THE CHALLENGE

Lewisham and Greenwich NHS Trust (LGT) was formed after a merger on 1 October 2013. The Trust is responsible for running two acute hospitals, Queen Elizabeth Hospital, Greenwich (QEH) and University Hospital Lewisham (UHL), in addition to providing community health services in Lewisham.

At the time of merger, LGT had two concurrent Cerner Millennium Electronic Patient Record (EPR) implementations underway:

  • QEH, under the National Programme for IT (NPfIT), was migrating from its legacy systems onto Cerner Millennium and went live in July 2014
  • UHL, via its own procurement, was moving from its own legacy systems onto Cerner Millennium and launched in June 2015

The result was Cerner Millennium systems with differences in functionality, usage and configuration capability which acted as a barrier to creating a single acute service across the two sites. This could only be resolved by merging the two solutions to create a single digital acute patient record across the Trust. In January 2016, following a competitive tender, LGT awarded Nautilus Consulting the contract to deliver this outcome (the iCare merge project).

THE SOLUTION

The iCare merge project was initiated in February 2016 with Nautilus delivering the following services:

  • Programme/project management
  • Change management
  • Data migration
  • End to End Testing
  • Cutover management and transition to service
  • Management of the Trust project team and third-party data migration contractors
  • Management of other third-parties, including the relationship with Cerner

From the outset, a number of key delivery challenges were identified:

  • The two Millennium systems had been built and configured differently
  • 30% of patient data was duplicated in both systems
  • BAU pressures resulted in insufficient Trust capacity
  • An aggressive 52-week project delivery timeline
  • No existing means of migrating essential clinical data

These required innovative solutions:

Due to the tight schedule and the set up time for Cerner domains, two Cerner domains were run in parallel to build and test the merged system. This removed delays between project stages due to domain preparation.

The Trust’s clinical staff were clear that key clinical data (results, clinical documentation, future orders for phlebotomy, scanned documents, maternity information for open pregnancies and pregnancy history) needed to be migrated. Cerner data migration tools did not support this. So, Nautilus developed bespoke tools for:

  • A viewer, integrated with Cerner Millennium, to display any clinical information that could not be migrated originally
  • A maternity robot to port data from one Cerner Millennium system to the other

Nautilus also utilised its 835 analytics platform as the source for data migration as well as information and reporting testing. This made the process of data extraction and postmigration validation faster and more accurate. The Trust had a planned reporting outage of only a few hours for critical reporting like RTT PTL following cutover.

Throughout, Nautilus defined clear roles within the project team to ensure joint focus of all parties on addressing all the challenges and meeting the deadlines.

THE OUTCOME

The project was delivered on time and within budget.

Key objectives achieved:

  • Configuration between the two Cerner solutions was merged in a way that worked for both sites
  • All third-party systems were integrated seamlessly with iCareLGT, the merged Millennium system
  • All relevant data was migrated to the merged Cerner
  • Millennium system without any errors
  • Patient care was unaffected by the merge process across both QEH and UHL
  • The project was closed on time within two weeks of going live, having achieved the exit quality gateway.
  • No major incidents were reported during the 14 days early life support following the go-livea

LGT is now using the Nautilus 835 solution for its near to real-time reporting from Millennium, providing critical reports including RTT PTL , A&E dashboard and Theatre dashboards.

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“Nautilus formed a good relationship with us by ensuring all the project team worked as one and bringing in highly skilled resources. Any problems were sorted quickly and easily.”

Barbara Tringham, Head of information, Clinical Coding and Medical Records