Digital transformation objectives underpinned with pioneering benefits realisation review

In 2023, the trust began its digital transformation journey by implementing Altera's integrated EPR system to accelerate its digital maturity. The goal? To meet the following transformation objectives:

1. Streamline clinical workflows to reduce administrative burden on staff and improve operational efficiency.
2. Improve documentation that can support improvements in patient outcomes.
3. Enhance access to data to ensure clinicians can quickly access high quality data and use reliable data to support informed decision-making.
4. Meet the National Wound Care Strategy Programme goal by reducing variations in care.

The EPR system is being delivered in phases, and this benefits review focused on tissue viability to understand and maximise its qualitative impact in both areas where EPR was already in use and areas it was yet to be introduced. It represented a seminal step for the trust to map the benefits of the EPR system with a focus on specific patient outcomes and quality improvements in tissue viability services.

"This was a quality-driven initiative as tissue viability is a key quality improvement priority for the trust. The effective prevention and management of skin and soft tissue health are critical in preventing complications like pressure ulcers and complex wounds. These can lead to prolonged hospital stay, increased morbidity and significant health costs, particularly for vulnerable patient groups such as the elderly and immobile patients."

Jackie Edwards
Chief Clinical Digital Engagement Officer at Worcestershire Acute Hospitals NHS Trust

In addition, full optimisation of EPRs is a challenge across NHS trusts. According to a research report published by the Health Foundation, when EPRs are used well they can unlock important care and productivity improvements. However, with England on the verge of every NHS trust having an EPR system, many aren't yet using these systems to their full potential. By assessing tissue viability which represents one element of the holistic EPR functionality, this has identified multiple system-wide opportunities to optimise and improve adoption of EPR that are relevant to achieving benefits from the entire range of EPR functions.

Robust, multi-disciplinary-led methodology

To inform the review, HIC led a multi-method assessment involving direct stakeholder engagement with staff across a broad range of departments - such as ward teams, tissue viability nurses, governance teams, digital leads, medical consultants and senior nurse leaders. This wide-ranging engagement ensured a thorough understanding of the real-world experiences of those using the system daily and those still using the paper processes and the diverse challenges and potential improvements related to the use of the EPR system in tissue viability management.

Many of the recommendations are widely applicable and not specific to tissue viability and hence implementation of these changes will amplify the benefits across EPR function, optimising patient outcomes and improving efficiency.

Engagement during the discovery phase was carried out via a stakeholder and staff workshop, ten 1-2-1 interviews and a trust-wide, semi-structured questionnaire to gather experiences of frequent users.

Analysis of the survey and interviews were combined with process mapping information, system data and use cases to measure qualitive benefits realised so far, baseline benefits and identify challenges.  By establishing a baseline of current benefits, it offered a clear pathway for ongoing improvements to maximise the EPR's potential in enhancing patient outcomes, streamlining workflows and reducing the administrative burden on staff. The baseline would also serve as a benchmark for assessing the impact of future system optimisations, as well as improving the effective roll out of these features to other parts of the trust.

Key findings: Patient safety outcomes significantly improved

Qualitative benefits realised so far

The phased introduction of the Sunrise EPR system at Worcestershire Acute NHS Trust has led to notable advancements in tissue viability management, moving from a cumbersome, paper-based process to a more efficient and cohesive digital workflow. The system's ability to centralise patient data, provide real-time access, and automate critical alerts has significantly improved clinical decision-making, continuity of care, cross-departmental communication and patient safety outcomes.

Feedback analysis highlighted key benefits, such as enhanced compliance with care protocols and quicker interventions for high-risk patients. As one clinician remarked, "The EPR system's ability to centralise information has allowed for quicker interventions without needing to be physically present, offering a comprehensive view of patient risk factors."

The shift from manual documentation to digital record-keeping has reduced errors commonly associated with illegible handwriting and fragmented paper trails, streamlining the work of the tissue viability team and governance staff.

• 96% of survey respondents found the trust's practices for managing tissue viability effective
• 60% of survey respondents said it was easy to document and access patient information related to tissue viability using the EPR system

Challenges identified

While the Sunrise EPR system has brought about several improvements, there are areas requiring optimisation to fully realise its potential. The discovery phase highlighted that due to the phased EPR roll out, manual processes, fragmented integration and incomplete data capture in specific areas are hindering full efficiencies, adoption and patient care improvements. Limited EPR training and awareness are also restricting optimal use of the system.

Providing closing thoughts on the project, Jackie Edwards, said: "This comprehensive programme has given the trust a fantastic opportunity to deep dive into a key quality priority, important to patient safety and outcome, and offer a meaningful process for digital and clinical staff. It's supported the trust to develop an implementation approach that is firmly grounded by better outcomes and will provide the best possible springboard to achieve our objectives."

Strategic recommendations and next steps

The following recommendations were shaped by HIC's analysis of system use, staff feedback, and baseline benefit mapping to address current challenges, realise planned benefits and support a strategic roadmap for optimising the system.

Quick wins for immediate patient care impact:

• Introduce mandatory fields and branching logic within the EPR referral forms to align with paper-based workflows, ensuring that all required information is captured consistently.
• Add a simple tick-box indicator within the EPR that flags when a wound image has been uploaded. This will allow clinicians to quickly check whether visual documentation is up to date, streamlining access to wound images and ensuring that relevant teams have the latest information available.
• Create a dedicated tissue viability summary view that consolidates all tissue viability-related documentation (e.g., wound assessments, SSKIN bundle forms, body maps, specialist nurse reviews, links to images). This will streamline document navigation, reduce the likelihood of missed notes and improve efficiency by providing a single access point for relevant information.

System optimisation for medium to long-term improvements:

• Integration with other key systems, such as medical photography
• Automated alerts for high-risk patients and repositioning reminders
• Integrated clinical guidance for high Waterlow scores (tissue viability risk assessment tool)
• Expanded options for surface selection in SSKIN bundle assessments
• Enhanced documentation clarity for recording offloading devices
• User-friendly interface with enhanced search capabilities
• Bedside access to observations
• Comprehensive training and education plan to elevate EPR competency across the trust

Why adopt a quality-assured EPR optimisation model?

This innovative approach to benefits realisation offers the following major benefits:

• Full understanding of benefits achieved, current challenges and recommendations for optimal EPR utilisation.
• A clear, data-driven plan for ongoing improvement to maximise the EPR's potential to enhance patient outcomes, streamline processes and free up time for staff to reinvest into patient care.
• Promotes strong staff engagement and adoption throughout digital programmes.
• Addresses common issues with low EPR utilisation across the NHS.
• Contributes to a robust framework for evaluating and realising digital benefits for wider system implementations across the trust.