A presentation by Lisa Emery, chief information office at Royal Marsden Hospitals NHS Foundation Trust.

1. The Royal Marsden
Perspectives from the NHS
Front Line
Lisa Emery
Chief Information
Officer

2. 2 The Royal Marsden - Confidential
The Royal Marsden
• Opened in 1851 as the world’s first hospital dedicated to cancer diagnosis, treatment, research and
education.
• Today operates as a specialist cancer hospital and National Institute for Health Research (NIHR)
Biomedical Research Centre for Cancer, working closely with its principal academic partner,
the Institute of Cancer Research (ICR).
• The Royal Marsden and the ICR are ranked in the top five cancer centres in the world for the impact
of their research, treating over 59,000 NHS and private patients every year.
• Reputation for groundbreaking research and pioneering the very latest in cancer treatments and
technologies, as well as specialising in cancer diagnosis and education.
• Operates from two centres with c.200 total beds, in Chelsea and Sutton, and a Medical Daycare Unit
at Kingston Hospital.
• Founder and host of RM Partners, the Cancer Alliance for west London, which includes St George’s
Healthcare NHS Foundation Trust, Imperial Healthcare NHS Trust, and other trust and clinical
commissioning group (CCG) partners across north west and south west London

3. 3 The Royal Marsden - Confidential
RMH/ICR Biomedical Research Centre
Imperial College Academic Health Science Centre (AHSC)
• Partnership between Imperial College London, The ICR, Imperial College Healthcare NHS Trust, the Royal Brompton
& Harefield NHS Foundation Trust and The Royal Marsden NHS Foundation Trust. One of the six strategic
University-NHS alliances aiming to accelerate the translation of scientific breakthroughs into patient care.
• Contributing to NIHR Health Informatics Collaborative (HIC) themes: lung cancer, colorectal cancer and critical care.
Health Data Research Hub for Cancer (DATA-CAN)
• Founded by researchers in London, Belfast and Leeds, involving collaboration between seven BRCs. Aims to
transform the ability of researchers to use high-quality cancer data by bringing the data together to help develop
improved cancer treatments and ultimately inform how NHS cancer services can be improved.
RM Partners
• One of 19 Cancer Alliances tasked with trialling and rolling out new models of care and reducing variation in
outcomes following the recommendations of NHS England’s National Cancer Strategy.
CRUK Accelerator Network
• Lead and participate in CRUK Accelerator Network initiatives to develop and lead large scale research including:
• Advanced radiotherapy technologies
• Cancer immunotherapy
• Data-driven personalised therapeutics
• Precision medicine tools and resources

4. 4 The Royal Marsden - Confidential
RMH Digital Strategy
• Large digital transformation programme over the next 2-3 years which includes:
• Digital Workplace: new wired and wireless network, Windows 10, Office 365 and
Teams, unified communications
• Digital Health Record: procurement of a new EPR, patient portal, other clinical
systems
• Digital Diagnostics: new Radiology and Pathology systems, support for specialist
areas such as Molecular Pathology, Genomics and Stem Cell
• Digital Research and Informatics: new data warehouse and business intelligence
tools, digitisation of clinical trials, high performance computing, support for
research innovation (AI, RPA etc.)
Much of this underway at the point that Covid-19 took hold…..

5. 5 The Royal Marsden - Confidential
Impact of Covid-19 – Initial Approach
Imperative: Support clinical teams to keep the sites Covid-free, support working from home at scale
Digital Services Approach: stabilise current systems, scale up remote access, minimise change
Key points:
• Digital Services leadership part of Command Centre structure from start
• Heard clinical and operational teams and responded accordingly
Delivery Focus:
• Rapid scale up of O365/Teams deployment
• Rapid build and deployment of virtual desktop solution to unlock laptop shortage
• All MDTs taken to virtual immediately
• Virtual appointment and patient contact platforms stood up rapidly
• Support for continuation of clinical trials using remote access tools
• Digital teams enabled to WFH and support remotely
• Support and escalation processes streamlined

6. 6 The Royal Marsden - Confidential
What Worked Well (and Not!)?
Positives:
• Digital leadership in the room – able to hear directly from clinical teams and translate to solutions
• The decision to minimise change/new systems and focus on stabilising and scaling access to
existing ways of working
• MDTs moving to virtual
• Able to support clinical trials to restart using remote access and monitoring
• Virtual desktop solution freed up home working at scale and saved money
• Most staff adapted quickly to new ways of working and digital tools
• Balanced risk/benefit appetite with good access to decision makers
Learning Points:
• Support, support support – difficult with digital team already stretched
• Over-complicated escalation process
• Don’t jump to solutions too fast
• Review your decisions frequently!

