, Cambridge University Hospitals FT, there are still only a handful of other acute trusts that use the expensive but well regarded EPR, with Guy’s and St Thomas the latest to commit to the company.

The RD&E project is significant for two reasons:

1) It is the first deployment of Epic by an NHS acute and community trust; and

2) It marks the start of Epic gaining a foothold across an integrated care system, rather than just being used by trusts.

‘Hard to exaggerate the complexity’

Speaking exclusively to The Download, RD&E medical director Adrian Harris described the implementation as “enormously complicated”, with the needs of the trust’s community team adding an extra layer of complexity.

The added complexity of the community division came in the form of giving staff a tech solution which provided access to records from remote locations in Devon. The solution – called Rover – needed to work on GPRS (general packet radio service) and 4G when wi-fi was not available and needed to be interoperable with existing systems.

“It’s difficult to exaggerate the complexity of the project,” Dr Harris said.

“We had about 10,000 bits of new equipment purchased, and there were many systems we needed to interface Epic with.”

However, although the tech aspect was “immensely complicated”, preparing all the staff for the deployment was even harder, Dr Harris said.

After postponing go-live due to the outbreak of the pandemic, trust chiefs opted for an October launch. Any sooner was not desired due to staff being on summer holidays, while any later would risk the added interference of winter pressures.

Epic normally recommends a programme of training for staff that runs up to 12 weeks, individuals doing up to 30 hours of training depending on their role at the trust.

Due to travel restrictions, Epic’s USA-based staff instead had to create several hundred different videos tailored to each of the trust’s specialties. Dr Harris estimated staff were only given around 30 per cent of the usual face-to-face training.

“Some doctors would normally get 12 hours of training but only had four hours, and pharmacists ended up with about 12 hours when they would normally get 30,” he said.

“However, we were able to get every individual working in the trust to undergo the amended training programme.

Boost for contact tracing

The actual deployment of the system itself happened at 4.45am on a Saturday morning. Epic uses the “Big Bang” approach – essentially like flicking a switch across the whole trust – rather than a phased go-live at different stages.

“We were slightly delayed by 45 minutes, but technically we were in great shape and the system has run without a hitch since then,” Dr Harris said.

The go-live came at an opportune time for the trust, which shortly afterwards began to see an increase in covid-19 patients admitted as winter approached.

Having Epic installed just before the second wave of covid-19 also brought some “incredibly helpful benefits”, Dr Harris said.

The new EPR provided the trust with vital information to help with contact tracing when patients tested positive for covid-19 in hospital.

“We could see which patients had covid, which patients were awaiting a covid test, when the test results were available, and - because we knew exactly how long each patient was in each bed - we could determine if an individual had come into contact with a covid-positive patient,” Dr Harris said.

Taking a system approach

Now that infection rates are lower and the winter pressures have started to abate, the trust will enter the “stabilisation” phase of the Epic implementation.

This means collecting more feedback on how the system has performed and customising it to people’s needs.

The process usually takes several months. RD&E chiefs are also determined in the longer term to roll out Epic at Northern Devon Healthcare Trust, with which RD&E is merging.

Additionally, a memorandum of understanding with neighbouring Torbay and South Devon FT on strategic projects further raises the prospect of the three trusts using the same EPR in future.

This would put Epic in three of the Devon’s four main acute hospitals, which would likely offer further opportunities to collaborate on patient pathways and data.