Liverpool Women's CIO on the EPR Implementation Journey

Sobol: Well, today I am pleased to have a co-host on the show for the first time Dan Eyre. Dan is the vice president of business development for CereCore International. At the end of 2022, we expanded our operations into the UK, and Dan was one of the first to join our team at CereCore International. So, Dan, welcome, and why don't you tell the folks a little bit about yourself? 

Eyre: Thank you very much. Yeah, Phil, as you mentioned, I joined early in 2023 as the VP for Business Development. I have got a lot of experience within the NHS, and I am really proud to be joining CereCore, especially CereCore International. 

So, I wanted to introduce our guest today, a guy called Matt Connor, who is the CIO of Liverpool Women's NHS Foundation Trust. Matt has been a digital leader for over 20 years in healthcare. He started his role in networking and IT support, and today, as I mentioned, he is the CIO of Liverpool Women's NHS Foundation Trust. 

We have been working with Liverpool since the beginning of this year, and we are really proud to be part of the significant milestones and the EPR implementation of MEDITECH Expanse. As you may or may not know, Liverpool was the first trust to go alive with MEDITECH Expanse within the UK, and we are really proud to be a part of that organization. So, hello Matt. 

Connor: Hi, Dan, are you okay? 

Eyre: Yeah, it is good. 

Eyre: So, I wanted to start off with, for our listeners, walk us through a little bit of your EPR implementation journey. What has it been like? What have some of the key milestones been, and some of the scary bits maybe? 

Connor: Okay, absolutely. So, I joined Liverpool Women's Hospital in December 2019. So, literally three months before the world went mad, and COVID happened, and there was a huge pull on digital transformation during that time. 

During the same time, we were just coming out of a failed EPR program. So, as you can imagine, there was quite a lot of confidence that had been lost in digital systems. And let's not forget that we had a legacy environment to our paths, which had been a really well used and trusted system, was over 20 years old. In fact, it was closer to 25 years at that point. 

So, you can just imagine it served its purpose quite well, but it was getting long in the tooth. We rapidly needed to put in place a new strategy, and a new director of travel. So, we managed that, and we implemented a new strategy called Digital Generations. And our focus was to replace that legacy system with a modern modular EPR system, which was MEDITECH Expanse. Our journey officially started around September 2020, and it has been an enjoyable and challenging, almost three years since we embarked on that journey. 

And I think some of our key challenges were to stabilize the legacy system on new hardware initially. And then it was really much around the engagement of the organization. As, you know, a successful EPR is only as good as it's configured and the clinical leadership that you have got within the program, so, that was our main focus. 

And then of course, I think, whether it be in a new product in the NHS, we are the first to go live with MEDITECH Expanse in the NHS. There is a fair degree of bespoke tailored, and customization within the product that would meet the needs of the NHS really. So, that was our key focus as well. But it has been a huge amount of work, I would say, Dan, and we are just pleased to be at this point now. 

Eyre: Excellent. 

Sobol: All right, that is great Matt. It has certainly been quite the journey for you, and yes, joining an organization just prior to the COVID hitting is always a fun one for sure. 

So, I think a lot of people are probably curious about what it was like working with CereCore International, with us being an international company, and having folks there in the UK as well as resources here in the US. Perhaps, how did it work? How did it go? What were some of those benefits and challenges of working with an international company?   

Connor: Yeah, absolutely. Hi Phil, first of all so, absolutely spot on. It was a new experience I think for us and CereCore as well. What I would like to say, the most important bit, is about relationships and partnership working, and it is about building trust. I think we met originally, Dan, and some others at the MEDITECH user network conference in Liverpool last year. 

And at that point, I think, we were really faced with a couple of challenges. One was resources and skillsets. It is a constrained market really, I think, we often pull on the same resources in the NHS, and I think what stood out for CereCore was you have got that skillset, you have got that knowledge base, and you understand the products. That was quite compelling for us. We sat down and we had some discussions around where our challenges were.  

Predominantly, I would say in two areas. One was around again, that requirement for specialist knowledge and support around the product, particularly with configuring our EPR to meet the NHS standards. We are a bit different in the NHS. There are things that are common, but of course, there are things that are very particular to how we work here. 

