Maidstone and Tunbridge Wells NHS Trust (MTW) has achieved significant workflow and efficiency improvements through the deployment of automated vital signs integration within its Sunrise EPR system, supplied by Altera Digital Health. The project, which connects Welch Allyn physiological monitoring devices directly to the EPR, has streamlined the capture and documentation of observations across the trust's wards.

Initial time-and-motion studies demonstrated an average saving of 2.5 minutes per observation, equating to approximately a 50% reduction in the time required to record vital signs. Observations that previously took up to 45 minutes to appear in the EPR are now transmitted and displayed within around one minute.

Addressing inefficiencies 

Before automation, MTW's clinicians used portable devices to capture patient vital signs, manually transcribing results into the EPR. This process was time-consuming, prone to transcription errors, and created delays in data availability.

‘Our EPR was well established,' explains Johanna Kelly, chief nursing information officer at MTW. ‘However, taking observations required both a large mobile workstation and an observations machine. With many of our wards comprising single-patient rooms, that setup wasn't practical from either a logistical or infection control perspective.'

As a result, many nurses resorted to paper-based notes for efficiency, introducing an unavoidable data lag. ‘That delay meant the data wasn't visible to anyone else on the system until later,' Kelly adds. ‘We recognised a clear gap that automation could close by transmitting data directly from bedside devices to the EPR.'

Developing and integrating

The project represented a first-of-its-kind integration for both Altera Digital Health and Baxter Healthcare, which supplied the Welch Allyn devices. MTW's digital and clinical teams worked closely with both vendors to establish the middleware and interoperability architecture required to enable real-time data transfer into the EPR via the trust's integration engine.

‘It was a complex build,' Kelly says. ‘We had to ensure the middleware could handle patient context management, user authentication, and data validation seamlessly. It took about a year from concept to completion, and we ran multiple pilot iterations to ensure reliability and accuracy.'

Challenges included handling patient visit identifiers, ensuring alignment between inpatient and outpatient records, and configuring the system to support National Early Warning Score (NEWS2) parameters. ‘Each pilot revealed new nuances in how the EPR handled observation data,' Kelly notes. ‘It was a steep learning curve, but one that taught us a great deal about both our systems and workflows.'

Implementation and adoption

Clinicians now scan both their ID badge and the patient's wristband before recording observations, ensuring accurate attribution and eliminating manual entry errors. The system automatically populates the EPR with results, tagged with time, date, and clinician identifiers, strengthening the audit trail.

‘Barcode scanning ensures the right data goes to the right patient every time,' Kelly explains. 

Once the integration was validated, rollout proceeded floor by floor across the trust. Training combined short video modules with in-person support from MTW's digital nursing team.

‘We focused on habit change rather than just system use,' says Kelly. ‘Nurses already knew how to take observations, we were teaching them a new process to capture and transmit them more efficiently.'

Outcomes and next steps

The automation has led to an increase in the frequency of recorded observations, reflecting improved efficiency and ease of use. It has also enhanced situational awareness for teams monitoring deteriorating patients. ‘Our outreach teams now receive live NEWS2 data,' says Kelly. ‘That enables earlier intervention and more proactive care.'

Minor technical challenges, such as patchy Wi-Fi on a few wards, have been addressed through local support and infrastructure reviews.

MTW is now exploring further automation projects, including direct ECG integration into the EPR. ‘ECGs remain one of the few processes still requiring paper,' Kelly notes. ‘We're assessing how to digitise that workflow while ensuring verification and clinician sign-off.'

Kelly concludes: ‘The project's demonstrated that by challenging EPR systems to evolve with clinical workflows - rather than around them - we can make meaningful, measurable improvements in patient safety and operational efficiency.'