• Royal Devon and Exeter Foundation Trust implementing new electronic patient record
  • Care pathways to be redesigned as part of project
  • Work being carried out in a bid to avoid problems faced by other trusts moving to Epic

An acute and community trust is reviewing four of its main care pathways in an effort to avoid issues faced by other providers as it prepares to switch to the Epic electronic patient record.

Royal Devon and Exeter Foundation Trust is the first combined acute and community provider in England to deploy Epic’s electronic patient record.

Cambridge University Hospitals FT, which was the first trust to switch to American company Epic’s software, endured more than a year of difficulty upon rolling it out. These difficulties contributed to the trust facing financial problems and being placed in special measures

A review of the implementation by Stanford University Hospital identified one of the main issues which led to problems was CUH’s failure to reconfigure any of its clinical pathways ahead of Epic’s implementation. 

Therefore, the Exeter trust has decided to review and redesign elements of its elective, emergency, outpatient and community services as part of its implementation process ahead of its go-live scheduled for June 2020.

The system is expected to replace 60 other systems currently used by the RD&E, including a patient administration system which is more than 30 years old.

Tracey Cottam, director of transformation and organisational development at the trust, told HSJ some pathways may need redesigning to fully take advantage of the Epic system.

For example, in outpatients, patients can access a “portal” on computers or mobiles to enable “remote monitoring” of some conditions. This means people can be assessed in their own homes and be seen when “need arises, not as a matter of routine”.

The trust will also work with GPs to develop a portal for sharing information to better link up care records across primary and secondary care.

The pathway reviews are expected to conclude later this year.

Asked what the biggest risk to the trust during implementation is likely to be, Ms Cottam highlighted data management as a concern.

“We have to make sure the data quality is up to scratch,” she said. “We don’t want to fill up the new system with inaccurate data.

“Another threat is making sure the change doesn’t affect how we deal with our operational pressures. If they get even worse than they are now then we need to make sure we’re still delivering care to patients the way we are now.”

More than 120 staff have been hired to work on Epic’s implementation, of which around 80 were existing members of staff at the RD&E.

Ms Cottam said the programme involved a large cultural change.

“The reason this [programme] exists is to help the organisation deliver care in a better way,” she said. “We have to change the culture and prepare 8,000 staff for a new way of working.”

While Ms Cottam said it was “too early to say” if the move to Epic would lead to some jobs being scrapped, she said  “a number of roles will change”, such as administrative and clerical roles. She said job tasks were likely to change, rather than the job itself.

She described the response from the unions as “positive”.

University College London Hospitals FT went live with Epic last month, while Great Ormond Street Hospital FT is also planning to implement the software

RD&E’s neighbour Torbay and South Devon FT is also considering choosing Epic as its new electronic patient record system.