7. 7 The Royal Marsden - Confidential
Ongoing Covid-19 Support
• Planning for lockdown 2 - continuing with new ways of working
• Consolidating digital tools (e.g. Zoom, Teams)
• Focus on completing core infrastructure and digital tools projects
• Starting back up our strategic programmes (EPR, diagnostics, R&D)
• Focus on supporting Outpatient services to offer more (and improved) remote access
• Reviewing all decisions and re-visiting IG, security etc.
• Enhancing support for R&D
• Introducing some new content – remote symptom tracker for pre-chemo visit, PPE tracking app,
clinical trial digitisation, support for remote training of clinical teams
Building on the momentum gained for digital transformation over the last 8 months!

8. 8 The Royal Marsden - Confidential
What Next? Back to Strategy With a Sprinkling of Innovation!
• Covid-19 HR chatbot ‘Maisie’
• Covid-19 remote symptom tracking with link to electronic patient record
• PPE and vital supplies tracking app
• Remote monitoring for clinical trials
• Clinical trials digitization
• Standing back up strategic work programmes e.g. EPR, patient portal
• Building the new data warehouse and BI tools
• Supporting research teams through the BRC Digital Theme
• Exploring new technologies (Hololens, remote assist)

9. 9 The Royal Marsden - Confidential
Covid-19 Remote Symptom Tracking
Background:
• Requirement for a solution to triage and monitor patients with COVID-19 to
facilitate ongoing patient activity and maintain a safe site.
Solution Description:
• Convert existing paper COVID-tracker forms into e-forms.
• Build Web page e-form to allow external validation of patient details/hospital
number as part of form security.
• Each form-type has its own landing page on the RMH e-forms website.
• Clinical staff able to issue the e-form web-link via email or text message to
patients.
• Functionality to include the ability to trigger an ‘alert’ email to a dedicated mailbox
if certain identified questions answered affirmatively. Where an email is triggered,
patient contact to be initiated by the critical care hotline team.
• Submitted e-forms validated by staff to confirm hospital number and
demographics before ingestion into the Trust EPR.

10. 10
COVID-19 e-Forms Homepage

11. 11 The Royal Marsden - Confidential
Clinical Trials: Remote Monitoring
Background:
• Pre-pandemic, external monitors came in person to verify the data entered in the clinical trial
database against the patient trial data collected in EPR and in a paper ‘third-file’.
• With external monitors unable to visit due to Covid restrictions, requirement for monitors to
be able to remotely access all patient-related trial information.
Solution Description:
• Configure printers with ‘scan to EDM’ button to allow trial coordinators to import patient-
related content into EDM, using agreed key words for metadata, rather than filing into the
‘third-file’.
• Define a QA process for Trial Coordinators to verify accuracy of scanned content prior to final
release to the EDM viewer accessed via EPR. Configure Teams private channel in O365 to uplift
scanned documents from the Investigator Site File into the same process.
• On release, scanned documents stored in a ‘Trials’ section of the patient record in the EDM
viewer in EPR displaying the completed keywords as a document name.
• Provide remote access to authenticated RMH monitor accounts, defining access window time
and auto expiry.
• Provide appropriate EDM permissions to RMH monitor account on the agreed inspection date;
giving access to a controlled set of documentation restricted to the Clinical Trials remote
monitoring needs only.

12. 12 The Royal Marsden - Confidential
Clinical Trials: Trials Monitoring in EDM via EPR

13. 13 The Royal Marsden - Confidential
Towards the Full Digitalisation of Clinical Research
Progress to-date:
• RMH remote monitoring solution has been warmly welcomed by Pharma companies.
• Solution is now being rolled out to all RMH research clinical units to ensure remote
monitoring facilities for all trials.
• Current deployment provides an effective solution to the need to remotely view patient
centric information and delivers an immediate solution to the current difficulties caused
by Covid-19 restrictions.
• In tandem, work is in an advanced state to prepare for deployment of a trials centric
view via our eTMF/eISF solution which will allow RMH staff to manage Clinical Trials
remotely, and ensure more efficient filing of essential documents, with improved
quality control, timeliness and completeness.
Proposed Developments:
• Work is under way for further digitalisation of the third-file to move towards paperless
records and streamlining of the collection of clinical trial information not captured in
EPR.
• Configuration of the electronic eTMF/eISF platform as a structural framework to
replicate and replace the current paper documents process in use.

14. 14 The Royal Marsden - Confidential
The Importance of Networks
• ICS CIO group – particularly important in Covid-19 response, continues to strengthen
• London CIO Council
• National networks e.g. Digital Health CIO Advisory Panel
• WhatsApp groups, Twitter(!)
• Pathway-based networks, hubs

15. 15 The Royal Marsden - Confidential
Education, Training and Professionalisation
Drive to provide a professional framework for IT and Informatics
Some areas we are focussing on:
• Bringing in graduates (e.g. through Graduates Into Health)
• Organisation BCS membership, encouraging teams to register professional
qualifications (RITTech, FEDIP)
• London CIO Council exploring relationship with London ISDN – learning and
development for staff at all levels, opportunities to network
• CPD, events, conferences
• Collaboration and skill-sharing across systems and specialties

16. 16
Thanks – Any Questions?