Transformation Directorate

Using digital, data and technology to improve the outcomes of patient care in North West London

Imperial College Healthcare NHS Trust provides acute and specialist healthcare in North West London for around a million people every year. It has five hospitals and over 13,000 staff. The Trust is part of the Imperial College Academic Health Science Centre and the Health Informatics Collaborative, and hosts a biomedical research centre with Imperial College London for the National Institute for Health Research. Imperial is one of the four acute trusts in the North West London Integrated Care System.

The EPR system at Imperial

The critical step of replacing the patient administration system happened in 2014 and clinical modules were introduced in stages between 2013 and 2019. This staged implementation was possible because we were largely replacing paper and not an existing electronic patient record (EPR) system. In contrast in 2019 we collaborated with our neighbouring Trust to switch them to our EPR during one weekend. We use the Cerner Millennium system.

The EPR system in the digital strategy

The North West London Integrated Care uses a seven steps framework to inform its digital and data strategy. The second step is digitising the patient record and, combined with resilient infrastructure, it provides the essential foundation for everything else For example, data from our EPR system goes into:

  • the London Care Record for staff for direct care (data sharing)
  • the Care Information Exchange portal for patients (patient empowerment)
  • the Whole Systems Integrated Care system (population health).

We have been continuously developing the EPR to improve patient safety and care, and clinician and patient experience. This process accelerated when Chelsea and Westminster joined us on the system and will expand again when it becomes a four trust collaboration at the end of 2023.

What the EPR has helped us deliver

Paper free outpatients

Introducing the EPR took away 80% of the paper in outpatients, and the paper-free project tackled the remaining 20%. Now when adult patients visit our hospitals for outpatient appointments, all of the records held by the Trust relating to the patient are available to clinicians from their computers. Clinical decision making can always be supported by all the information available to the Trust, and the reliance on having the right paper records in the right place at the right time is removed. This has delivered a £1.2m net reduction in the annual budget for health records rising to £2m recurrent by 2023, and has released 1680m2 of hospital space for operational use.

Wireless entry of patient vital signs

Nursing staff routinely take observations like blood pressure, heart rate, temperature and oxygen saturation using mobile bedside monitoring devices. Previously these observations had to be entered manually into the electronic patient record. Now the information goes directly into the patient record over WiFi. This reduces the risk of error, increases patient safety by triggering alerts for deteriorating patients, and saves time. It’s available on wards across the Trust and releases 23,000 hours of nursing time for care every year.

Digital monitoring of foetal and maternal vital signs

Around 10,000 babies are born at Imperial College Healthcare every year. Contractions and foetal and maternal heart rates from cardiotocograph (CTG) devices were previously printed out on rolls of paper and midwives added handwritten clinical observations. These records were hard to share quickly for a second opinion.

The solution was to connect the CTG machines to the EPR system. Maternity staff can now view electronic, graphical displays of heart rates and contractions for all mums and babies on Trust labour wards. They can spot signs of distress and take action quickly, improving patient safety. The data is recorded in the electronic patient record.

Using data to improve care

Clinical data analytics is enabling improvements in clinical practice and better outcomes for patients. Digital sepsis alerts, test bundles and treatment plans were central to an improvement initiative that led to: 

  • 71% increase in the likelihood of patients receiving timely antibiotics
  • 7% reduction in the chances of a patient experiencing a long hospital stay
  • 24% reduction in the risk of death from sepsis.

Analysis of the effectiveness of risk assessments for venous thromboembolism (VTE) demonstrated a clear benefit to patient care from timely risk assessments and preventive treatment where needed.

Care Information Exchange

More than 400,000 patients have access to parts of the hospital health records including appointments, test results and letters via the web or via the NHS app. This helps give patients the information they need more quickly and gives them more of a sense of control over their health and care. All of the data comes from our EPR system.

London Care Record

This gives access to data from North West London GP practices and from the nine acute trusts across London that use Cerner. It is also the way that clinicians access the Urgent Care Plan system. This is invaluable for clinical staff particularly when treating patients who are new to the Trust. One of our consultants reported that she uses the London Care Record for every single patient. The system is available primary and secondary care clinicians from the EPR systems they use every day.

Whole Systems Integrated Care

Whole Systems Integrated Care provides a single integrated care record for clinical analytics, case finding, population health management, research and innovation. The system has coded data from primary, acute, mental health, community and social care providers across NW London. It provides capability to identify cohorts of patients for intervention through interactive dashboards.

Next steps

By the end of 2023, the 12 hospitals from all four North West London acute trusts will be using the same Cerner digital patient record system. This will deliver significant benefits for the individual trusts:

  • reduced payments to the supplier
  • improved staff experience for those who work at both trusts
  • patient safety benefits with information available to clinicians regardless of which hospital administered the treatment.

And it will support the accelerating collaborative work across the ICS and the transformation of clinical pathways.

Testimonials

Imperial College Healthcare completed its Cerner EPR implementation journey in a series of go-lives over eight years between 2011 and 2019. The global digital exemplar programme allowed us to work in partnership with our fast follower to launch the same system at Chelsea and Westminster in one weekend in 2019. And the journey has not stopped there. By 2024 we will have four acute trusts sharing a single EPR system in North West London.

Kevin Jarrold, Joint Chief Information Officer, North West London Health and Care Partnership, Imperial College Healthcare NHS Trust and Chelsea and Westminster Hospital NHS Foundation Trust

Our Digital by Design programme is supporting the Trust and the wider ICS to exploit Digital Data and Technology and embed a digital culture to deliver better health for life. Our EPR system is absolutely fundamental to that work.

Linda Watts Associate Director of Digital Transformation & General Manager Outpatients & Patient Access, Imperial College Healthcare NHS Trust  

Digital, data and technology are allowing the nursing community to drive improvements in practice and increase patient safety. One of the keys to success is making sure that new digital solutions are always within the context of the EPR system that nurses are using every day.

James Bird Chief Nursing Information Officer, Imperial College Healthcare NHS Trust  

The digital patient record and real-time operational data are now as essential to the front-line clinician and operational teams as the oxygen supply. They are mission critical systems. One example of this is the role of digital and data in our work to improve the speed and effectiveness of our response to suspected sepsis when a digital sepsis alert is triggered. This led to a 24% reduction in the risk of death from sepsis.

Dr Anne Kinderlerer, Consultant rheumatologist and Acute Physician Associate Medical Director