Colin Brown on NHS digital innovation and patient care

The chief clinical information officer at University Hospitals of Morecambe Bay NHS Foundation Trust describes himself as a ‘digital socialist’. He tells Lyn Whitfield about the trust’s pioneering deployment of the Lorenzo electronic patient record, and why he is proud of the system and the role that the trust, its clinicians and its IT team have played in its development over the past decade.

He also outlines the healthcare economy’s ongoing digital ambitions and puts forward a strong argument for why every area should be able to access the resources it needs to reshape care for the 21^st century.

Colin Brown describes himself as a “digital socialist.” The chief clinical information officer at University Hospitals of Morecambe Bay NHS Foundation Trust argues that it has done some pioneering health tech work.

Yet it has done it without the kind of resources lavished on ‘devoManc’ or the local health and care record exemplars; and it still has a long way to go to address the needs of an area with significant social problems and an imminent workforce crisis.

“I was asked by one of our local councillors recently what we needed to get more done, and I said it all comes down to people, money, and time,” Brown says at one point in a wide-ranging interview.

“We have some great people, but I would love to see Lancashire and Cumbria resourced properly. I do feel like a digital socialist. I think all communities and all clinicians should have the same digital resources to work with.”

Lorenzo pioneers

On the pioneer front, University Hospitals of Morecambe Bay is best known for launching the Lorenzo electronic patient record that was created by iSoft/CSC, back in the days of the National Programme for IT in the NHS.

The trust gave Lorenzo a ‘soft landing’ on one ward at Furness General Hospital in 2008, and followed up with a more functional version, L1.9, a couple of years later. At this point, Brown was an interested spectator.

As a consultant gastroenterologist, he had developed a passing interest in medical computing while running projects to refit oesophageal function labs; and he liked the library of letters that was scanned into Lorenzo, because it gave him access to patient information that he wouldn’t have had previously.

However, as the system bedded in, he became increasingly frustrated with the contractual environment in which it was being deployed. “The customer was Connecting for Health [the agency in charge of NPfIT] not us, so a lot of what was built was divorced from the front-line,” he says.

“I became sufficiently antsy for the chief executive to ask the IT team and the company to ‘talk to Colin Brown’, so I went to have lunch with them, and when they asked me what I wanted, I said: ‘Stuff that works’.”

As an example, Brown said he wanted to be able to send discharge letters to GPs electronically, because the trust’s typing backlog had built up to the point where it was taking four or five months to send these important documents. Eventually, the trust became the first in the country to use the Medical Interoperability Gateway to send discharge letters into EMIS system used by local GPs.

‘Taking the pain’ for other trusts 

When the trust’s clinical lead for Lorenzo retired, Brown was asked to take over the role. But with only two sessions a week available, it became clear that the trust needed a chief clinical information officer.

Brown wrote a job description for what was, at the time, a relatively new and developing role, applied – and got it. Since then, he says, he’s worked hard to maintain his initial focus on the front line. “Some CCIOs are really techy, but I am not,” he says.

“I am a working clinician, with a practical bent. I don’t want to get in the way of the IT boys and what they do. I see my job as looking at the clinical requirements and getting support for meeting them.”

This was not always an easy process. “Over the years,” Brown says, University Hospitals of Morecambe Bay “really took the pain for the NHS in terms of developing Lorenzo.” The trust was the first to use its bed management, maternity and emergency department modules.

On its own behalf, the trust also ran a paperless outpatients department, that informed a well-received roll-out of digital nursing notes, which got clinicians interested in a similar development for clinical notes.

And it undertook a first of type deployment of Lorenzo e-prescribing, getting it live on one surgical ward in 2013. It had to close the project down because there were “no resources to roll it out across the trust at the time”; but other organisations picked up the work.

Much done, much still to do

By 2015-16, University Hospitals of Morecambe Bay had made progress; but it still had work to do. It’s long-standing chief information officer, Steve Fairclough retired, and his immediate successor ran an EPR re-procurement project.

