Apollo Epic at GSTT and Kings

Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts went live with their new electronic health record on October 5. We are aware that the roll out impacted some of the ways primary and secondary care interface and partners have been working to address the digital issues over the last few weeks.

Thanks to your input, we are aware of some instances where systems are working as intended, but there are improvements identified to support clinical practice. Two new forums have been established to help escalate and address these outstanding concerns.

  • A Primary Care Liaison Group has been established to help take forward optimisation requests and further strengthen the interface between primary and secondary care. The group includes representatives from across the acute Trusts and primary care, alongside leaders within the ICB.
  • A Primary Care Standardisation Group has convened to improve the understanding of how different processes are carried out in primary care across the six boroughs, with a view to achieve consensus on how to align and where possible standardise moving forwards. This group includes primary care representatives from every borough.

Over the last three months, we’ve been sharing regular updates on this webpage and via a couple of bulletins each week. Moving forwards, the SEL GP bulletin that is shared every Thursday will contain any updates you need to be aware of.

Ongoing support for issues

Moving forwards, please use the below contact details for ongoing support. A useful summary guide has been created to print and display in your practice.

Supporting information

We are aware that you may be facing some challenging conversations with patients due to the delays and changes over the recent weeks. To help support you, a brief patient facing update has been prepared below for you to share should it prove useful. In addition, you can signpost patients to additional updates on the KCH and GSTT websites.

You might have heard that Guys and St Thomas’s and Kings launched a new patient electronic health record system, Epic, on 5 October. Epic brings together hundreds of different systems from across hospitals and community services and changes some of the ways we, as primary care, work with them. In addition, Synnovis, our pathology laboratory partner, have changed some of their systems to improve integration.

As a result, our processes for pathology and radiology tests and results, and some of our systems for discharge letters and appointments have changed. We’d like to reassure you that we are working closely with partners to resolve early teething issues. We’re sorry for any inconvenience and appreciate your understanding and patience as the new systems embed.

You can find further information on the changes on the KCH and GSTT websites.

On 5 October 2023, Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts went live with their new electronic health record (EHR) system.

The new system, powered by Epic as part of the Apollo programme, replaces multiple clinical systems in use across both Trusts with a single, integrated and comprehensive electronic health record. It also improves the consistency and timeliness of information being provided to GPs.

As a result of the changes in IT infrastructure, there have been some changes in the way primary care interfaces with secondary care. Please have a read of this briefing document to provide you with an overview of the steps we have taken to minimise disruption to you and your colleagues.

As part of the launch, we worked with primary care colleagues to re-design letters to GPs. Letters will now have a clearer layout, with GP requested actions and patient advice highlighted more clearly at the top. You can view example new patient and sample follow-up letters.

A series of drop-in sessions were ran prior to go-live. Watch the recording below to hear from system leaders and take a look at the FAQ document that was created to address the points raised.

Background information

Due to the transition to Epic at GSTT and Kings, existing electronic links for requesting and receiving Radiology reports ended on 5th October 2023 when Epic went live. A new electronic requesting system (ICE) has been deployed and directly links between EMIS and Epic. It allows requests to be made instantly, and reports to be viewed as soon as they’re authorised.

For GSTT and KCH, the ICE go-live date was October 5. Following a robust clinical review, a decision has been made to delay the ICE go-live for the Lewisham and Greenwich NHS Trust (LGT). Patient safety remains our primary concern and we are keen to ensure configuration is finalised and secure ahead of switching over to ICE for LGT. In the interim please continue to use your current radiology referral process for LGT and we will share a revised timeline in the coming weeks.

What is ICE?

ICE is an electronic requesting system that is linked to EMIS. It allows requests to be made instantly, and reports to be viewed as soon as they’re authorised. ICE also enables digital clinical decision support which assists in the appropriate selection of examinations. The ICE system offers enhanced security and shows patient demographics in context in EMIS.

IRMER regulations underpinning NMR imaging requests

The implementation of ICE has highlighted that we need to move towards a more robust clinical governance system to ensure we are meeting regulatory and CQC requirements in relation to Non-Medical Referrers (NMRs) requesting imaging scans.

To support this implementation, SEL has developed a SOP which details compliance with IRMER regulations for NMRs in GP practices. The SOP states that within six months all NMRs and (within a year) GPs will need to have completed the IRMER training course outlined in detail here. The training video can be accessed here and you’ll need to contact selicb.beth@nhs.net to confirm completion and receive the certificate. There will be a local audit process to confirm this. This timeframe takes into account the current pressures on primary care and overall patient safety considerations.

