Merger note on an Electronic Patient Record/digital hospital

Having an Electronic Patient Record across both hospitals has been billed as a substantial benefit of the merger of the Royal Surrey and Ashford and St Peters. This blog seeks to help understanding of the extent to which it will be realised, when, and its cost and benefits

A digital hospital

A merger project is considering the broader matter of how to achieve a digital hospital within which a fully (or partially) paperless electronic patient record would be part. It will include electronic communications with outside bodies e.g. GPs. It will facilitate immediate access to accurate and comprehensive information for all a patient’s carers in the merged Trust and allow electronic communication with GPs and other carers e.g. community clinicians.

To date

·         Systems in USA have been seen albeit they are generally, at their core, billing systems and very complex and expensive to adapt to UK NHS practice.
·         A baseline review has been completed of systems in use in both Trusts
·         workshops involving large numbers of clinicians have been held.

The way forward has been agreed.

 Way forward

·         Each Trust uses different systems and in the first 12 months after merger the best of each will be installed across both e.g. a very good system comprising a simple electronic patient record is in use in St Peters.
·         In the first 2 years of merger harmonisation and documentation of core processes (administrative and clinical) will be achieved. This is an essential and very difficult first step for implementing any IT (IT is generally not very flexible and needs to be told what the process is and then demands that everybody abides by it or, alternatively, the chosen IT is already built on the basis of standard processes and everyone has to adapt). Achieving this in one Trust which is used to its processes is difficult enough – doing so across two merging Trusts is very challenging (but necessary irrespective of IT).
·         After the above has been achieved there will be a better understanding of how to progress to a digital hospital.

It will thus be two years after merger before any proposal on to how to proceed to realising a fully digital hospital will be formulated and a full business case with costs and time lines produced. Costs could be around £10million or more.

Summary

In the first two years of merger harmonisation of existing systems and of clinical and administrative process will be the focus. Whereas the ambition will be to create a digital paperless merged Trust, it will be at the earliest 2 years after merger before the way forward will be determined and a Full Business Case with cost and time lines produced for approval.

Does this need a merger?

A merger is not necessary to achieve a digital Royal Surrey - the hospital would need to achieve that in the future anyway since it is presently somewhat behind the pack. However merger will release funds which would make a digital hospital feasible in a shorter time frame and it is expected (albeit without substantiation) that costs will be smaller if spread across two hospitals rather than one.

The proposed merger.

A good deal of Governors' time and that of the hospital Executive and Board is being devoted to the application to merge with Ashford and St Peters. The timetable has slipped a little but the hospitals hope that, if approved, the merger will come about in the middle of next year. Approval is required by several central bodies and of course by both hospital Boards and by both sets of Governors.

I chair the Royal Surrey Merger Working Group of Governors. The WG's task is to assist governors     

• in understanding the processes such as the legal grounds on which governors can turn down the proposal,
• in keeping in touch with what is going on
• in interpreting various voluminous and complex documents
• in ensuring the hospital meets its legal responsibilities to inform the public (and staff) and take account of any concerns and to ensure they undertake 'due diligence' in all aspects of  the business case for the merger i.e. they do it properly in a well researched and honest way.

The main advantages foreseen for the merger are

• a secure financial position of being in surplus avoiding the possibility of both hospitals otherwise slipping in to deficit
• '7 day working' in a number of specialties
• improved cancer services from an increased catchment area
• the creation of a digital merged hospital including electronic patient records
• more research projects.

The Merger WG is critically examining these matters as details emerge and I will report what I can in my blogs.

My main concern at the moment, which is shared by most governors, is that far too little has happened about communicating with the public and Trust members and about formally capturing and taking account of their views. I and one other governor  represent the Royal Surrey governors on a so called Stakeholder Committee which draws together internal staff members and representatives of external bodies to advise on communications. I have made known my opinion that too much effort is being devoted to producing and updating a strategy for communications and too little in actually doing it - time ticks on!! I shall continue to make this point.