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Abstract
Introduction Obsolete bleep/long-range pager equipment remains firmly embedded in the National Health Service (NHS).
Objective To introduce a secure, chart-integrated messaging system (Epic Secure Chat) in a large NHS tertiary referral centre to replace non-emergency bleeps/long-range pagers.
Methods The system was socialised in the months before go-live. Operational readiness was overseen by an implementation group with stakeholder engagement. Cutover was accompanied by a week of Secure Chat and bleeps running in parallel.
Results Engagement due to socialisation was high with usage stabilising approximately 3 months after go-live. Contact centre internal call activity fell significantly after go-live. No significant patient safety concerns were reported.
Discussion Uptake was excellent with substantial utilisation well before cutover indirectly supporting high levels of engagement. The majority of those who previously carried bleeps were content to use personal devices for messaging because of user convenience after reassurance about privacy.
Conclusion An integrated secure messaging system can replace non-emergency bleeps with beneficial impact on service.
Introduction
In 2019, the UK Health and Social Care Secretary announced that the National Health Service (NHS) should remove bleeps and pagers for non-emergency communication by the end of 2021.1 2 While this technology is now in costly obsolescence and pilot studies have shown efficiency saving3 using smartphone messaging, legacy equipment remains firmly embedded in the NHS. Optimal strategies for adoption have received little attention4 and barriers to adoption have been identified.5
Cambridge University Hospitals (CUH) NHS Foundation Trust has used a comprehensive Electronic Health Record (EHR, Epic Systems Corporation, Verona, Wisconsin, USA) since 2014. An information-governance compliant messaging solution (Epic Secure Chat) allows for messaging from smartphones, tablets or from within the EHR itself (desktop). The system is fully integrated with the patient chart so that messages and all read/reply times become part of the patient record. Large-scale implementation of an EHR-integrated messaging system to replace non-emergency bleeps/long-range pagers in an NHS organisation has not been previously described.
Setting
CUH is a large, tertiary referral centre in the East of England. It offers a diverse range of services with over 1100 beds and approximately 16 000 staff. A significant EHR upgrade (from Epic 2017 to the November 2020 version) was undertaken during the implementation period bringing additional Secure Chat functionality. The implementation period also coincided with a major Wi-Fi infrastructure upgrade to give full coverage across the estate.
Our aim was to replace all bleeps/pagers apart from ‘cardiac arrest’, ‘major trauma’ and ‘fire’ with Secure Chat (online supplemental S1).
Methods
Secure Chat was made available at our organisation in July 2021. A go-live date in early 2022 was initially chosen due to ongoing COVID-19 pandemic disruption and to leverage additional necessary Secure Chat functionality that would only become available after an Epic version upgrade planned for November 2021.
An implementation group with executive responsibility was formed with representation from the hospital’s divisional structure to oversee the project. Socialisation was achieved by a network of ‘clinical champions’ and through regular communications including trust bulletin items, face-to-face and online question and answer events as well as information on screensavers and posters and offering at-the-elbow support in clinical settings. An etiquette guide was published to define appropriate use of different methods of communication. Our safety surveillance is described in (online supplemental S5).
Contact centre (online supplemental S2) workload was a key concern at the time of cutover since any communications difficulties would likely result in a call to an agent for help. For safety a transition period where contact centre operatives would send messages both to Secure Chat and to existing bleeps for 1 week post go-live was planned. Secure Chat would not be available during (un)planned Epic outages for which the contingency was to fall back on an internal directory of alternative contacts securely maintained by the contact centre and this was widely publicised.
Secure Chat allows for various groups to enable team and role-based messaging. Because of system limitations at the time of the original implementation, our hospital had not fully implemented a sign-in system which we could leverage for automatic group creation. Instead, we created ‘opt-in’ groups to replicate existing roles, relying on staff to opt-in (out) at the beginning (end) of their duties (online supplemental S3).
Mean comparison was with t-tests; structural breaks were examined using the Chow test. Statistical significance was taken at p<0.05.
Discussion
We demonstrate that secure messaging can be implemented in a tertiary NHS hospital without significant incident or negatively impacting on contact centre activity. This was possible even without physically retiring the legacy system: bleep counts dropped to negligible levels (online supplemental figure S3) which is important as multiple coexisting communication methods risk overload.5
It is anticipated that the bleep system will be decommissioned in due course depending on a future resilience analysis.
While a minority of staff expressed reservations before go-live citing privacy concerns we were able to provide assurances; most were ultimately content to use their personal devices which offered convenience advantages. The largest complaint received from users concerned inappropriate use of Secure Chat for non-urgent messaging. This is a known issue3 but the etiquette guide which set out clear expectations was key central to empowering staff to challenge inappropriate messaging.
A number of short (1–2 hours) routine Epic upgrade outages have subsequently taken place (scheduled at weekends and night-time) during which time Secure Chat was not available. Concerns that the contact centre could be overwhelmed at these times have not materialised.
Conclusions
We were able to effectively replace non-emergency bleeps/long-range pagers with a messaging system integrated with the patient chart in a large NHS academic hospital by the soft approach of socialisation before cutover. Discounting the time before our EHR upgrade in November 2021, we were able to do this in 7 months with message numbers and support needs stabilising within approximately 3 months of go-live using existing infrastructure and without significant incident.
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