Neil PoundISUG 2012

Plan• How we transferred from Isoft to TPP

(And a little bit about why)

• How we switched• What went right & wrong• What to ask the suppliers at the demos• Where we are now• What I wish I had known 12 months ago

This isn’t going to be…

• Advice on which system to choose• A plug for TPP (but we do like it now)

• A model example of best practice

But it will be warts and all truthful!

Background

• Woodlands Medical Practice, PMS PFI 10yrs ago• Sutton in Ashfield, deprived• 9200 pts, increasing• 5.2wte doctors, 4wte nurses (NP)• F2 training• 4 reception, 2 nurse admin, 2 script admin, 2

data quality, low staff turnover• Host nursing home coordinator service

Background: IT• Isoft Premiere 10+ yrs (Microdoc)• Apollo SQL/Apolloscan (8 yrs)• Frontdesk/Contract+• Easylabeller• Cardiosoft ECG• Welch Allyn ABPM• GPintranet

Background: Organizational

• Paper-light• Nurse Clinical coder (QOF)• Touch screen check in / Jayex• On line appointments / script ordering• Pathlinks (one local provider)• Data “cleansed” (IM&T DES)• No dedicated IT person

Me• Ex nurse/IT trainer/programmer/systems

analyst• GP (9.5 clinical sessions)• Federation chair• QOF/IT lead• No links to Isoft/TPP• My views are my own!

Why did we change?• Isolation• Functionality• Disastrous trials ETP/C&B• Lack of support (local / Isoft)• Complexity of integration• Lack of robust hosted solution• Future uncertainty

Choosing a system (Avon IM&T)

• Practice (clinical benefits / strategy / impact)• Strategic fit (local / national)• System (status / roadmap / functionality)• Financial implications (practice / PCT)• Management considerations (practice / PCT)

• Decide priorities • NO SYSTEM MEETS ALL REQUIREMENTS

What to look for• Don’t just consider the clinical consultation• Functionality: gains vs losses• Where do you want/need to be in the future• Commissioning• Add-ons (current/integration/necessary)• QOF (updates)• Reporting• Current software & developments

What to look for: data sharing

• Locality teams (DN, palliative, MH, sec care, HV)• Templates• Formularies• Organisation• Messaging• ? Problems / access / “ownership”

What to look for at the demo

• Sales reps will have an orchestrated demonstration: break it up, use real time demo if poss, ask Q’s ‘show me’

• Beware airware• Involve as many staff as practical and at least one

reception/admin/nurse• Arrange a second demonstration• Examples (eg set up template / search / recall

communication)

Important questions for new provider (1)

• What data loss during the transfer?• Reference sites (local)• Is data in other systems (eg Frontdesk) part of

the clinical record & will this transfer?• What happens to data fields not mappable?

Important questions for new provider (2)

• How is potential data loss (Premiere) handled?

• Does deleted data transfer?• Will recalls be directly transferred?• Will prescription history & reauthorizations

transfer?• How about pts not currently registered

Important questions for current supplier

• How long will your database be accessible?• What happens if we need access to the data

after this period (costs & how long)?• Will you provide a named contact for data

queries (for the transfer)?• Do you need info from any other systems

(FDW)?

Questions for IT• Will current hardware suffice (full survey)• Costs?• Branch surgeries• Extras (new equipment)• N3 link issues / reliability

Timescales• August-Sep 2010 demonstrations providers• Sep-Oct shortlisting, further demo & technical

queries• October 2010 decision to change• March 2011 project initiation• September 1st data cut & verification• October 26th 2011 TPP go live

Planning (6+ months)• Pick a go live date and fix it• Try and have all GPs present• Consider absences, QOF, holidays• Arrange locum support in advance• Backfill for ALL staff• Training needs assessment (differences)

Planning (months)• Form project team in practice (?PM)• Monthly meetings in house• Supplier/training/IT meetings • IT survey (hardware)• Backup verification• Smart cards

