The trust
Royal Brompton & Harefield NHS Foundation Trust (RBHT) is the largest specialist heart and lung centre in the UK, and one of the largest in Europe.
The trust provides its services from two hospitals, Royal Brompton Hospital in Chelsea and Harefield Hospital near Uxbridge. In addition, thet trust has specialist care private outpatient and diagnostic services based at Wimpole Street, London, including an inherited cardiac conditions clinic, heart screening clinic, and advanced diagnostic imaging.
The challenge
In 2016, RBHT undertook an internal restructuring of its imaging IT team, which saw a change of ownership to the trust’s cardiology solution, McKesson Cardiology.
In parallel, the system was also rolled out from its initial implementation at the Royal Brompton, to Harefield Hospital. This, together with the opening of the Wimpole Street site, presented an opportunity for a full evaluation of not only the cardiology solution, but also the trust’s wider imaging IT infrastructure and workflows.
Tracey Yarker, imaging and IT services transformation lead at the trust, said: “Imaging plays an integral role in the services we deliver.
“We know that we need to upgrade some of our systems in order to meet our clinicians’ evolving requirements, and to achieve this goal we need clear understanding of how some systems worked in order to implement change efficiently and cost effectively.
“Different aspects of imaging IT systems historically have been managed by different divisions, and our organisational structure is tailored to each site.
“We have multiple IT systems within radiology and cardiology, which can duplicate functionality and lead to working in isolation.
“At the same time, we recognise the need for an integrated enterprise imaging system that involves the standardisation of cardiology processes, consolidation of all imaging IT systems, and the upgrade of storage capacity, which is what we set out to ascertain.”
The solution
McKesson Medical Imaging Consulting, now a part of Change Healthcare, assessed the current installation of McKesson cardiology products across the trust.
Following an initial meeting, the scope was expanded to include all of cardiology and radiology imaging IT systems.
The stated goals of the assessment were to:
- Provide an analysis of the trust’s clinical operations, technical architecture, and data management operations through stakeholder interviews, system analysis and clinical walk rounds
- Identify possible ‘quick wins’ that could be implemented easily to improve operations
- Make recommendations and support the development of an implementation plan to help the trust achieve cost savings through economies of scale, improving workflows, clinical data consolidation and analysis, and system integration and communication
In March 2017, Change Healthcare undertook a full on-site imaging assessment across Royal Brompton Hospital, Harefield Hospital, and Wimpole Street.
The team interviewed 47 stakeholders, including consultants, clinical radiographers, service leads, cross-site clinical directors, some of the trust’s executive team, and the director of strategy.
Change Healthcare then developed an imaging scorecard, providing a holistic evaluation of the people, processes, and technologies within the trust’s cardiology and radiology imaging departments.
The scorecard is intended to be used as a tool to identify areas of general improvement, with different items ranked as ‘red’, ‘amber’ or ‘green’ according to their importance and urgency. In turn, this led to the creation of a prioritised action list to address the key areas.
Change Healthcare also identified a number of ‘quick wins’ that could be implemented rapidly at no, or low, cost to deliver immediate improvements. These included:
- Holding an ‘Adoption and Change Management workshop’ to provide users with tools and techniques that could be used throughout a Change Cycle to address obstacles to adoption and increase user satisfaction, employee morale, and patient and physician experience, ensuring maximum ROI on the trust’s existing investments
- A Business Intelligence pilot for Wimpole Street to create custom dashboards and a single source for viewing critical data as defined by the trust to gain a better operational understanding and to establish benchmarks
- Adoption of an asset management system to improve control of clinical applications and potentially reduce the cost, complexity, and compliance issues related to managing software assets, thereby freeing people from day-to-day operations to focus on delivering value to the organisation
“The ultimate outcome of the assessment was the identification of a trust-wide imaging strategy of ‘any image, anytime, anywhere’,” Yarker said.
“While we are in the final stages of agreeing with our executive team the next steps and priority actions, the assessment confirmed that we are moving collectively in the same direction toward an enterprise imaging strategy and solution.”
“As the IT imaging landscape evolves, there is no longer any ‘one-fit’ solution,” she added.
“Trying to find the right approach that maximises existing investments while embracing innovation and delivering a futureproof IT imaging environment now demands collaboration between trusts and their multiple vendors.”