EPMA system migration – The Wirral Experience

| March 28, 2020

Project Background

Wirral University Teaching Hospital NHS Foundation Trust (WUTH) is one of the largest and busiest acute trusts in the North West of England. It provides a comprehensive range of high-quality acute care services to a population of approximately 400,000 people across Wirral, Ellesmere Port, Neston, North Wales and the wider North West footprint. It operates from two main sites:

  • Arrowe Park Hospital, Upton – delivering a full range of emergency (adults and children) and acute services for adults in the main hospital building. The Wirral Women’s and Children’s Hospital provides Maternity, Neonatal, Gynaecology, Children’s inpatient, day case and outpatient units.
  • Clatterbridge Hospital, Bebington – undertaking planned surgical services, dermatology services, breast care and specialist stroke and neuro-rehabilitation services.

WUTH has had an Electronic Patient Record System (EPR) since the early 1990s and electronic prescribing and medicines administration (EPMA) was introduced around 1993. The system was the American TDS 7000 system known locally as PCIS (Patient Care Information System) and EPMA was one module of this integrated system. The process of selecting a new system to replace PCIS began around 2001/2. It was accepted that the system was nearing the end of its life and the Eclipsys company who now owned the product would no longer support it.

After a long and complicated process, the Cerner Millennium system was chosen to be the replacement and the first phase of the Cerner EPR implementation took place in 2010. Work on the EPMA system started in 2011 and there was an acceptance that a number of enhancements were needed before the system could be deployed. These included minimising drug name truncation in certain screen views, introducing order sentence filtering by age and weight to support paediatric prescribing, building new discharge medicines workflows and building new in-patient supply processes.  The EPMA system was delivered in November 2014 and the PCIS system was turned off at that point.

The November 2014 implementation replaced all the EPMA functionality that had been on PCIS. Over the next few years work was done to make the EPMA system more comprehensive. It was rolled out in the Emergency Department in 2015. In 2016 it was deployed in adult critical care and also used for the prescribing and administration of fluids and continuous infusions across the Trust. In 2019 it was then rolled out to the maternity and neonatal units.

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How we did it

This project involved moving from an end of life legacy EPR system with the aim to switch off completely before the end of 2014 to a new Cerner EPR system that included an EPMA module. We have broken this down into key sections as listed below:

Planning: There were many elements of planning in this whole project. This ranged from planning to replace the new system to planning the build of the EPMA system components and the subsequent testing to planning the go-live itself.

Procurement: These were a long procurement process to determine the system that would be procured to replace the legacy PCIS one. This included being part of the NPFIT southern cluster for a few years before then entering into a direct contract with Cerner. It also included significant investment in the hardware and infrastructure as well as the Cerner EPR software.

Governance:  There were several layers to the Governance structure.

  • There was the Trust Project Board with representation from the Trust Board, Senior Clinicians, Senior Nurses, Senior Pharmacy and Informatics Staff
  • Then for the EPMA project, there were two new teams:
  • Cerner Medicines Management Multi-Disciplinary Project Team with a range of medical, nursing, pharmacy and informatics staff
  • Cerner Medicines Management Pharmacy Project Team with a range of pharmacists, pharmacy technicians and informatics staff

 Data & Information: There was an existing reporting team who delivered a range of medicines related reports. All the reports were reviewed to determine what was still required and each of these reports had to be rebuilt and tested so that they were ready to be generated once the new Cerner EPMA system had gone live. Data migration was a major part of the EPR replacement project. This basic patient information migration had been completed before the EPMA go live. Allergy information was not migrated directly into the new EPMA system but a view was created where allergy information and some other medicines specific information was available to be viewed by clinical staff and could be reinput into Cerner if necessary.

Patient Safety:  In terms of patient safety the aim was to replace the PCIS system with a system as least as safe. Some of the enhancements that were requested and delivered were to maintain patient safety. These including ensuring complete and consistent drug displays as well as introducing functionality that allowed us to maintain safer prescribing for children. One area where there was improvement was in allergy recording. Cerner had interactive allergy checking and allergy recording was mandatory and codified. There was a reduction in the number of allergy-related incidents in the year following the introduction of the Cerner EPMA system.

 Productivity and Efficiency: There were a number of workflow improvements as a result of deploying the Cerner EPMA system.

  • The drug administration system was a big change for nursing staff but it was felt to be a big improvement. It was now a fully electronic system as opposed to the hybrid paper/computer workflow that had been in place previously. There was also a much clearer drug administration record available for clinicians.
  • In terms of pharmacy workflows, there was a more transparent discharge prescription process and a better system for electronic in-patient supply requests.
  • The pharmacy worklist also gave the pharmacy team the ability to organise their clinical work more easily.

Lessons learnt – How could others do this?

  • Realistic Scope – Be very clear with the project scope. It may not be possible to do everything at once so need to be clear what is part of the initial implementation and what can wait for a future date.
  • Get essential changes before go live – if there is functionality that is lacking or not working as required then work with the system supplier to get this rectified before the initial go live. The suppliers are usually committed at this stage to a successful delivery and are more likely to consider essential changes. Once the system is live it is much more difficult to get significant change.
  • Resources – Adequate resources are essential both for the project go live but also ongoing afterwards for system optimisation and maintenance. Too often there is a focus on resources to get a system live but there needs to be the same focus to have sufficient resources in place for the years after go live. As the system becomes more comprehensive and covers the more complex clinical areas then a well resourced EPMA team is essential.