Can this implementation of EPRs succeed where past attempts have failed? Quality Engineering is the key to success.

The NHS first began launching electronic patient records (EPR) in 2005 with the goal of providing all patients with a centralised health record by 2010. While some hospitals managed to launch an EPR system during this period, others failed to do so. The system, known as Lorenzo, was dogged with concerns about patient confidentiality and safety, usability, and problems with migration compatibility. Ultimately, the programme was abandoned in 2012 after a cost to the UK taxpayer of £12 billion. It has been described as the biggest IT failure ever seen.

Despite these issues, Sajid Javid has stated he is determined to "create a single, life-long digital health and care record for everyone by 2024” which could pose a challenge considering one in seven NHS trusts were still using paper patient records in 2022. So, what can be done to reassure the British public that lessons have been learnt and this attempt at digital transformation will be successfully delivered on time and on budget? After all, the failings of the Lorenzo project are not unique as only 30% of all software implementations are deemed successful.

It all comes down to Quality Engineering (QE). From the early planning stages, right through to implementation and delivery, quality must be a focal part of any digital transformation.

Quality from the outset, it’s everyone’s responsibility:

Traditionally, quality was the sole responsibility of the technology team and was usually deployed towards the end of a project. However, in today’s increasingly complex world, everybody needs to take responsibility for Quality Engineering and it needs to factor into every aspect of a project from start to finish. Ignoring quality could impact the success of an entire project and result in poorly designed or implemented software systems, leading to errors, delays, unforeseen costs, damage to brand reputation, and even legal liability.

Considering quality from the outset will ensure any problems are caught and resolved in the early stages, before they become much more complicated, time-consuming, and expensive to fix later down the line.

Quality from a healthcare perspective:

When considering a digital transformation project as vast, complex and important as the implementation of EPR, it is absolutely crucial that quality is considered throughout the process to ensure it is delivered on time, on budget, and is fit for purpose.

The NHS requires reliable 24/7 access to vital systems to ensure they can deliver the best quality care to their patients. The new EPR system is no different, it needs to function correctly. So how can we make this a reality with the use of robust quality engineering?

Everyone needs to do their part:

From the healthcare staff who will use the EPR system, to the IT departments involved in project management, everyone needs to take responsibility for quality. The senior leadership team also need to do their part, and ensure they foster an environment where people feel their opinion is valued and they can call things out that might not be going to plan. Ensuring everyone knows they have a responsibility to uphold a high standard of quality within a project will help to ensure success.

Define detailed project requirements:

A detailed and exhaustive list of requirements needs to be created and delivered to the supplier. It should outline what functionality is required, define explicit roles, responsibilities, scope and timescales for all aspects of the project to ensure everyone is aware of what is expected. Doing your due diligence at the very beginning of a project, while it may seem time consuming, will save time and money in the long run when you are not having to go back and fix errors resulting from poor planning. As many people as possible will need to contribute to this initial piece of work to ensure nothing is overlooked or missed.

Hold suppliers to account:

It is important to check the project requirements are indeed met by the supplier to ensure the delivered solution is free from defects and is in compliance with legal regulations. The NHS do not want to repeat any of the same mistakes from the previous EPR launch, so ensuring suppliers meet quality and functional standards is key. Third party intermediaries like Roq can help ensure suppliers are held to account by providing an expert, non-biased view of the quality of a project, however this works best when we have been involved in a project from the very beginning.

Communication:

Communication is of paramount importance when embarking on multi-faceted, highly complex digital transformation projects. Regular, transparent and straight-talking communication between the customer and supplier is an important means of guaranteeing quality and success upon delivery.

Test at the start and throughout development:

Traditionally, testing and quality assurance is something that tended to take place towards the end of a project. Quality Engineering should be front of mind throughout the entire development lifecycle. It is not something to implement as an after-thought, just before deployment.

Simply put, solving problems throughout development is much easier than having to peel back many layers of coding to reach a small mistake that was made in the earlier stages.

Conclusion:

The introduction of a single cloud-based mega-vendor in a mammoth migration project like the NHS EPR could bring tears to the eyes of even the most seasoned IT professionals. However, if everyone takes responsibility to ensure Quality Engineering is at the heart of this venture from start to finish, a successful delivery is realistically achievable.

Better use of data and technology has the power to improve quality of care and create much-needed cost efficiencies for our national health service. Once this goal is realised it will streamline the way the NHS stores and accesses data, giving all clinical teams across the UK secure and appropriate access to a complete view of a patient’s health record.

Reach out to us:

If you want to learn more about Quality Engineering and improve the outcomes of your digital transformations, please don’t hesitate to reach out to us at mark.lambert@roq.co.uk