Where can I find more information?

We’d encourage you to watch this 8 minute training video which provides a straightforward demonstration of ICE.  You can also read this FAQ guidance document. If you experience any issues at go-live, please contact your IT lead in the first instance to ensure that you’ve been set up correctly and each practice has a super user identified.

A FAQ document has been created to address questions you may have.

If you have any further questions, the central ICE Project Team are contactable via SELGPordercomms@rbht.nhs.uk

Information for patients

Patient information sheets have been created by GSTT and KCH to assist patients requiring radiology exams.

Business continuity

A business continuity plan is in place that details what practitioners should do if they’re unable to access ICE to request radiology tests at GSTT and KCH.

What has changed?
  • Beaker LIMS: A new LIMS (laboratory information management system) has been introduced powered by Epic
  • tQuest Consolidation: The multiple versions of tQuest have been consolidated into one
  • GSTT Haematology: Haematology analysers at GSTT have been replaced with new analysers
What does that mean for me?
  • Beaker LIMS: There are changes to reference ranges, tests and calculations across all sites. Details of these changes can be found here: https://www.synnovis.co.uk/reference-ranges
  • tQuest Consolidation: The microbiology test catalogue is now standardised across SEL primary care. GPs now benefit from an expanded, fully electronic process and a more resilient network.
  • GSTT facing GPs: Haematology reference ranges have changed at GSTT and for GSTT facing GPs. Details can be found here: https://www.synnovis.co.uk/transformation/gstt
  • Raising orders: You can still raise orders from 5 to 9 October. It is critical to the efficient operation of laboratories – and the expedient turnaround of test results – that all tests are ordered electronically. We will continue to accept samples accompanied by paper booking forms, but would note that turnaround times will be notably slower for these samples owing to the additional admin required.
Disruption to pathology services
  • tQuest printer settings: Synnovis have consolidated tQuest into a single instance and due to this change, the tQuest printer margins will have defaulted back to factory settings. For the majority of printers, the settings of 0,0,0,0 (left, right, top and bottom) margins are working. Occasionally the margins may need to be edited to suit the individual needs of the practice, depending on what printer model or drivers are in place. SEL and Bromley IT have provided guidance on the respective Halo portals on how to find, edit and save the margin configuration settings.
  • Logistics: Synnovis courier routes and collection times will remain unchanged throughout the activity reduction window to ensure the timely collection of urgent samples
Who do I contact if I need further support?

For issues and queries relating to tQuest, please contact tquest@synnovis.co.uk

For issues and queries relating to EMIS, please contact the EMIS helpdesk or ICB helpdesk

For any other queries, please contact customerservices@synnovis.co.uk 

The activity summary provides an overview of the impact of these changes

As part of the Epic roll-out, MyChart has launched. MyChart is a new online service for patients that makes accessing health records easier. People can use the MyChart app on their mobile, tablet or computer.  It is a positive step forward for patients and gives them access to investigation results and letters, facilitates direct communication between patients and their hospital teams, and ultimately empowers our patients to get more involved in decisions about their health.​

Take a look at this guide that has been developed for primary care – it outlines the benefits for practitioners and patients. A patient letter has also been created to help support practices should you have any questions raised.

​MyChart allows people to securely and easily access their health record, giving them more control over their care. They can:​

  • Find test results and letters in one, easy place. ​
  • Get more time in appointments by telling us what we need to know beforehand. ​
  • Save time travelling by having a video appointment. ​
  • Keep their medical information up to date.  ​
  • Share their health record with the people who matter. ​
  • Support their friends and family by helping to manage their healthcare. 

​What is changing?

In the long term Trusts will send letters to GPs via MESH instead of NHSMail. There will be a phased approach to this change. In the interim period, from 5 October, GP practices already using Docman 7 or Docman 10 will receive letters from the Trust into their Docman, and practices using MESH will receive letters via MESH.

Why is this happening?

At present, both Trusts send letters to GPs via NHSMail, which doesn’t enable GPs or either Trust to effectively track transmission and receipt of letters once they have been issued. From 1 July 2023, the tracking functionality of NHS Mail was further deprecated nationally, and Trusts and GP practices have been encouraged to move to MESH transmission. The launch of Epic gives us a superb opportunity to do this in a better and more streamlined way.

Where can I find more details?

We strongly recommend that all practices review the below top tip guides and update your local document filing processes. The documents contain important information to ensure a smooth transition and compliance with the GP letters transmission.