Craig York, chief technology officer at Milton Keynes University Hospital (MKUH), has a far-sighted vision of the kind of digitally enabled healthcare organisation he’d like to create over the next two years.
“There’ll be no pieces of paper at all,” he says. “We’ll be sharing data with all healthcare and social care partners that we talk to. I want to connect into everything and provide more of a comprehensive record as well, so that our clinicians have a complete view of all patients’ medical history.”
York is already making solid progress. The hospital shares records with local organisations, including community health, mental health, urgent care centres, hospices and all GPs across Milton Keynes and Bedfordshire. What is more, MKUH’s commitment to a cloud-first digital strategy will help the organisation develop further information-based services.
“We already make use of some clinical decision support, but I’d like a lot more,” says York. “That’s straying into AI [artificial intelligence], but clinical decision support is the right term – automatically bringing in data from primary care on allergies and alerts and linking that information effectively, so that when you are prescribing or making any decisions, our electronic patient record is helping you do that safely.”
York, who has worked for the hospital for 20 years, says he will use a range of standards to ensure digital transformation targets are hit. “Over the next few years, we hope to reassess and see where we are against others around the world,” he says.
Creating an integrated data platform
Like other hospitals, MKUH is reliant on its data platforms. Two of the most important are CCube Solutions’ electronic document and records management (EDRM) system and Cerner’s Millennium electronic patient record (EPR).
Unlike most hospitals, however, MKUH has decided to bring these two platforms together. At the end of last year, the hospital completed a project to fully integrate and embed its CCube EDRM system, which contains over 80 million scanned legacy patient records, within Cerner’s Millennium EPR.
This UK-first approach to system integration allows 3,800 staff to access digital patient notes contained in the CCube EDRM from within Millennium – and without clinicians having to log in and out of the two systems, inputting usernames, passwords or any medical record numbers. York says this level of integration is a boon for productivity.
“Sometimes in healthcare, we underplay how complicated things are” Craig York, MKUH
“Going into multiple systems is a pain for our clinicians,” he says. “It’s not very efficient, and you need to keep track of the different patients that you’re looking at across the same timeframe. We have embedded the EDRM system within Cerner Millennium, so our EPR is the system of record for our clinicians.
“You click a button and it logs you into the medical records and you can scan through those as you wish. You’re in the right record, there’s more efficiency, and there’s better patient safety as well.”
The hospital’s internal IT team undertook the project working in close collaboration with software developers at CCube Solutions. York says it was a complex project, but by working together to achieve set goals, the integration of EDRM and EPR systems is now delivering big benefits for the hospital.
“Sometimes in healthcare, we underplay how complicated things are,” he says. “The work with CCube is an example of where we’ve asked an organisation to step up and deliver on our requirements, and they’ve done it and they’ve proved their capabilities. We are now reaping rewards from that effort, so I’m thankful to them for that.”
Embracing a cloud-first digital strategy
MKUH’s EDRM system runs in a secure Microsoft Azure cloud environment, which reflects the hospital’s enterprise IT strategy – cloud-first and digital at the heart of everything. York says the integration of EDRM and EPR systems fits well with the hospital’s desire for technological agility, scalability, security and flexibility.
“We are a fairly digitally mature organisation,” he says. “We finished Windows 10 a while ago and we’re already rolling out Windows 11. I think it’s going to be a long time before other organisations are in that place. The reason we can do it so easily is because, for us, it’s simply an update. We’ve got our own tenant for Office 365 linked to our own tenant for Microsoft Azure in the cloud. More than two-thirds our infrastructure is now migrated to the cloud.”
“I don’t want to say that moving to the cloud is for cost savings, but it does bring real flexibility and agility”
Craig York, Milton Keynes University Hospital
York says this cloud-first strategy gives the hospital the opportunity to embrace new innovations and new ways of working, without being hamstrung by legacy processes and hardware. More importantly, it means MKUH can make its own IT choices.
“I don’t want to say that moving to the cloud is for cost savings, but it does bring real flexibility and agility,” he says.
“We have two on-site computer rooms. There was a time when the main one was chock-a-block with racks. Moving to the cloud means you can do everything in a few seconds, and you don’t need your own infrastructure and don’t need to wait for supply chains from the hardware vendors.”