At the end of that, the trust decided to stick with Lorenzo; but secured a number of improvements from the process. It moved the system onto its own servers which, Brown says, gave it an “immediate performance uplift” as well as much greater control over updates and roll-outs.

It also secured a resource wrap to run a number of optimisation projects that were given visible, board-level backing. These included new functionality for admin staff, a revised version of its established nurse and doctor records, the introduction of an admissions proforma and VTE tracking, and paper-lite working in ED.

Also, the extension of the system to theatres, an improved maternity record, linked to a Mums App (“the first patient-facing thing we have done”) and a go-live for e-prescribing; which, this time, was rolled out across 58 wards in just two months. Overall, Brown says, “that piece of work was really well done” and “the new instance of Lorenzo works well” for the trust.

University Hospitals of Morecambe Bay is now focusing on its ambition to progress to level five and then six on the HIMSS EMRAM maturity model and on sorting out user-issues identified by a KLAS survey. Perhaps predictably, this uncovered grumbles about access to the trust’s virtual desktops, wi-fi, and a demand for more personalised training – all of which are being addressed.  

Integrating the health and care economy

Brown is also keen to see more IT-supported integration across the local health economy. The area has a number of high-profile CCIOs and pioneering GPs, has developed an ‘air traffic control’ system to digitise referrals to a wide range of services (using technology from Strata Health).

It is working on both a shared care record (the Lancashire Person Record Exchange, or LPRES) and a digital image sharing strategy (with Sectra). However, the shared care record’s content is currently limited to PDF documents. This puts it some way behind those high-flying LHCRE projects; and there are significant challenges to developing it further.

For instance, the other hospitals in the area use different systems; most of them old or under-developed. Consolidation on a single system might make sense; and while there is a long way to go, Brown says shared decision making is getting easier as the local sustainability and transformation plan area matures into an integrated care system.

“In June 2018, we launched a new digital strategy and what struck me was how much everybody bought into it,” he says. There is particular enthusiasm for advancing the ‘empower the patient’ agenda through a new app that will enable local patients to get advice from NHS Choices, see their records, and book appointments at GP practices, community and hospital services.

Lessons learned

Over the years, Brown has learned many lessons about digitising health services. First, he says, “digital is hard work” and organisations that are just embarking on their digital journeys need to recognise that. “Second, you need to have leadership.” Not just a chief information officer or lead clinicians, but “an engaged board and directors who ‘get it’” and doctors and nurses who do the same.

Then, you need clinical engagement. “I can’t predict as CCIO how to [build a particular system]: because I don’t do all the jobs around the trust that IT needs to support. If you want to develop a nursing record, then you need nurses to tell you how it should work.” And, finally, there is resourcing “because if you do not resource infrastructure, and kit, and training, it is a struggle.”

Show me the money

It’s the last point that he can hardly stress strongly enough. Asked, at the end of the interview, if there is anything that has not been covered or been given sufficient focus, Brown says: “Money.” And then: “No, honestly, money. Really, money.

“We are at business as usual [with Lorenzo] and we are doing more things [with the system and across the healthcare community], but we need money. It is not the only thing, but you need money to breathe oxygen into things and to get them done. That’s why we look so enviously at Leeds, Manchester and London, and the resources they have got.”

It’s not just envy, he adds. Addressing the digital agenda so the local area can tackle population health issues and make the very best use of the staff and facilities it has got, is going to be critical to its future.

“I see us moving towards this great workforce cliff-edge,” he says. “In three years, we will have 25% fewer consultants and GPs, and we have not been able to change our systems and our working practices to cope. So, when I say what we need is money, I do mean money.

“Yes, we need to engage patients in their health and care and yes, if we could get smart, engaged patients accessing their records, and looking at their care plans then we could provide more effective and more personalised care. But we have a workforce that is constrained: that is the big issue; that is what we need money to address.”