EPMA system migration – The Wirral Experience

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.


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.