Improving Eye Care in the NHS

Moorfields Eye Hospital in London is one of the World's leading centres for eye care. The hospital has been developing its own ophthalmology electronic medical record (EMR) system, called OpenEyes. In late 2014, Moorfields decided to restructure the development process, improving governance and involving other Trusts to make the OpenEyes system suitable for use across the rest of the NHS. The Peak Consultancy took on the role of leading development and embedded a Programme Manager in early 2015.

The Brief

We were tasked with rebuilding the development team to adapt OpenEyes to work in general hospitals as well as Moorfields' specialist environment, whilst putting in governance appropriate to a large NHS project. We were fortunate in that the incumbent Product Owner remained in place and there was a strong internal project support team.

The Process

Our first step was to recruit a skeleton development team to pick up product maintenance while we re-assessed the product backlog and defined a new standards-based development process. OpenEyes is an open-source project and one of the key remits was that everything must be fully open source throughout. We settled on an agile Scrum approach with continuous integration, using a GitHub public repository and supported by the Jira project management system.

"the approach selected instantly gave the Moorfields senior management team a degree of visibility that previously did not exist"

Jira gave a lightweight set of governance controls and the ability to easily generate progress reports for lightweight governance; Scrum gave us the ability to track, prioritise and work on requests from clinicians across over 20 sites and continuous integration meant we could easily manage the software release processes and integrate with Moorfields' quarterly deployment cycle.

"managing the needs of consultants, doctors, nurses and clerical staff across 20 sites is incredibly demanding; this setup helped enormously"

We next helped Moorfields build the development team whilst also acting as Scrum Mentors to help embed the process in the new team. We set up a regular reporting cycle to the Moorfields Programme Board and also brought in involvement from other NHS Trusts through the newly formed OpenEyes Foundation (a registered charity set up for the purpose). With the team expanding, we were able to make good progress through the new Product Backlog and also start re-engineering the system to make it more suitable for other NHS Trusts.

The Results

The new development management processes and systems gave the Moorfields management team clear visibility of the work requests and allowed external input for the first time. It accelerated change approval through efficient governance and led to greatly accelerated development and deployment.

"James was an excellent program lead for OpenEyes during his time at Moorfields- great to work with and really made a difference"

Professor James Morgan, then CCIO at Moorfields Eye Hospital.

The new team won the 2015 Code4Health "How Clean is my Code?" challenge and full control of the system was handed to the OpenEyes Foundation in early 2016. The Peak Consultancy has remained heavily involved, helping Bolton and East Kent NHS Trusts deploy the system later in the year.

Lessons

Careful planning and a methodical approach can encourage innovation

One of the concerns we had with this project was that OpenEyes is a very innovative project while healthcare systems demand extreme rigour to ensure safety. We approached this by managing the project on two levels:

  • at a programme level, we have a very careful, methodical approach that ensured everything that reached live deployment had been tested thoroughly
  • at the project level, we encouraged the team and other stakeholders to experiment and innovate in "sandbox" environments

We maintained the dividing line through strict environment control and continuous integration protocols, ensuring that everybody knew at all times whether a feature was a prototype, in development, ready for patient safety assessment or ready for live deployment.

If you have a chellenging project with conflicting demands and heavy regulation, we would love to help - please get in touch using the link below.

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