Health Service Focus

01.10.15

Open source future

Source: NHE Sep/Oct 15

Wye Valley NHS Trust has become the second trust to opt for an open source EPR. NHE spoke to Simon Lind, project and portfolio manager for the implementation at the trust, and Leesa Ewing from supplier IMS Maxims.

Wye Valley, the acute and community services provider for Herefordshire, also serving parts of Powys, is starting a two-year implementation of a new EPR (electronic patient records) and clinical IT system that will end the trust’s historic over-reliance on paper. 

After an extensive output-based specification, the trust chose to work with IMS Maxims, choosing its open source software via the NHS Shared Business Services (SBS) framework. 

Simon Lind from the trust said the fact the software was open source was “attractive”, though not in itself a primary driver. He said: “We’re hoping to quickly and safely move towards a paper-light environment within the trust. At the moment we’re very heavily paper-dependent in our clinical records and our noting and our recording. That’s really holding us back in terms of enhancing our patient care.” 

The new system will make clinical information “much more readily available”, he said, than the current software from CSC, originally delivered via the National Programme for IT (NPfIT). 

The capital cost for the new project is about £14.8m. The trust won £1.35m towards this from NHS England’s Integrated Digital Care Fund, which was less than the £6m initially requested, but the shortfall was funded via an NHS Trust Development Authority (TDA) process. 

The first phase, to go live in autumn 2016, will be to replace the trust’s two patient administration systems (PAS) and ORMIS theatre system. Lind said: “After that first initial phase and go-live, we’ll be looking to increase further the clinical functionality and the way the clinicians engage with the system. That will be completed in the autumn of 2017. 

Special measures 

The trust remains in special measures after a critical CQC inspection in summer 2014, though when NHE spoke to the trust, the CQC had recently done a reinspection. Their report is not yet available. 

Leesa Ewing, business development manager at IMS Maxims, suggested that because the trust was under the spotlight, it made sense to go for a simpler and cheaper procurement, rather than a full drawn-out OJEU process that could take up to two years. She said: “The formal OJEU process is very expensive, not only for SMEs like ourselves, but also for trusts – it can take up to two years to run a process. The NHS SBS framework significantly reduced that length of time, from making a decision and looking at the marketplace and deciding what offering you wanted to go for, to actually contracting. For a trust that was in special measures and under the watchful eye of the TDA etc, I don’t think it would have been wise to go through a very lengthy, expensive competitive dialogue and OJEU process.” 

She said other trusts should consider looking at the NHS SBS framework and G-Cloud 7. “It’s less costly for trusts, and it’s less costly for us as a supplier. We can pass those cost savings back into the NHS. We’re excited that we’ve proven it can be done.” 

The trust has been keen to ensure the change is clinically-led, not just an IT project, which tallies well with IMS Maxims’ approach, since the whole reason it went open source was to get more clinical input into its code. Ewing particularly welcomed the input of Dr Jake Burdsall, consultant lead for IT, who said: “To have visibility of a patient’s record, especially in emergency situations, is fundamental for improving care.” 

Wye Valley has also been working with Taunton & Somerset NHS FT, which last year became the first trust to go for an open source EPR from IMS Maxims. Its director of informatics, Malcolm Senior, wrote for NHE at the time, when he said: “Lessons learnt from NPfIT suggest that a one-size-fits-all approach for EPRs has its limitations, as every trust made the case, rightly or wrongly, that it was somehow different. This is why we believe that open source provides another way of delivering those clinical benefits; trusts can take ownership of the code and develop it alongside clinicians to their requirements.” 

Lind said: “We haven’t always felt very supported by some of our incumbent suppliers, so having that facility of being able to go outside and alter the code is something that is of interest.” 

NHE spoke to Wye Valley the same week that Cambridge University Hospitals NHS FT was told it would be put in special measures, partly because of its own troubled EPR implementation, known as eHospital. We asked Lind about Wye Valley’s resilience and contingency plans and he said: “At the moment we’re getting the team together; we’ll need to ensure processes are tight to get the best from the system and new clinical processes. We’ll test them and test them, and in the end we won’t go live until we are ready and can demonstrate that.”

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