NHS Higher Education Network London, 16 January 2020
Cindy Fedell Chief Digital & Information Officer, Bradford Teaching Hospitals NHS Foundation Trust
Digital Senior Responsible Officer, West Yorkshire & Harrogate Health & Care Partnership
@CindyFedell @BradfordDigital
From near the bottom to the Top 10
– Bradford’s Digital Journey So Far
A large, young, diverse & fast growing city; fastest in Europe
5,800 staff and 500 volunteers
Annual turnover £400m
Teaching hospital
Some specialist care
Research Institute
7th Most Digitally Mature Trust in England (no GDE funding)
Bradford is
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Our journey started off poorly ... Cultural separation
3 digital strategies had failed
Plasters and the knitting machine
Resulting in poor data quality issue with regulators
Paradoxical position – poor data but high data use with Bradford Institute for Health Research
Hungry for digital but wary
Set the scene with good principles
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… from a digital perspective The Wild West
Homegrown, unsupported critical information systems
Bought development effort that never materialised
Shadow IT departments; & they almost crashed the network
No analytics skill set or desire
Limited ITIL
Long list of projects in progress but few completing
About >200 Access databases in routine use for regulatory reporting
Oracle and others hovering re licensing
No governance
No-one believed was could achieve digitisation
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A year long exercise in “engagement”
Exercise to produce a Clinical Informatics Strategy
• Everyone to agree – disciplines, areas, Board, Governors
• Show them what good looked like - Industry-ranked tools
• Change-resistant culture – Big bang to force change
• Complementary strategy for business intelligence but nowhere near ability to have those conversations
• In the meantime started an optional EPR procurement with CHFT
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We needed to crack the divide & set ambition …
Overhaul the data infrastructure
• data warehouse, manual data flows, manual processing, roles, people and mindset
Get an EPR; takes a long time so started early
Hardware across the board was good
Standardise processes in IT
Find a way to overcome years of resistance on both sides
Do the basics first to ensure long term sustainability & strategic direction
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… and needed to -
We did it all at once …
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EPR was the face of everything
Progressed all at the same time
Overhauled all things BI
Introduced standards
Progressively built confidence and ambition
Co-designed not “engaged”
@CindyFedell @BradfordDigital
Together, putting patients first
… to create a mostly simplified architecture with trusted partners
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Swung pendulum to the opposite of bespoke
Vanilla-first approach
Simplified architecture
Automated data flows
Good quality data
Now small set of partners not suppliers
Utilise regional initiatives
Core is simple, allowing modular approach on top
@CindyFedell @BradfordDigital
Success came from working as one team
Operational, clinical, administrative & technical with executive involvement
Design & test people, process & technology
For EPR
• Everyone in the Trust had a role > 600 Friends
• 60 EPR Friends, 70 supplier, 170 elbow support
• 3-4 months just for readiness
For Command Centre
• Rapid Application Design – iterations & data focus
Supported by Communications
Together, putting patients first @CindyFedell @BradfordDigital
Simulation
In situ validation, eLearning,
use Practice EPR
Start/Stop/ Continue
documents
Self-declared Readiness
Assessment
Go-Live planning &
Trust readiness
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Our Trust today looks like this …
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71% use of predefined Admission Order sets
EPR adoption benchmark in top quartile:: 1st Allergies & Use of order sets, 2nd Record Opens, 3rd Documents created
No winter wards opened last year & no cancelled surgeries
2.1% staff, 1.8% budget Efficiency & maturity
benchmark top quartile & 1st Digital Readiness Two shared & no
outsourced digital services Almost 1:1 user:device Locked down devices ISO security certification Almost HIMSS 6
Electronic Patient Record
Almost no paper-based processes left
Patient safety enhanced by smart technology
#1 ranked software
HL7 Integration to ensure one source of truth for any clinical information system
Native regulatory reporting, i.e., no data manipulation
SNOMED & ICD10 coding
Added in single sign on as a sweetener
Proved to Board that it paid for itself
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Command Centre Modernisation of site management
• Trial run: improved Emergency Care time by 12%, Ambulance handover time by 20% , bed occupancy 10%
Action Tiles
Draw from many sources
Informed by Machine Learning in Digital Twin using historical data
Present actions not data
Co-locating people and Tiles to take interventions that remove bottlenecks, reduce risk, alleviate pressure -
• Deploy resources to wards under greatest pressure
• Action orders approaching turnaround times
• Resolve missing cross-match to prevent procedure cancellations
• Prioritise housekeeping and portering based on highest priority
• Mitigate conflicting appointments to avoid cancellations
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Command Centre
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Capacity Snapshot What is the current bed status, and where will I have problems
later?
ED Status How much pressure is A&E
facing, and which patients have needs now?
Discharge Tasks Which patients are ready to go, and what are they waiting for?
Patient Transfers Which patients are ready to
move, and where are the delays?
Ward Link Which alerts across the
Command Centre are relevant to my ward?
Care Progression Which patient services are delayed? Where is there
potential risk?
Right Patient, Right Place
Where is my non-elective pathway feeling pressure? Where
are the outliers?
Deterioration Where are my sickest patients,
and are they getting what they
need?
Together, putting patients first @CindyFedell @BradfordDigital
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#City of Research
Non-traditional data sources
Building more + richer data
Complications - processing power, access
Non-traditional data sources
Multi-agency analytic skill set required
We also service our Research Institute …
Our current strategy focusses on
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Two approaches
1. Building more on top
o Operational dashboards & Tiles
o Real time quality dashboards
o Population Health Management
2. Leveraging/using what we have
o Clinical AI
o Robots
Local health & care economy digital maturity including University
Virtual hospital
Efficient investment
Virtual Care @ home
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Ambulatory Care Experience (ACE)
Step up pathway for acute kids
1st in UK with TytoCare
Diagnostic-quality kit @ home
Tech Pilot successfully completing
Developing machine learning to optimise referrals
Model that allows spread and co-innovation
Research evaluation
Part of 200+ virtual beds
Clinical AI
Tom Lawton – Head of Clinical AI (1st in UK), Consultant Anaesthetist, BIHR researcher
Within Wolfson Centre – Universities of Bradford, Leeds & York
AI Big Problems to be solved
o Expediting A&E assessment and treatment by forecasting the type of tests needed
o Predicting length of stay
o AI/Safety analysis of medication management
o Predicting deteriorating patients
o Optimal paediatric pathways
o Reporting of plain film radiography
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1. Going big can be successful
2. Start with the end in mind – rich data
3. A simplified foundation/investment can be leveraged
4. A digital shift is a cultural shift – both an opportunity and a requirement
5. Must work as one team #WeAreBradford
6. One team is now @ Place
We learned
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Our near future
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At Bradford Teaching working within Bradford District & Craven -
o Proactive intervention by any organisation, e.g., pre-diabetic
o Higher acuity virtual services and at home rehabilitation
o AI-driven clinical prioritisation of patient appointments & follow-up
o New service models to support “on demand” from patients
Merging of
o Traditional & non-traditional data
o Consumer & clinical tools
o Tech for community, primary & acute services
o Research and real time care
o Roles - not just front line but analytics & tech
Use of non-traditional data & tech
Shift to on demand services Place-based management & care