The second thing was also building a pace. So, we had quite a lot of challenges, I guess, in terms of the volume of work in our clinic builds, in our electronic prescribing, and also, within our roles and our configuration of access for staff as well. So, I think that is where we really benefited from working with CereCore. 

And in terms of the US and the UK team, I felt that we worked really well. So, what you had was a very approachable, very likable, very understanding UK team who understands our environment, but with a strong US subject matter expert in the teams of the products. And again, there was some of that also in the UK team, but I think that really helped us to kind of get to where we needed to be within the timescales we had. 

Eyre: That is brilliant. Thank you for that, Matt. I think that sort of leads on too, and I know it is relatively short after you have gone live, but now you have had a couple of weeks to reflect on some of the key ingredients to your success. What lessons have you learned so far? And obviously we know there will be more lessons to learn going forward, but have you had time to reflect on anything that you might want to share? 

Connor: Yeah, absolutely. I think the first thing I would like to start off with is having strong executive support has been key, because they discharge them of some of those responsibilities across their portfolio. 

So, let's think about the really strong operations support we have had which is key, in terms of planning, cross over planning, and then managing the impact as you go live. So, that executive support has been really strong and that is key, I would say. We have also then from an extension of that, we have had an effective clinical digital team. So, we have had from trust wide CCIO, which is a Chief Clinical Information Officer, supported by, we would take divisional CCIOs or departmental CCIOs. 

We have had a number of digital lead nurses, pharmacy leads to build the EPMA, and a really strong clinical network, basically around that it has been the governance. So, we have had sort of design authority structures in place that has been essential to ensure that we get the system largely right. And I'll say largely right because you can never be 100% right. Because you learn things as you go live, and your optimization and stabilization phases kick in. 

But it has been absolutely key getting the majority of the build right. Then I guess beyond that, we have had the really talented digital team. My team is quite small, I would say, but we have utilized predominantly the staff that are employed and have worked here for some time, and we have supplemented them with an agency. I guess we have been quite lucky with agency because we have had some absolutely fantastic training resources, which is difficult to secure and can be a risk to a program if you do not get your training right. So, we have had that blend of permanent and some sort of agency and temporary staffing that has helped the actual technical components of build.  

And then I guess from a success piece, it is the strong identity that we have had. We developed a brand called Digicare. Which is interesting because the staff does not talk about necessarily the product itself, they talk about Digicare, which is the brand. That has really helped kind of bring a lot of things together from the communications through how people interact with the system and understand what the system is about. 

I guess in terms of the lessons, how we can be even better. I guess we have had some issues around role-based access control, which is not totally unsurprising, I guess, given that our system was 27 years old at the time of its removal, so there was not even a concept of such a thing then. And as you can imagine, people implement workarounds, and things evolve organically. I think that does not always translate well into a structured role-based system. And then the other thing just to kind of, what we would always say is training. It is really difficult because people have got a day job. 

We have got a very pressured healthcare environment, and people are quite rightly focused on clinical service delivery. So, getting the training right, and making sure it is in the life of is probably an area we did not get quite right. That being said, what we did deliver was impressive. And again, that was based on the talent of the team that we had at our disposal. 

Eyre: That is great. You know, obviously you have mentioned how big a change the EPR implementation is, you put a whole brand behind it, and that is how big a change it was, and you mentioned some of the stuff around role-based access control, and some of the training. But have you had a chance to see any of the benefits for the staff or the patients yet or is it still a little bit early in your journey? 

Connor: It's probably a bit of both, isn't it? I think there are some early benefits, from a safety perspective. The strengthened electronic prescribing piece has been really well received. And again, that is because we have had really strong pharmacy leadership, but the benefits obviously from a safety perspective are at instant, in terms of co-signing, drug dispensing, and prescribing. 

Again, we have got a lot more auditing capability around our ordering and results piece. And of course, a lot of our documentation now is a lot more structured than it was in previous systems. But let's be realistic, you get a lot more disbenefits in those sorts of very destructive first weeks, and probably months, in terms of new processes. It is a real shock for people. It has actually happened, and they are getting used to the system. 

So, that will take some time, and what we will expect to see then is some really great ideas of how we can make it better. I think we have tried to manage the expectation as best we can because we have always said, this is day one, so we are in sort of week three now of our journey. 

So, what we have got is the platform to be really great in terms of digital maturity, and positive impact for patient care for our clinicians, nurses, and midwives. But it will take some time to really drive the benefits through adoption. But yeah, I think there has been a combination of both, I would say, so we have got some disbenefits, but there are some early wins already.   

