How digital patient records can improve frontline productivity

Alex Claybrook: Hi, I’m Alex Claybrook. I’m a Deloitte UK partner that leads our practice on financial improvement and digital transformation. I’m here, today, with Professor Andy Hardy from University Coventry Hospitals in Warwickshire. Would you like to tell us a bit about yourself and your hospital, please, Andy?

Andy Hardy: Hi, yeah, thanks for that introduction there. [I am] Andy Hardy, CEO at University of Coventry in Warwickshire—a job I’ve had a great honor and privilege to do. And it’s good to be working with you.

Claybrook: Excellent. Thank you, Andy. So, the purpose of today’s conversation is around EPR optimization and digital frontline productivity. UHCW went live with its EPR about two years ago now. It’d be interesting to understand what lessons you’ve learnt over the last two years, what have been the biggest challenges, and how you’ve overcome some of those, really.

Hardy: Okay, yeah, thanks Alex. Exactly two years ago, I should say it was, it was June 15, 2024. We went live with our hospitalwide EPR.

So, what are the key lessons? I think the first one really is in relation to the fact that that go-live is actually just the beginning. Yeah […] people feel a sigh of relief [that] it’s in; actually no, that is literally just the beginning. Reminding the organization that actually it’s not a digital program project or a program about getting the EPR system in […].

I talked beforehand and still do about the fact that this is fundamentally the biggest transformation project we’re going to undertake as an organization and certainly in our organization’s history, since 18 years before when we’d moved two hospitals into one large university hospital.

And so it’s, being honest, open, and you know, expecting there to be hiccups—to be bumps in the road. Yeah. And it’s how do you overcome them, give people the tools to do that, and work alongside people and listen to their challenges.

Claybrook: From your point of view, before we dig into some of those challenges, what do you think have been some of the successes and some of the real impacts that you’ve seen for your organization as a result of the EPR being in place?

Hardy: That is a good question, because it’s too easy and often the case to focus on the challenges of a huge new system, [that] a huge new change brings to an organization. But we saw some very early wins. I remember I was trying to spend as much time as I can in clinical areas. Not long into the new EPR system, I was spending some time with pathology.

Some of our microbiologists who were already saying how having all the information in one place was helping them identify likely issues with the patient—so they could stream in much earlier in the pathway of care to what were the right antibiotics [they’re] supposed to give. Well and so, those benefits were really quite early on.

Claybrook: And the clinical engagement, I presume, was supremely important for you to drive that through as a message for your organization. Has there been a change in the mindset of your clinical leaders as a result of the EPR program?

Hardy: Yeah, you’re right. I mean, we’re a hospital, so if clinicians aren’t bought into a change, it’s going to be very difficult to land anything. We took time in the in the run up to go-live to have some experts in each area trained in what the new system would look like, what it would feel like, and what it could deliver. And so, each and every area had a lead clinician there.

And they really became the ambassadors for it in each area and also the go-to for their colleagues to say, well, what does this mean, how does this work, and also to talk about the benefits and they continue today. So, we call them subject-matter experts—SMEs—and they’re still in place now in each area, two years on.

Claybrook: Awesome. I do want to get into the benefits, but before we do, it couldn’t have all been plain sailing. So, what were the biggest challenges in the lead up to go-live itself, with the sleepless nights, and then post go-live, what have you seen as been the biggest operational delivery challenges you’re facing?

Hardy: Well, as you say, they’re incredibly large and complex and varied challenges associated with bringing in an EPR system that was actually replacing over 300 different clinical systems and nonclinical systems.

So, there’s the whole situation of overcoming skepticism and cynicism for some people. We knew [it] actually represented the step map because they got things that were tailored to them.

So, it’s talking about the wider good of the organization. The fact that we were bringing in a system that would become the digital bedrock of our systems, moving forward upon which we can deliver care. I had to try and educate best part of 11,000 people in the new system—that, in itself, is a huge undertaking.

