Working together to align digital services with CNTW’s core mission.

Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust (CNTW) provides a range of mental health, disability and specialist services across the north of England. The Trust, which has an Outstanding rating from the Care Quality Commission (CQC), has been working closely with BigHand for over a decade to support clinicians in delivering frontline mental health services. Using Digital Translation and mobile technology, CNTW has removed manual processes and paperwork and automated the collection and curation of clinical information.

As Gail Williams, Digital Project Manager, CNTW, explains, the guiding principle for all digital investment is to support CNTW’s core mission: delivering quality, person-led care where it is needed and being a great place to work. “We want to use technology in a way that empowers our people by giving them the time and information to do their jobs and deliver truly effective care. That is the digital strategy and our investment in and relationship with BigHand is tightly aligned to that objective.”

Delivering Critical Service Support

A key aspect of the BigHand partnership is support for CNTW’s 24/7 service delivery. CNTW clinicians use the BigHand Healthcare app and voice recognition in tandem with a dedicated North East transcription team to update clinical records within the Electronic Patient Record (EPR), making it a key tool in the delivery of frontline mental health services.

The mobile aspect of the solution is critical given the demands for community-led mental health support. Clinicians work with patients not only in their homes but in crisis situations as well as fast food outlets and local parks. With the use of larger devices such as laptops more likely to create a barrier between clinician and patient in such scenarios, the ability to seamlessly use less-intrusive technology – e.g. mobile phones - to record vital information improves the experience for both patients and clinicians. Critically, CNTW’s highly efficient processes ensure each patient interaction is rapidly updated into the EPR and available to the rest of the Trust.

“When providing services that can make a very tangible difference to patient outcomes, the digital solution has to work and be reliable 24/7. Within mental health services, when a patient maybe in crisis and call multiple times within a matter of hours, it is vital that information such as a crisis assessment is updated rapidly to ensure every clinician has a complete understanding of the patient’s situation.”

Seamless Support amidst Operational Change

CNTW in its current form was created in 2019 when the mental health and learning disability services in North Cumbria were transferred to Northumberland, Tyne and Wear NHS Foundation Trust. Following the transfer to NTW, Cumbria staff faced a significant overhaul of IT systems as well as working for a new employer; it was, therefore, vital to avoid any interruption to service delivery. With NTW an existing BigHand mobility, digital dictation and speech recognition user, the decision was taken to fast track its extension. As Gail Williams says, “The entire transition was undertaken at pace, which meant a lot of technical work had to be done in a very short space of time. We engaged with BigHand early in the process to understand the best approach CNTW IT could undertake ensuring a seamless migration for the Cumbria users.”

One of the key concerns for the Cumbria implementation was the use of a different operational model and, therefore different workflows, to those deployed by CNTW in its North East transcription centre. “Cumbria uses local transcriptionists, which isn’t how we operate across the rest of the Trust,” Gail explains. “We decided to keep close to their existing processes to make the change as easy as possible.”

The addition of new workflows within BigHand, including direct secretarial workflows, was a change for the trust but, once the viability of the new approach was confirmed by BigHand, CNTW was able to rapidly undertake the work internally and quickly deliver the new solution to the Cumbria users.

Cross-Discipline Upgrade Support

The strength of the BigHand partnership was also underlined in 2020, when CNTW opted to upgrade the solution as part of contract renegotiations. Due to the critical, 24/7 demand for the BigHand software, CNTW runs a complex environment, including separate test, train, live and disaster recovery versions. The solution is also run on-premise, which meant the Trust had to spin up new servers to support the upgrade. Adam Johnson, Digital Project Manager, CNTW, explains, “CNTW worked incredibly closely with BigHand throughout the upgrade process, including not only our digital team but also infrastructure and technical support.”

In addition to engaging with multiple people throughout the CNTW IT operation, BigHand also supported the Trust during the complex testing process, especially in achieving the Trust’s very specific Disaster Recovery requirements. “There is a lot of complexity in Disaster Recovery,” Adam Johnson explains. “The Trust doesn’t flip turn on Disaster Recovery if the outage is small – only if a disaster has happened. Creating the optimal implementation required a lot of functionality and process testing. BigHand was incredibly supportive throughout, from both a project and technical perspective.”

 “One of the great aspects of working with BigHand is that we have always have a consistent project team, including a project manager who understands how CNTW is set up and our specific operational demands. That consistency means we never have to take time to explain, they know how we work. It is a great relationship.”

Voice Recognition Update

This relationship was also key to enabling a smooth evolution to BigHand voice recognition powered by Nuance in 2023. With CNTW staff already very familiar with – and reliant upon – voice recognition, it was essential to avoid any downtime or lack of access to the technology. To support the transition, BigHand shared information about the new solution ahead of the implementation, enabling CNTW to engage with stakeholders and complete configuration and development work.

Gail Williams confirms “Given the level of throughput within the transcription team, we knew any downtime would really impact their turnaround times and hence the speed of updating the EPR. BigHand’s constant communication, including very regular meetings and updates, as well as proactive support throughout the testing process, ensured we achieved a smooth transition for over 800 users.”

“CNTW has worked very closely with BigHand over the past decade to ensure that the Trust understands the product and, critically, that BigHand understands our clinical ways of working and operational processes to ensure that together we can deliver a really good solution for our clinicians and patients.”

Conclusion: One Team

CNTW continues to focus on further innovation to support the Trust’s goals of quality-led care and a great working experience. The digital team is working closely with BigHand on the future development of clinical correspondence to leverage the improvements in user experience in the latest version. Expanding the use of the mobile solution is also a key goal, given the enormous geographical area covered by community-based staff. The Trust also plans to move from its on-premise solution into the cloud, a process which will require further engagement with BigHand to ensure existing software integration, such as to the in-house access request management system (ARMS) software used to request access to BigHand, is supported.

The strength of the relationship between the two organisations remains key to the evolution of these vital support services. 

“Throughout the partnership, BigHand has been not only positive and supportive but always looked to work out solutions that improve CNTW’s environment. Even though we are two organisations, a commercial supplier and an NHS trust, we are one team working together to get the best for our patients and staff.”