Data, information and technology should improve outcomes for patients, create better experiences for staff, and shape more efficient ways of working. This was the vision outlined by nurses and midwives taking part in a consultation organised by the Royal College of Nursing last year in the UK. 

But their findings also indicated a disconnect between the expectations of staff and what was happening on the ground. It highlighted challenges around the use of outdated technology and further issues stemming from organisations not prioritising the voices of nurses or midwives in digital leadership. 

Earlier this month, Healthcare IT News (HITN) caught up with Katie Trott, chief nursing information officer (CNIO) at the Royal Free London NHS Foundation trust. The Royal Free is one of the biggest trusts in the UK, delivering care and treatment to over 1.6 million patients each year across three main sites, the Barnet, Chase Farm and Royal Free hospitals. The Chase Farm Hospital, which opened in September last year, was validated at Stage 6 of the HIMSS Electronic Medical Record Adoption Model (EMRAM) this summer.

Trott will be speaking at the beginning of October at the Healthcare Excellence Through Technology (HETT) event in London, where HIMSS, owner of HITN, is launching the Nursing & Midwifery Informatics (England) Network. The new initiative recognises the need to promote the role of nurses and midwives in the implementation of digital technology, marking the first local representation of the HIMSS Nursing Informatics Community in Europe. 

Ahead of the event, Trott spoke to HITN about the trust’s EPR go-live, the role of the CNIO and preparing staff for the digital future.

This interview has been edited for length and clarity. 

Q: You went live with an electronic patient record system at the Royal Free last year, facilitating the opening of the new Chase Farm Hospital. What can you tell us about the implementation, and how is the system enabling nursing and midwifery staff deliver better care to your patients? 

A: Our EPR implementation was actually a bit of a one-of-a-kind in some ways. We did an 11-month project, which is particularly short for an EPR deployment. We worked with the supplier [Cerner] to have a baseline that came from their work with a number of other UK trusts that we validated, rather than starting with a blank sheet of paper to design the EPR from scratch. The actual implementation itself, the first three months were spent doing clinical and operational validation for everything going into the EPR for content and functionality. We had lots of workshops with a variety of clinical staff and operational staff.

We then had a three-month period of testing, and that was both testing by our technical testing team, but also what we call user acceptance testing. So again, we had lots of clinicians coming along to sessions. I actually called it “break the system” rather than testing, because I sort of set them the challenge to tell us what is not working so that we can fix it now [at the time].

After that, we had about eight weeks of training leading up to the go-live itself, and then D-Day came, and we had a small period of down time where we were just uploading everything and moving across all of the data from our older systems into the new system. We then went live all together in one weekend with the clinical services on five hospital sites. 

Q: And how did you prepare your workforce for the change? 

A: We were quite mindful of this [during the EPR implementation], because we had a lot of staff that were very IT-literate, but we also had staff that might never have used a computer before in a work setting or any sort of technology other than medical devices, so different approached were employed. 

There’s a real diversity with the background, skills and experience of people, and therefore their training needs. While all clinical staff had classroom training in role based groups, encouraging the adoption of the EPR was supported by our operational and clinical leaders, and the chief medical information officers, EPMA pharmacy team and change and adoption leads. 

The biggest thing is, there’s no one-size-fits-all, everyone has to have nuances and different ways of working, and some people need one-to-one support, others don’t. It’s just being prepared to provide that. 

Q: What about burnout? How are you helping to ensure that the technology deployed eases pressures on staff and does not make their jobs harder instead?

A: This is actually a piece of work that we’re currently working on, because once we went live, we let things embed in before working with teams to revise their workflows and use of the EPR. What we didn’t want is people to turn around and say, ‘I don’t need this’, having not had a chance to use it and decide whether they really need it or not. 

But now, we started it six months after go live [the project], people have had a really good opportunity to use the digital solutions, and not just the EPR, but all the other digital solutions that we set in at the same time, they’ve had an opportunity to use those in real clinical settings repeatedly. We’ve had several listening events where the staff have come along and been able to share with us their experiences, their thoughts, their wants, and we have a weekly change group where staff can submit development requests for any of our patient systems.

Q: And that speaks to the importance of the CNIO role and having someone that understands what their needs are be involved in the decision-making process. 

A: Absolutely. As a nurse and midwife I bring an understanding of clinical needs.  And we’re very fortunate that we’ve gota range of clinical staff that work in my team. There are EPMA expert pharmacists and six doctors that work part-time with IT. They’re still clinical andout there in a clinical environment, and so they come back and say, ‘This doesn’t work, or this would work better, or this is where we’ve got a bottleneck, what can we do about that?’

Q: Susan Aitkenhead, director of nursing and professional development at NHS England, has emphasised on a number of occasions in a column for HIMSS publications that there is a “vast amount of untapped nursing and midwifery digital leadership”. What has your experience been like in this field, and what made you turn towards clinical informatics? 

A: I was doing some service transformation work, and I was approached by the CCIO [at the Royal Free] at the time who said they were going to be doing more with IT for clinical staff. At the time, the IT department were looking at electronic patient records and improvements in digital solutions, but obviously all of those are very clinically-based, and they had identified that they would probably need some help with that as a sort of translator. 

I’ve been doing the role now for four years, and it’s really changed dramatically in that time. Moving greatly towards being a truly clinically led IT strategy. It’s been a real development to change towards that, and I’d say particularly the last two and a half years I’d say have really promoted clinically-led innovation, rather than innovation for innovation’s sake.

Sometimes, you see something that people will say it’s clinically-led, but what they mean is a clinician doing it for them rather than a clinician coming and saying what they need and IT enabling it, and I’ve been really fortunate to be in a trust where there’s an emphasis on ensuring it’s the right thing clinically.

Q: What would you say is being done to expand this approach and ensure that the voices of nurses and midwives are heard when looking at the implementation of technology?

A: It’s about really encouraging this work. I’m fortunate that I work in an forward thinking team, it’s just a really nice mix that brings different skillsets, experiences and different ways of thinking, because there’s never one single way and it’s really good to have those discussions. By being able to have the group approach, it really makes a difference to what we achieve at the end. 

I still think it’s a role that can keep developing. Often, there’s an emphasis on doctors, however, the nursing workforce is often much greater than the medical workforce. And so making sure that they’ve got full representation of that is really important, particularly as we have nurses taking on more and more extended roles where they’re seeing patients autonomously. 

That’s where I see real value in the CNIO role going forward, to really promote that and make sure that we’re fulfilling what we need for that huge nursing and midwifery workforce.

Healthcare IT News is a HIMSS Media publication.