And you need to be able to do that as close to go-live day as possible, so people remember what you taught them, but also take on the logistical challenge of actually doing that.

And actually, I think that’s a really important lesson moving forward is that, that education shouldn’t stop at go-live. It has to carry on. And giving people the tools and the know-how how to overcome the challenges they’re inevitably going to face.

For some clinicians, [there was] incredible frustration around the fact [that] they were having to do what they see and saw as more administrative tasks than you had done before—more number of clicks of the buttons, etc. So, going through that and saying more is worth it.

Claybrook: And from our point of view, from Deloitte, we were obviously lucky enough to spend some time with you, your team, and your clinical community to really understand how they’re using and engaging with the EPR, which has been eye-opening for us as an organization.

One of the things that we’ve observed is some of the local practices where some of the clinicians and the operational teams haven’t quite fully embraced the power of the EPR.

And is that one of the things that you’ve got to take away and get those comms clear with your people about how to see the benefits if we use it in the right way?

Hardy: Yeah, I mean, as you say, people often refer back to the way they’ve always done things. Yeah, so, they could they see if they can do that even with a new system.

And, alternatively, another one of the challenges which you highlight is that the system is designed in a certain way. And actually, you know, it’s a system we codesign, you know, you take a base program, but we set the system up. But then people find workarounds if they think it’s going to be quicker and easier for them.

It’s then coming back to those individuals and saying, “We get what you’re doing now, let’s see if we can just tweak the system so it’s as easy as the workaround you design,” because actually the workaround you design are often meaning that we can’t get the full benefit out of the project and the program.

And the data is not in the right place where we want it to be. So, it’s trying sometimes to get people to avoid those workarounds.

Claybrook: And, on the subject of benefits, standing back now, two years in, what do you see as the most impactful benefit as a result of the EPR being in place?

Have you seen the kind of return on investment you were looking for? And if you have got some examples of where you found that’s been really powerful with either you or your clinical teams […]?

Hardy: I suppose the single biggest benefit is we’ve moved to a situation where we’ve got one source of truth for the organization: One clinical record about what happened to the patient—one we’re after and under our care—but also what conditions are there [that] they’re suffering from, their comorbidities, etc.

And also, then, as I mentioned earlier, the EPR becomes the bedrock, the sort of the foundation stone for all of our digital and data innovations, which we can add on, but that’s where the data sits and having that one source of data helps those other benefits come from add-ons, whether that be about AI, etc.

Claybrook: Excellent. And I suppose my broader question now is Coventry is two years into the journey. But there are lots of organizations that haven’t gone live or have just gone through a go-live process.

What are the lessons that you’ve got […] What should be the first 100-day targets to get through once you’ve gone live? If you were to do it again tomorrow, what would you say to your exec team and your colleagues? These are the three things we’ve got to get right in the first 100 days.

Hardy: Across any major change in the healthcare setting has to be to [the need to] maintain the safety of all your systems. So, whilst you go in the go-live of two or three days, of course you go into business-continuity plans. And you really need to keep them close to hand just in case because something might go wrong.

But it’s about keeping resources available to be wrapped around colleagues, whether be clinical or nonclinical, to remind them what their training told them, possibly to retrain them if they forgot, but also to be able to just give them a bit of a comfort and a safety blanket.

I’ve talked about having experts in every area […] clinical, but it’s nonclinical experts as well because actually this is a huge change [to] the administration of the organization.

And we did find some significant data-quality challenges in the first 100 days because we weren’t doing things in the way the system was intended [to work] and was designed and you know we just talked about people finding out little workarounds.

So, it’s really wrapping resources around the organization, and I say not just thinking once you’re going to go live, you can take a deep breath and think oh yeah we’ve made it—because you haven’t. Not at all.

Claybrook: Super, and then, so that’s the looking back, that’s what your lessons would be. Looking forward then, what do you want the vision for UHCW to be? How do you want the hospital to look and feel like in two, three years’ time from now as a result of going through what you’ve gone through?

