In this case study, Jay Khan, Digital Pioneer Fellow at South-West London Integrated Care System (SWL ICS), Programme Manager (Shared Domain) in the IT, Digital and Technology Department at St George’s Hospital, explains how he is working to bring together the GESH group of hospitals (St George’s, Epsom and St Helier) on a single shared domain electronic health record (EPR).
Project summary
By March 2025, all NHS organisations must achieve a baseline level of digital maturity, including implementing a modern, up-to-date electronic medical record (EMR) system. St George’s is a legacy site running an Oracle Cerner EMR, while Epsom and St Helier Hospital use iCM and iPM with limited capabilities. The three hospitals (known as the GESH Group of Hospitals) are separate legal entities, meaning data segregation requirements may differ for each hospital at the data warehouse and reporting level.
To address this, we developed a domain plan as a roadmap, listing all projects, activities, configurations, workflow testing, data migration, integration, interface requirements, and compliance with governance, country reporting, and application rationalization. Some of the challenges we faced included parallel project activities, variance in workflows and/or configuration, different system policies, and different user roles (e.g., role-based access control).
the project’s 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 for the first planning phase
- Hospital at night
- Accession numbering
Location near St George’s Hospital:
Due to delays in data migration and reporting, GESH Hospital Group experienced a shift in project timelines, impacting the domain plan. While the initial go-live date was set for 2024, technical issues required a thorough review to establish a realistic and safe timeline for go-live. This review is currently underway and takes into account factors such as resource availability and planning constraints for GESH Hospital Group and the vendor, Oracle Cerner.
Impact/Results
Implementing an electronic medical record (EMR) system in hospitals can cost millions of pounds per hospital. However, innovations have emerged to reduce this capital expenditure.
Over a decade ago, St George’s Hospital implemented the Cerner EPR system. Based on this, a business case was developed to extend this system across all GESH Group hospitals by implementing a shared domain, enabling 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-based shared EPR programme, leveraging St George’s existing EPR as a baseline, enabling all three hospitals to effectively utilise the Oracle Cerner EPR.
The three hospitals have also planned future innovation launch cycles, which will deliver a range of benefits to staff, including integrated care, shared health records, simplicity, ease of use, improved access and reduced contract costs. The Domain Share EPR programme will serve as a model for other NHS organisations, demonstrating the benefits of a shared EPR system over individual investments.
Next steps
EPR domain sharing programs are now a reality, dramatically reducing procurement and deployment costs. EHRs are an example of this approach, aimed at reducing expenses and saving taxpayers’ money by using resources economically and wisely. By leveraging efficient technology, these programs improve the user experience, streamline maintenance, and capitalize on profitable procurement contracts through economies of scale.
The benefits of domain sharing programs also extend beyond financial savings. They enable streamlined organizational structures, agile teams, and pave the way for new innovations (e.g., robotic process automation (RPA), artificial intelligence (AI), machine learning (ML), large language models (LLM), integration of tools like ChatGPT, and efficient cloud hosting options to reduce capital expenditures).
With 930 NHS hospitals in the UKThere is considerable potential for savings in public funds by using existing resources and coherent technology. The project has already proven its ability to deliver effective solutions and, in the long term, will contribute to reducing costs through the continued implementation of a smart long-term strategy, appropriate governance and economies of scale.
Jay Khan is a member of the first cohort of the SWL ICS Digital Pioneer Fellowship program.
THE SWL ICS Digital Pioneer Scholarship Program supports change makers employed by the NHS, local authorities and voluntary sector organisations in South West London to design and lead health and care transformation projects supported 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 aimed at staff employed by the NHS, local authorities and voluntary sector organisations in South West London.
To learn more about the other fellows in the first cohort of the SWL ICS Digital Pioneer Fellowship program, please refer to our innovation directory.
