Domain Share EPR Programme for the GESH Group of Hospitals

In this case study, South-West London Integrated Care System (SWL ICS) Digital Pioneer Fellow Jay Khan, Programme Manager (Shared Domain) at the Informatics, Digital and Technology Department in St George’s Hospital, shares how he is working on bringing the GESH group of hospitals (St George’s, Epsom and St Helier) together on a shared domain single Electronic Patient Record (EPR).

Project Summary

By March 2025, all NHS organisations must achieve a core level of digital maturity, including implementing a modern, up-to-date Electronic Patient Record (EPR) system. St George’s Hospital is a legacy site running an Oracle Cerner EPR, while Epsom Hospital and St Helier Hospital use iCM and iPM with limited capability. The three hospitals (known as the GESH group of hospitals) are separate legal entities, meaning that data separation requirements may differ for each hospital at the Data Warehouse and Reporting level.

To address this, we have built a Domain Plan as the RoadMap, listing all the projects, activities, configuration, workflow testing, data migration, integration, interfacing requirements, and compliance with Governance, National Reporting and Apps rationalisation. Some of the challenges we have faced include parallel project activities, the variance in workflows and or configuration, the different system rules as well as the difference in user roles (e.g. Role Based Access Control).

Project Objectives

Between April 2023 and December 2023, several Shared Domain projects were delivered for St George’s Hospital. The site was the first to go live with Oracle Modules in the Shared Domain, which included:

Shared Domain Project:

• Security Matrix
• Capacity Management
• Orders to Scheduling Phase One
• Hospital @ Night
• Accession Numbering

Local to St George’s Hospital:

• Digital Whiteboards

Due to delays in Data Migration and Reporting, the GESH group of hospitals has experienced a shift in the project timelines, affecting the Domain Plan. Though the initial Go Live date was set for 2024, technical setbacks have necessitated a thorough review to establish a realistic and safe timeline for the Go Live. This review is currently ongoing and considers factors such as resource availability and scheduling constraints from both the GESH group of hospitals and the vendor, Oracle Cerner.

Impact/Outcomes

Implementing an Electronic Patient Record (EPR) system in hospitals can cost millions of pounds per hospital. However, innovations have emerged to reduce these capital expenditures.

Over a decade ago, St George’s Hospital implemented the Cerner EPR system. Building on this foundation, a business case was developed to expand this system across the GESH group of hospitals by implementing a Shared Domain, allowing for a suitably configured EPR to be hosted and shared. From a return on investment (ROI) and benefits realisation perspective, it became a viable strategy for all three hospitals to pursue a Domain Share EPR Programme, leveraging St George’s Hospital’s existing EPR as the baseline, enabling all three hospitals to utilise the Oracle Cerner EPR efficiently.

All three hospitals have also planned future Innovation Release cycles, which will bring numerous benefits to staff, including integrated care, shared care records, simplicity, ease of use, improved access, and reduced contractual costs. The Domain Share EPR Programme will serve as a model for other NHS organisations, demonstrating the advantages of a shared EPR system over individual investments.

Next Steps

Domain Share EPR Programmes are now a reality, significantly reducing procurement and deployment costs. Shared Care Records exemplify this approach, aiming to reduce expenditure and save taxpayer funds by using resources economically and wisely. By leveraging effective technology, these programmes enhance user experience, streamline maintenance, and capitalise on cost-effective procurement contracts through economies of scale.

The benefits of Domain Share Programmes also extend beyond financial savings. They enable streamlined organisational structures, Agile teams, and open doors to further innovations (e.g., Robotic Process Automation (RPA), Artificial Intelligence (AI), Machine Learning (ML), Large Language Models (LLMs), the integration of tools like ChatGPT and efficient cloud hosting options to reduce capital expenditures).

With 930 NHS hospitals in the UK, there is significant potential to save taxpayer funds by utilising existing resources and cohesive technology. The project has already proven its capability to deliver effective solutions, and in the long term, will help to reduce costs through the continued implementation of intelligent long-term strategy, appropriate governance, and economies of scale.

Jay Khan is a Fellow from Cohort One of the SWL ICS Digital Pioneer Fellowship programme.

The SWL ICS Digital Pioneer Fellowship programme supports change makers employed by NHS, Local Authority and Voluntary Sector organisations in South-West London to design and lead health and care transformation projects underpinned by digital innovation. Funded by the South-West London Integrated Care System, the programme builds on DigitalHealth.London’s Digital Pioneer Fellowship programme but is specifically for staff employed by NHS, Local Authority and Voluntary Sector organisations in South West London.

To find out more about the other Fellows in Cohort One of the SWL ICS Digital Pioneer Fellowship programme, please refer to our innovation directory.