Hardy: So we’re very clear, we’ve had an organizational vision at UHCW, which is to be an […] international lead in healthcare, recognizing […] in the local communities.

And that means wherever possible providing world-class care to our patients whenever the need is, whatever the need is for. And reminding people that having such great digital infrastructure, having the right data about our patients in the right place at the right time, helps us give the best care.

And we want to be known for that and the innovation that we can bring. And so already, so that data we have used for a number of different ways, using AI, data-process mining, to be able to improve our processes. One of the sayings we use a lot of UHCW is that our individuals, our teams are only as good as the processes we wrap around them. Having the data in one place—structured data—means we can get those processes ever better.

Claybrook: Thank you. And we’ve heard other presentations at HLTH over the course of today and clearly tomorrow as well around the impact of AI in how hospitals will be running.

And there’s a presentation just on what it what will it mean for the future workforce for hospitals themselves. Have you got to a place now where you’re starting to think about the shape of your workforce in the future, or is it still too early with those to wrestle with those questions?

Hardy: It is a really important question, because I can say that, as the leader of a hospital, I rarely go a week when somebody doesn’t ask me, is AI going to replace my role? Yeah, and I say I don’t think it’s going to replace many roles. It will replace some, but what it will do is change all of our roles.

We need to see AI as a key tool to help us deliver what we want to do and say, in our case, deliver world-class care to our patients but also certainly change administration tasks. It doesn’t necessarily mean we’re going to lose those tasks, those colleagues, because actually we have to get them to do different tasks, which add value.

Claybrook: Yes.

Hardy: We are utilizing a lot of different AI, whether that is [for] clinical or nonclinical tasks. But again, it comes back to the fact [that, when] you’ve got one source of data, data you can rely on, data that is then structured, you use AI better.

One of my favorite stats is that 30% of the world’s data is generated by healthcare.

Claybrook: Yeah.

Hardy: And that is grown every year exponentially by about 25%. But 97% of that data is unstructured. So, having one source of data, utilizing AI to structure that data, means you get better decisions, both clinical decisions [and] nonclinical decisions, which makes it more effective, more efficient for our patients.

Claybrook: Excellent. And then, not going into the detail of who your EPR provider is, but is there a sense of that’s a relationship that you want to grow to see if we can work with them to build out and make changes to the EPR system, or is it something that you’re comfortable with as it stands now? Is it would you like to see them come with you on that journey as that transformation journey evolves as well?

Hardy: I think that’s a really important point. It’d be very easy to see an EPR supplier as an EPR supplier. Well we're in our case [it’s] a 10-year contract. I don't want to see them as a supplier. I want to see them as a 10-year partner—one of our key partners. I say it’s the most significant piece of digital infrastructure we’ve got.

So, actually working alongside them as a partner to say well what are the developments you can offer us? What are the developments we want? I’m very keen in the whole of the organization looking at all the different digital technology we utilize is that not just looking for point solutions, but thinking around you know what are the problems [that] we’ve got, what are the challenges we’ve got that they, as a partner, can help us overcome.

Claybrook: Yeah.

Hardy: And also, you know, we’ve touched on benefits realization. I don’t think we’re unique in the fact that, you know, we’ve put a business case together. It outlines a number of benefits. Frankly, some of those have not been touched yet. Some have partially been delivered, some nearly fully delivered. And actually, we’re finding other benefits. We’ll actually work with a provider as a partner to drive out those benefits.

Claybrook: And I think that’s the important bit for this, in the back end of this conversation, is what we’re seeing is organizations like yourselves have articulated a vision for productivity and efficiency post go-live, but really only touched the surface.

They’ve got to the point of addressing the licensing issues and the software issues. But really visioning what the hospital could be like and feel like for the patient and for your staff in years three, four, and five after go-live seems to be the one area that everyone’s wrestling with.

