CareDirector, COVID and the post-launch analysis

It’s been a little over 8 months since we launched our new electronic patient system, CareDirector. Launching any new EPR system was always going to be hard as we take on new working practices and make significant changes to the way we record patient information.

We had put a lot of work into planning the launch knowing change like this is tough and takes time.  Making the system live in the midst of a global pandemic brought even more challenges and we know that many people had concerns about getting to grips with a new system alongside managing our response to Covid.  It was for this reason we carried out three pieces of evaluation including the use of our Your Voice Counts platform.  While the response rates to this were relatively low (11% of all staff) there were some recurrent themes, which is why I am sending out this blog now.

Taking the decision to launch Care Director when we did was far from easy.  However, I believed then, as I still do now, and taking into account a whole range of risks and issues that this was the right thing to do.  What has emerged from the evaluation work we have done is the rationale for that decision was not communicated as widely as we hoped it would. This has understandably led to some misinformation and mistrust about our rationale, intent and our motives which makes for difficult reading.

So I want to take this opportunity to reassure you and reiterate that the decision was not made lightly and was based on the assessment of some significant risks and issues – not least that had we not gone live when we did we faced the likelihood of ending up with no EPR.  Reflecting on where we are now and how differently we are working, that would have been catastrophic.

As we went into lockdown we saw over 1300 staff in our Trust move to remote working and therefore needing to access records in a very different way.  I remain immensely grateful to every one of our staff for how they have adapted and responded – including the implementation team for Care Director.

However I also want to acknowledge another theme in the evaluation feedback relating to training and ongoing support.  Regarding the training that was provided we have heard loud and clear that for many staff it didn’t sufficiently equip you with the skills, tools and confidence to make best use of the new system, and I am sorry for the stress and pressure that has created.   The ongoing support model we had developed was hampered by the Covid pandemic and the team responded very quickly and effectively to adapt.  I know some of you found this responsive and supportive and have fed this back, and I also heard that for some teams and individuals this wasn’t enough and you are still in need of more tailored and targeted support.

We had said from the very start of this project that CareDirector would not be a static system and there would need to be further development work post-launch so that we can create a system that works for us.  We’ve not got everything right – and we’re taking every opportunity we can to learn and work together to develop this system.

I have reminded myself that when we embarked on the work to replace our EPR, (at which point the feedback on our existing system was consistently and overwhelmingly negative) a close colleague commented that the process of change to a new system will not run smoothly and there will be a period when some people will wish we hadn’t made the change at all.  I know some of you feel this way and what I need now is for you to work with us as we put into place a series of actions in response to the learning and feedback so far. For those who are now more confident and getting good use out of the system, please share your learning and support to colleagues.  I read some great examples of this already happening in the survey feedback and it gets to the heart of the inclusive culture we are trying to create.

Some of the recommendations we are already implementing based on the evaluation so far include…

• We have worked with teams to develop team specific dashboards covering a range of themes including RAG rating trackers, safeguarding and a live activity overview allowing teams to respond in real time.
• We have reworked the “All Activities” view to ensure all notes are presented in the correct chronological order.
• We have provided direct access to the “Old Record Archive” without having to register a client in CareDirector.

The project team are committed to making CareDirector a useful tool for all users, and I would like to pay tribute to their efforts in getting this system live when they did.  I am grateful for your perseverance, creativity and honesty, and I’m thankful we are not living with the consequences of what might have been.

You can access the full report on our Quality Improvement Bookcase on Staffnet.  Please note you can only access Staffnet while on Trust premises or through a VPN (Virtual Private Network). 

Dr Sara Munro, Chief Executive Officer