Planning (weeks)

• On schedule?• Data cuts (verification/validation for

migration)• Test system available?• Detailed training schedule• Backfill/locum• Tell patients• Rota (less ? no routine)• Repeat prescriptions• Operational/business procedures (with

trainers)• Training (system administration)

Planning (days)

• Trainers on site (process review)

• Training in test environment

• Prepare (some) data for live site (templates, formularies, staff, configuration)

• Hardware installation & configuration

Planning (D-2)

• Last data cut• No scanning/pathlinks (manual systems)• Consultations ? Paper ? Old system• Shared list appointments (any practitioner)• No QOF, no “routine” work• Training• Heaven!

Planning (D-1)

• Technical go live• Hardware testing (IT on site)• (check data)• Training• Set up staff rotas• Transfer to live system

(staff/templates/formularies)

Go-live day• IT & multiple trainers on site ? in room if nec

• Longer appointments with breaks

• Review lunch & end of afternoon

• “Emergencies” only: no routine work

Post go-live (days)• More training (scanning/pathlinks/letters)• Catch up (scanning/pathlinks)• Template modification• Consolidation training • Back to usual appointment system• Routine work resumes

Post go-live (weeks)• Templates modifying (still)• Recalls updating• Repeat prescriptions restarting• Scanning/pathlinks catch up • Data re-entry from system downtime• Reports - reestablishing• QOF resuming

What went well• Data transfer • Negotiation with migration team• IT hardware (touchscreen, Jayex, printers)• Well planned project management• Patient appointments & scripts• Manual procedures pathlinks/documents• Electronic pathlinks & documents

What went a bit wrong• Communications & messages• Patient reminders• Templates• Scanning & document management• Configuration users & screens• QOF catchup

What went horribly wrong

• Training (inconsistent, inflexible)• Post go-live workload underestimated• Repeat script catch up• Scanning/pathlinks catch up• Christmas & the flu season (weather?)• Holidays• Recalls not serviceable• Appointments (searching)

What did we do?

• Panic• Review, discuss & change (daily team &

monthly practice meetings)• Looked at other practice’s use of system• Tried not to change too much too quickly

(process) • Extra work (me)

Overall Review

• Training: quality, duration, consistency • Business process management: don’t change

it if you don’t have to• Time bombshell• 3 months to be up to any speed• 6 months to be back where we were• 9+ months to be ahead of this

Costs?• Very difficult to quantify

• Main cost to practice is lost time & productivity

• Backfill & locum costs

• Extra time to configure system (me)

• QOF / complaints / stress

Regrets?• Lack training environment early• Didn’t realise poor quality training & little

understanding how GP’s (us) work • Didn’t recognise trainers misconception that

all practices work to same IT level• Didn’t look at how other practices use their

system early enough• Complacent (go live), lost overview

Currently• 11 months on• Functionality better (templates/macros)• Data sharing (safeguarding)• Prompt letters• ICE ordering & access to pathology• Reliable• Working remotely

What do I like?• Functionality better: Templates & macros• Formularies (Read/drugs)• Reporting (fast, easy)• Alerts• Customized views & configurability• Data sharing (safeguarding)• Prompt letters, ICE & access to pathology• Reliable• Working remotely

What do I miss?• Frontdesk• Upto date reporting• Error messages• Upgrades & multilex updates• ISUG conference

• ? control

Finally• Good luck: you will cope• GP’s flexible & resilient: cope with change• But timescales, so many changes, complexity…• It will be difficult but plan ahead• Think disaster recovery,

what if scenarios• Ask for help (SNUG)

Useful links

• http://www.gp.aimtc.nhs.uk/GPSoC_Change.asp• http://www.gpchoice.org/gp-choice/decision-to-

change-systems.aspx• http://www.connectingforhealth.nhs.uk/systems

andservices/gpsupport/gpsocce.org/gp-choice.aspx