And it does feel like the NHS England, as a regulator, is very keen to see how digital frontline productivity is driven for NHS organizations. Therefore, as an organization to mature in this compared to other organizations, what would be the one message you’d relay back to, with NHS England as a leader?

Hardy: I think you touched on there when we first time we talked about […] productivity.

Claybrook: Yeah.

Hardy: You know, it’s a huge challenge in the NHS at the moment, you know, we're seeing as being not as productive as we were pre the pandemic. Starting to get about there, but actually […] and productivity for a long time in the NHS became a bit of a dirty word. It wasn't used and then it was and why? Because people say, oh it's just about people working hard, it's not. To me, I talk about productivity around, you know, we spend 1.2 billion pounds’ worth of taxpayers’ money.

Claybrook: Yeah.

Hardy: And, as taxpayers, why would we not want to be spending that each and every pound of those 1.2 billion pounds effectively as efficiently as possible. And then looking at it from a clinician’s point of view, we’re utilizing each of those 1.2 billion pounds’ worth to treat as many patients as we can to the highest quality care and getting the best outcomes. And so, that’s how I address productivity.

And I think that’s what a lesson about […] England is about how we talk about productivity can turn people off, frankly. But actually we need to see it as a way of doing better for our patients within the resource we’ve got. And right at the center of that has to be digital and data developments.

Claybrook: Yeah. And connected to that is that one source of the truth. Because the clinical community and your operational staff will now see one set of data that says this is how we’re performing. It’s not questionable at that stage.

Hardy: Absolutely. And the key now is really to focus on outcomes. I think when people talk around productivity, they often don’t talk about value of healthcare. And value has to include outcomes. And these systems help you monitor and identify outcomes over a long period of time as well.

Claybrook: Honestly, you’re one of the Virginia Mason Trusts in the country as well. So you’ve got that added flavor of how to drive the productivity and efficiency through a quality lens as well. Because I know you’re incredibly proud of the UHCWI […] that you’re running. Just tell us a little bit about that please, Andy.

Hardy: Yeah well, as you say, we’ve been working with Viriginia Mason through currently 11 years now. So, alongside them, we’ve developed our own quality management system and organization—say UCHW improvement.

And how that’s benefited this implementation is that it’s given us a set of tools to make change. But also it’s very clear around giving people the tools and the permission to make change—to fail.

And actually as a leader, our role is to frame problems, not to provide solutions. And that you know, so when people […] oh this EPR system is causing me XYZ problem, stand back and say, okay, go and make the changes you think you need to do. If it doesn’t go right first time, try again.

So we’ve got that culture within the organization that allows people to make a change where they see fit for their patients. People who work, you know, one of our sayings is you know, those who do the work know the work, those who know the work can improve the work.

Claybrook: Yeah.

Hardy: And that’s absolutely relevant when you're bringing an EPR in.

Claybrook: Excellent. And I’m going to close with one last question, as a leader. I think I’m right, saying being a CEO now since 2010. Absolutely. Sixteen years at the house. Sixteen years, Andy. What would be [the] questions [that] leaders [should be] constantly be asking themselves? Someone as senior as yourself, what do you reflect on?

Hardy: Never forget what your key purposes are, both as an organization and an individual. What your values are, what your organizational values are. Are you making decisions with those things in mind all the time? And that every decision’s going to go the right way. Live with that as long as you know you’re trying to do the right thing.

And you know, for us, we have a […] our vision is the patient. So that is, you know, every decision we make, every process we design or redesign, is it truly putting the patient at the center of that. And keep for me that's what I keep coming back to And as long as I’m trying to do that, if I make mistakes, I make mistakes. But I know I’m always trying to do the right thing. I know the organization’s always trying to do the right thing.

Claybrook: Excellent. I couldn't have put it better myself. That's lovely. Thank you very much for your time, Andy. I hope you enjoy the rest of the conference.

Hardy: It's been a pleasure. Thanks very much.

Claybrook: And thank you for your time. Thank you.

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