The executives running MKUH can also see the benefits that come from embracing the cloud. York gives the example of a recent meeting with the hospital’s finance and investment committee, where executives were able to discuss the plus-points at first-hand.
“We talked about the Office 365 investment and some of the feedback we’d had,” he says. “That included feedback from private sector organisations that showed how we, as a hospital, are driving forward the use of 365. It’s clear not everybody in the NHS is doing this well – and our executives are glad to be part of an organisation that really is.”
Pushing digital transformation during a crisis
MKUH’s commitment to the cloud has paid big dividends during the coronavirus pandemic. Having already establishing a strong approach to on-demand IT, York and his team were able to establish remote-working methods to ensure elements of its disparate healthcare workforce were able to fulfil their crucial tasks.
“When Covid struck and, like other organisations, we sent people home who could, we needed to find a solution to enable them to work efficiently,” he says.
“Within a week, we had spun up a new Microsoft Azure desktop and we had people logging in. Within two weeks, we had connected the great proportion of our systems securely.”
During the first month of the pandemic, York says MKUH supported more than 400 people who were logging in to the network using a browser-based desktop through Azure to use a range of applications. Enabling that process included dealing with some key complications, such as allowing people to log in using the NHS Smartcard.
Some remote-working employees, for example, needed to use the EPR, which is a smartcard-enabled application. York and his team established “drops” around the hospital, where members of staff could turn up safely, pick up a smartcard-ready keyboard and return home to get on with their work.
Overcoming such challenges during the pandemic helped prove the benefits of digital transformation, says York. “I’m very conscious and aware of the impact of the pandemic on this hospital. But there has also been a new level of investment, and governance has been lifted. We, like others, have jumped forward several years – and continue to do that,” he says.
“So, while I’m conscious of the huge impact of the pandemic, it has been an exciting time to work in NHS IT because innovation doesn’t normally happen every day. There are great things that go live every so often. During the pandemic, we were asked to deliver new innovations every month, every week, every day – and we stepped up to that.”
Providing secure remote working
The establishment of remote-working processes has also required a commensurate focus on cyber security. York says all the hospital’s IT users are enabled for multi-factor authentication (MFA), using either a text message or Microsoft Authenticator to access systems.
“If executives are offsite and they try to access one of our applications, they have to go through an MFA – it’s very secure,” he says.
“For every single user in our organisation, their home drive is OneDrive” Craig York, MKUH
In fact, York says the past two years have helped to create a much deeper focus on how people across the hospital can use Microsoft technology to work remotely and securely – and still be highly productive.
“We don’t have file shares any more,” he says. “People don’t have home drives, they use OneDrive. For every single user in our organisation, their home drive is OneDrive. Everybody uses Teams and SharePoint files. It was a bit complicated for our finance colleagues, who had all their macros and automation in Excel.
“But even they got there eventually and now nobody would go back. Our clinical colleagues say they get much more engagement, especially the senior ones – they don’t mind logging on from home on their iPads. Meetings also bring much more engagement because people have got access to good technology that just works.”
Leading technology-enabled change
Other exciting plans for tech-led innovation are ongoing. In October 2020, MKUH became one of the first hospitals in the UK to allow patients to view consolidated healthcare records within the Health app on their iPhones. The feature shows health-related data from iPhone, Apple Watch and third-party apps.
With the checks made to ensure data is used safely and securely, York is eager to push the implementation with Apple to the next level. MKUH is also in conversations with Microsoft and Google about innovation and uses other pioneering digital services, such as Zesty’s MyCARE app, which enables patients to book and change appointments.
“One of the key lessons that I’ve learned over the last few years is that some of my peers have asked: how do you think you got the call from Apple? Why do you do some cool things with Microsoft? The answer is that you have a relationship with them to start with. I knew the person from Apple who phoned me,” he says.
“So, it’s all about relationships – and not just with suppliers, but across the NHS as well. There are good forums to meet up and link with your peers across the NHS, both supplier-led and from our side. You need to make the effort. And through that approach, there are always things that you can learn from your peers.”
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