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Sooraj Shah

Contributing Editor

Sooraj Shah is Contributing Editor of New Statesman Tech with a focus on C-level IT leader interviews. He is also a freelance technology journalist.

How Royal Papworth NHS Trust managed to integrate Lorenzo EPR with Epic

When Andrew Raynes joined Royal Papworth NHS Trust 18 months ago, the first thing he did as chief information officer was to evaluate where the organisation was from a technology perspective and create a strategy for the following two years. The trust was in the midst of implementing a new Lorenzo electronic patient record (EPR) from DXC Technology, but Raynes needed to consider what it would be working on beyond this point.

The hospital is preparing to move to a brand-new building on the Cambridge Biomedical Campus, alongside Addenbrooke’s Hospital, which is a part of the Cambridge University Hospital NHS Foundation Trust (CUHFT). As the two hospitals were going to share a pathology service, they needed to undertake a complex piece of integration work to make sure its clinicians could order tests and receive results electronically.

Up until now, specimen and blood tests sent from Papworth to Cambridge had to be manually entered into the system and then returned to Papworth in PDF format – this process took 24 hours.

In total, the trust had to integrate five systems, with the biggest challenge being to create an interface between Lorenzo and Addenbrooke’s Hospital’s Epic system.

“There was no reference anywhere else in the country for doing that, but we achieved a bi-directional interface and we did it in just seven months,” says Raynes.

“It has switched the previous 24-hour turnaround to being real-time, so taking into account the number of requests going through for lab results. The impact on clinicians time and on patient care is significant – it’s more efficient and better for patient safety,” he adds.

The project was the first of its kind in the UK, and globally there has only been one similar interface set up in New York between Cerner and Epic systems.

“It’s a very exciting opportunity that we’ve managed to grasp, and one of the challenges has been that by being first, there was no benchmark and no way of asking for support; you’re finding your own way, and we’ve had a lot of IT developers and integration specialists working on this and literally learning as they go,” Raynes says, adding that DXC Technology, and both trusts’ IT teams have worked long hours to tie these systems together.

Raynes and his team could have been forgiven for thinking the project would be even more challenging, considering the amount of negative press the Epic system at Addenbrooke’s Hospital has had. The trust had been put into special measures by health regulator Monitor back in 2015, after over-spending an average of £1.2m a week, in part due to the Epic system. There were issues with A&E performance, staff confusion on how to use the system, inaccurate discharge information and a detrimental effect on staff.

However, Raynes insisted that his team did not factor in the history of the Epic system at CUHFT.

“We know there have been many IT disasters such as the National Programme for IT (NPfIT), and we had heard about the reports on Epic but it wasn’t something that concerned us,” he says.

“With any system implementation, if you’re going to be first it takes courage and a certain aspect of it is you will have some exposure – not all of it good. We didn’t consider [the previous issues] as our focus was on the problem we were trying to fix and in trying to deliver patient benefits, safety and efficiency,” he adds.

Indeed, whatever issues the hospital may have encountered in years gone by did not affect the way both trusts worked together, with Raynes emphasising that the collaboration went smoothly.

Raynes believes that the trust has not only been able to provide more efficiency for its busy clinicians and improved patient safety, but has been important for a change of approach too.

“It’s important because there has been an idea, since the NPfIT that organisations all need to use the same system to be able to exchange information with each other,” he says.

“The Secretary of State for Health and Social Care, Matt Hancock, and the Wachter Review’s tech vision both say that interoperability is the way forward, and we have shown that is right: what matters is standards and open systems.

“Royal Papworth is ahead of the curve. We have put policy about interoperability into practice. We have done it,” he states.