Cambridge University Hospitals revalidated against new EMRAM Stage 6 standards

The HIMSS Analytics EMRAM standards were recently updated to reflect advancements in the healthcare information and technology space.
By Leontina Postelnicu
08:10 AM

Cambridge University Hospitals nurse using a handheld device integrated within the Epic EPR to administer medication; Source: Cambridge University Hospitals NHS Foundation Trust

Cambridge University Hospitals NHS Foundation Trust (CUH) has become the first NHS trust and the first Global Digital Exemplar (GDE) to be revalidated against the new Stage 6 HIMSS Analytics international Electronic Medical Record Adoption Model (EMRAM) standards that came into force at the beginning of the year.

The changes were designed to reflect progress in the healthcare technology and information space during the past few years, with the Picture Archiving and Communication System (PACS) requirement, for instance, moved from higher to lower stages of the model (PACS is now part of the Stage 1 criteria, as opposed to Stage 5).

New standards were also introduced to ensure that cybersecurity and disaster recovery were “fully recognised as important factors in a modern health service”, John Rayner, Regional Director for Europe and Latin America, HIMSS Analytics, told Healthcare IT News.

“In addition, areas of compliance have been increased to raise the bar and to acknowledge the importance of having these critical services hospital-wide, rather than in a single clinical area. As a result of these changes, some hospitals are likely to find achieving the higher stages of the model more challenging than they did prior to January 2018,” Rayner said.

Cambridge University Hospitals went live with Epic back in 2014

CUH, which runs Addenbrooke’s Hospital and The Rosie, originally achieved Stage 6 of the EMRAM standards back in 2015, following the creation of its eHospital digital transformation programme.

The HITN team visited CUH more than four years after the “big bang” go-live of their Epic EPR,  configured during an 18-month period to incorporate the trust’s clinical workflows and to support local and national guidelines, and found overwhelming support for its digital agenda. Their EPR is now reportedly being used by around 3,400 staff at peak times across all clinical areas, and Luke Bage, Senior Charge Nurse, told HITN that the system “continually seems to improve”. 

“The Epic that you see at the beginning of the year is not the same Epic that you see at the end of the year,” said Dr Afzal Chaudhry, Renal Consultant and Chief Clinical Information Officer (CCIO) at the trust.

After developing electronic early warning alerts within the EPR, launched in their Emergency Department in 2016 and across all adult inpatient areas at both hospitals in 2017 to ensure that nurses and doctors are notified if a patient’s clinical observations meet sepsis criteria, the trust has seen a 42 per cent reduction in sepsis mortality.

In April this year, CUH linked Epic to the Cerner Millennium system used at West Suffolk NHS Foundation Trust, helping clinicians securely access clinical information about a patient held within each other’s EPR to improve quality of care, as figures show that nearly 30 per cent of their patients attend both trusts for treatment.

The next month, through a digital primary care portal called EpicCare Link, a similar initiative was launched to help GPs and community nurses securely access clinical information about their patients from within the Epic EPR, currently available at Granta Medical Practices in Cambridgeshire.

The Care Everywhere HIE functionality also connects CUH to Epic hospitals around the world and, once University College London Hospitals NHS Foundation Trust and Great Ormond Street Hospital for Children NHS Foundation Trust go live with Epic next spring, the trust will also be connected to them.

CUH wants to become the first trust to reach EMRAM Stage 7 in the UK

Meanwhile, CUH signed a £107m seven-year contract with Novosco in June to replace and strengthen its infrastructure to take account of “more mobile working, device integration, and accommodate telemedicine, whilst keeping the system secure, protected, and accessible”, according to Chaudhry. The transition process is underway, and the trust now has an ambition to reach Stage 7 of the EMRAM. 

“The main things that we would like to focus on are a robust methodology for quality improvement informed by the use of data, so that we’ve got real data-driven analytics to help us understand where we have the greatest opportunities to improve patient care and to measure the beneficial outcomes of that in a sort of continuous improvement cycle,” Chaudhry said.

Commenting on today's announcement, Dr Ewen Cameron, CUH Executive Director of Improvement and Transformation, added:

“To validate against the new criteria shows how far we have come over the years since we implemented Epic and since our last HIMSS inspection. Our aim now is to further advance our use of technology to provide even greater benefits to our patients and staff and, as a result of doing this, become the first Stage 7 trust in the UK.”

Only two other organisations have previously reached Stage 6 of the EMRAM in the UK, Kingston Hospital NHS Foundation Trust and St George's University Hospital NHS Foundation Trust.

Twitter: @1Leontina
Contact the author: lpostelnicu@himss.org