Eyre: Excellent, that is good to know. Thank you. So, I wanted to ask around when you worked with CereCore International, what actually stood out to you as the difference and the experience that you had with us as a company? 

Connor: I think the first thing was you got it. I do not mean just in terms of the product, because you do have experience in terms of the EPR vendor and the product we implemented. But actually it was the understanding, it was the approach, it was everything you provided, and a degree of assurance I would say in those early conversations. Then you backed it up with a prompt, detailed, and robust offer that we took you up on. And, I would like to say that it has really been a success of this program because through that collaborative work, we built a strong partnership. 

I think one of the things that stood out, apart from the knowledge, was your commitment to the project and your agility. So, as you can imagine, things do change, and I think that the original scope of what we may have bought some days for or agreed to slightly shifted as we got into some of the more detailed components or the latter stages of the project.  

And even post go-live, you were there personally, Dan and others doing floor walking. So you have got a sense of what it means in terms of deploying our EPR, and you have got a sense of the experiences that staff have had in those first few weeks. And no doubt you take that back, and that feeds right back into your organization. So, it is like a cyclical thing. So, you really kind of stood with us side-by-side from a fairly early part of the program to post-go live as well. And that is what partnerships are built on. 

Eyre: Excellent, thank you.  

Sobol: Well, Matt, we certainly do appreciate that partnership. I had the opportunity to visit, it has been a few weeks ago now, certainly enjoyed meeting you personally as well as your team. Honestly, it was nice to observe everything that you had done and put in place to make this project and transformation a success for your organization. And just the collaboration between you and the rest of all the different stakeholders that you have talked about here was truly a good sight to see.  

So, we always like to wrap up these podcasts with an open call for you to share. Is there anything that is top of mind for you, having now gone through this EPR implementation journey, that perhaps other CIOs in your seat from any other organization might like your perspective? Or, for those maybe on the journey now or getting ready to embark on that journey, what words of wisdom might they benefit from? The top couple of things they just absolutely need to know. 

Connor: Yeah absolutely, thanks Phil. I think the overriding piece for me is it is less about technology, and it is more about people — at all levels and bringing people along. So, that is why having strong digital leadership around you and within the team to deliver. But also, it is about organizational change, and it just happens to be digital by nature. So, really embrace that by meeting it head on early because some of the slowest things to change are mindsets and preparation. You bring people along, so, we have done an awful lot of work on that. 

The other thing I will say is — it is okay to get it wrong, just be open to that. So, have strong governance and transparency. Utilize any external bodies you can. So, we work closely with NHS England to do sort of peer reviews on our program, and we have taken those lessons and recommendations on board, and that has really helped us. 

So, you know, be open to being better along the way. What you start off with won’t necessarily be how you finish it. Build those partnerships with organizations because you will struggle potentially with doing it all on your own. We just do not have some of the skill sets and the resources available unless there is a significant cost incurred. I think if you can utilize partnerships like we have done with CereCore International and others. We have also used others as well in terms of some of technology bits, it is really good to do that and go on that journey together. 

The final bit I would say is have a realistic scope. Take a risk-based approach if it is a significant change. You can always optimize later. It is about our safe implementation first and foremost. So, manage expectations as well on the ground. Because what you do not want is now it’s done, you move on. It is the start, isn't it? It is the start of really exploiting some of the technologies and exciting opportunities that innovation allows. So, that is, what I would say, those are my pearls of wisdom having gone through this.  

Sobol: Well, I would say your pearls of wisdom are spot on. I think that was a master's class, in all of those components. You talked about the individual people, the relationships, the communication, the governance, expectation setting, and the collaborative, non-silo driven approach is absolutely critical. 

So, Matt, thank you so much, not only for your time today but for your partnership with CereCore International. I know our team has enjoyed tremendously working side-by-side with you, your team, and we look forward to continuing to do that. As you mentioned, these EPRs are a journey, not just a simple project. And so, we look forward to being of assistance in any way that we can on a go-forward basis for you. 

Connor: Yeah, absolutely. Thanks Phil, and thanks Dan, and likewise we look forward to continuing that partnership with you guys. 

Eyre: Thank you, Matt. 

Sobol: Thank you.