The evolution of ppm+

From a simple spreadsheet to a Cloud-based system supporting regional data sharing, Leeds Teaching Hospitals’ electronic health record has evolved to meet a growing range of clinical needs over the last 20 years, now supporting everyday nursing, medical documentation and clinical processes for two of the region’s largest NHS trusts.

Leeds Teaching Hospitals’ Dr Paul Jones, Chief Digital Information Officer and Professor Geoff Hall, Consultant Medical Oncologist and Professor in Digital Health, explain more about the way PPM+ has evolved and the potential value it can provide across our region.

Geoff: PPM+ was originally built in 2002 as a cancer information system, collecting 20 data items. We originally started with a simple spreadsheet, which evolved into an Access database, before quickly realising we needed something more technically able - and so the first iteration of PPM was born.

We started to build more and more information into the system - outpatient events, admissions, MDT reviews, clinical letters and so on. One of the critical moments was when we started to use the system to collect cancer waiting times. By documenting and reporting these key targets within the system, all the other information we needed to enhance the clinical record - such as radiology and pathology results, cancer treatment including surgery, chemotherapy and radiotherapy - started to flow. This allowed us to build a detailed, comprehensive record of the cancer patients being treated at Leeds. Oncologists based in Leeds treat patients across the region, so they took PPM with them, which sparked a real demand for wider use across the Yorkshire Cancer Network.

Geoff: In 2013, we started looking for a Trust-wide EHR. By then, over half the Trust’s staff from many different specialties beyond cancer were using PPM. It was already established and well respected, so we decided to build on what we already had. We worked with the University of Leeds to develop a new enhanced system which could be accessed more widely. The launch of PPM+, a web-based system, was a real turning point and also when the clinical buy-in happened. We had developed a single system which could be used for many different purposes, capable of capturing the structured information required for cancer services, but also the unstructured narrative of a patient’s full needs, allowing anyone to sit down and understand the full spectrum of care being received by a patient. At this point, it’s fair to say we realised the true potential of the system we’d built!

Geoff: Having a focused, in-house team has meant we’ve been able to streamline our development of PPM+. So rather than having lots of people developing disparate functionality separately and then bolting this together, we’re forced to think carefully before we start to code. This means we can develop one piece of functionality and get the absolute most out of it. This also benefits our users - they can learn a single piece of new functionality that helps them do lots of different things.

Paul: The responsiveness of the development team throughout Covid has just been fantastic. In a matter of days we were able to build, test and deploy new functionality - because we have our teams here, integrated into the Trust alongside our clinicians, we can respond quickly, and build that response around clinical need. We’re in charge of our own destiny, so we were able to adapt our release schedule, moving from months to days almost overnight. One of the challenges during this time was the rapidly changing requirements - we’d build something, and before it went live, things would change. Whilst this is frustrating, it’s the kind of the thing that happens in the middle of a global pandemic. We were able to manage this because of the way we’re set up and integrated. 

Geoff:  PPM+ is more than the Leeds Teaching Hospitals EHR, it’s the EHR of people treated in Leeds and something we have always been willing to share with other clinical teams involved in their care. We treat patients from Leeds as their local hospital but we also provide specialist care regionally to a population of 3-5 million people. PPM+ as it stands today can easily support this. Alas, like most regions of the UK, the hospitals have different systems that often don’t communicate well with each other. Ultimately, we’d like to encourage regional partners to come and have a conversation with us so we can share what we’ve done. The key to delivering integrated care across a region is an integrated information system that allows data to flow between hospitals. It doesn’t matter if this is the same system or one that talks to other systems - the critical matter is that information flows because patients will always follow established pathways of referral and care.

Paul: PPM+ is already being used in Mid Yorkshire effectively and widely, which speaks volumes. Moving the system to the Cloud gives us a huge amount of scalability, flexibility and resilience, creating the potential to offer PPM+ to other hospitals. It’s genuinely an option other Trusts can confidently explore - we’re not trying to generate profits so it’s a significantly cheaper option. I joined Leeds with no affiliation to PPM+ or any other EHR and I genuinely believe there’s no better option out there for many smaller trusts - it’s a great, cost-effective option. We’re investing £3-4 million every year in the platform, so the benefits we can provide through on-going development and integration are huge. 

Geoff:  PPM+ is built by the NHS and is designed to be used within the NHS - functionality is prioritised and tested by the people who use the system and all the data we need for NHS reporting is already built in. The depth and breadth of cancer data in PPM+ is nationally and internationally respected. We continue to use that data asset to support research and innovation with clinical, academic and commercial partners to improve the pathways of care we can offer our patients.  

Paul: From a technical perspective we’re Cloud-based. This offers flexibility, scalability and resilience which delivers a huge benefit for a system which is relied on across the region. The fact is we can adapt and build things to align with our colleague’s needs across Leeds. Having that flexibility locally - and now the infrastructure to potentially share that more widely - is amazing.

Geoff:  The ability for patients to start contributing to their own care from home. Using functionality such as symptom diaries and simple e-form functionality to gather data can help us triage remotely. Then patients can begin to self-manage with automated systems spotting warning signs and triggering an escalation for the next level of care. This makes the best use of resources, and also ensures everyone receives appropriate treatment.

The potential to share this data across different specialties for patients with complex needs and re-use technologies across the patch is really exciting too. For example, a patient can input their height and weight once and then this information could flow to different areas of the system for a range of different clinicians to use. One day, we might even be looking at a version of PPM+ that supports primary, secondary and tertiary care in a single system - there are many challenges involved at the moment, but that’s the world we’ll be moving towards.

Paul: Integration of care across the Trust, region and more widely is at the heart of the NHS plan. PPM+ is already the bedrock of much of that integration in our region and we are looking to be a key part of the wider integration across the ICS and beyond. There’s a huge amount of potential for PPM+ to bring benefits to public sector organisations at a range of levels.