'Exemplar' digital hospitals trust hit by multiple tech-related traumas

An award-winning IT rollout at one of the UK's largest hospitals trusts is beset with problems that prevent staff from accessing the data they need, creating inconsistent and insecure electronic patient records.

A report by the Care Quality Commission (CQC), an independent regulator of health and social care in England, found that Newcastle upon Tyne Hospitals NHS Foundation Trust's information systems were not always integrated and secure and that staff could not "always find the data they needed, in easily accessible formats, to understand performance, make decisions and improvements."

Following an inspection from June to September 2023, it reported: "We found some of the trust's systems and processes for recording [were] inconsistent, for example the lack of electronic recording systems in theatres. Consequently, ward staff spent time transferring paper-based information into the electronic recording systems which posed a risk of lost information during the transfer process."

The hospitals trust employs around 17,500 staff and it processes roughly 7,500 documents per day across 40 sites. It went live with a Cerner electronic medical records management system in 2009. That same year it implemented a "Paperlite" system under NHS England's Global Digital Exemplars program, which aims to showcase "improvements in the quality of care, through the world-class use of digital technologies and information," the government quango said.

Newcastle Hospitals have been measured against the international standard for Electronic Medical Record Adoption Model (EMRAM) by the international Healthcare Information and Management Systems Society (HIMSS) and awarded a Stage 6, the second highest of an eight-stage system.

Nonetheless, England's independent care regulator saw another picture. In surgery, nursing staff told inspectors there were too many records to complete on the electronic systems, and navigation was confusing and time-consuming.

"Whilst reviewing one patient's records, we measured the time from log on to retrieval of vital signs and fluid balance to be 45 minutes," the report said. "The senior member of ward staff navigating the system for inspectors needed to ring for IT assistance to access the records that we requested. These records were safety assessments which should be readily accessible to all staff.

"We observed 15 minutes wait to contact IT with a further ten minutes to gain instruction. Staff told us they simply did not have the time or staff resources to navigate through patient's records."

Whistleblowers came forward

In services for children and young people, the inspectors found staff could not always easily access the electronic patient record system and care records. "We received whistleblowing in regard to the effectiveness of IT systems and how this was slowing down improvement within the service. Information reviewed during the inspection showed that system issues were a risk," the CQC said.

As well as similar IT problems experienced by other services, staff in maternity had to complete a duplicate entry of records of care and treatment on two electronic platforms: the new electronic computer record and e-obs. These two systems were not integrated, the CQC said.

The Trust has accepted the findings of the CQC report. In a statement, its new CEO, Sir James Mackey, said: "Their clear recommendations for attention and improvement are being worked on as a matter of urgency and I am confident we can fix this by working together across the organization and focusing on what matters to patients and staff."

He said a detailed program of activity was already underway and would continue until the Trust and the CQC are assured the issues have been addressed.

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Wasn't world beating tech supposed to clear hospital backlogs?

The CQC finding IT problems at a trust considered an exemplar for "world-class use of digital technology" should worry NHS leaders.

In 2022, the health secretary invoked "the latest technology" to clear a six-million-strong waiting list in England as the NHS struggles with a patient backlog which had grown by 1.6 million during COVID-19 pandemic.

"Using digital technology and data systems to free up capacity," said NHS England's elective recovery plan at the time. "Digital technology and data systems provide us with the opportunity to release capacity… by allowing us to deliver services in new ways that more efficiently meet the needs of both patients and staff."

After a commission of experts assembled by the BMJ medical journal called for the state of the NHS to be declared a national emergency, its leaders might heed the warning from Newcastle that getting results from IT investments is easier said than done. ®