The Secretary of State for Health and Social Care Sajid Javid recently announced that one of his key healthcare transformation priorities is for 90% of NHS trusts to have an electronic patient record (EPR) in place by December 2023 and the remaining 10% to be in the process of implementing one. Stating that EPRs are an essential prerequisite for a modern, digital NHS, these systems aim to enable virtually everything a Trust would need, including patient record keeping, prescribing, diagnostics, decision support, task management, appointments, transfer of care, patient apps and modules for each clinical speciality.
At the same time, we’re fast approaching a major shift in the way that healthcare is delivered at a local level. July 1st 2022 was the target date to grant integrated care systems (ICSs) statutory footing. What that means is that by this date, each Integrated Care System (ICS) should have in place an Integrated Care Board (ICB), a statutory organisation bringing the NHS together locally to improve population health and establish shared, strategic priorities within the NHS.
To achieve this will no doubt require robust information sharing capabilities across all the different organisations that make up an ICS, including councils, mental health and social care services, charities, and trusts. The widespread rollout of EPRs will play an instrumental role in helping to deliver on this objective.
However, EPRs are not yet found in all healthcare settings. In fact, one in five NHS trusts do not currently have one. There are various reasons for this – an important one being that although programme managers know that, as per the NHS procurement process, they need a business case, many have encountered roadblocks, such as a lack of sustainable funding or the manpower needed to move forward with implementation.
What’s more, of those that do have one, very few ICSs are made up of Trusts that all use the same EPR, and many have Trusts that use several different patient record systems across their hospitals. NHSE is therefore keen for ICSs to move towards its providers having a single system, or – where this is not possible due to funding or capability – EPR convergence, in which providers reduce the number of different EPRs in their ICS to improve interoperability.
ICSs were told earlier this year to submit details about their Trusts’ current use of EPRs, their plan for moving to a single EPR or make existing EPRs more interoperable, and how this would be funded. But what do technology providers need, in order to deliver the right service to Trusts and ensure that EPR rollout happens smoothly?
Detail EPR specifications
A Trust’s EPR rollout requirements are usually expressed as an extensive list of generic, functional ingredients, detailing the expected capabilities of the technology. However, that detail can be missing vital insight as to what the organisation is trying to achieve by deploying an EPR. Or put another way, the ‘what’ they want detail is there, but the ‘why’ and the ‘how’ may be missing. By including more of this kind of information as part of the procurement process, providers will be better able to articulate how their solutions could be best adopted by the Trust and the kind of relationship they could offer to help support its ambitions.
This information could include service improvement targets, such as measures relating to patient safety, clinical outcomes, operational efficiency, fiscal performance, or patient experience. These would be most useful identified along with baseline performance data. Risk management expectations for the mitigation of priority risks or the continuation of risk mitigations already adopted by the Trust are other useful pieces of the puzzle. They are especially useful where a Trust has an incumbent provider with customisations to reflect specific Trust needs or incidents. Unfortunately, it is common for such customisations to be missed from the broader procurement requirements specification but then be encountered during the implementation phase.
Take your transformation temperature
NHS Trusts can have common ambitions for their rollout of an EPR, but their individual capability and capacity to deliver large-scale transformation programmes can vary greatly. A realistic and independent assessment of the Trust’s experience with, and preparedness for, undertaking a complex and organisation-wide transformation programme would therefore be extremely useful to enable suppliers to more precisely deliver an EPR adoption model – and therefore timescales and resources – that would best reflect the Trust’s requirements. It would also give invaluable insight to the Trust for what lies ahead.
Where individual Trusts are jointly procuring an EPR and aim to have a single solution across all their services, having visibility as to the definition and progress for agreement for standardisation would also be incredibly helpful in making sure that any such decision making does not become a barrier to the subsequent deployment and adoption of the EPR. It’s also worth noting that for digital transformation to be successful, benefits realisation and change management need to be embedded within the change process. Without this, implementing a new EPR inevitably ends up replicating inefficiencies in the existing workflows.
There’s no doubt that a fully implemented and integrated EPR system across ICSs will ensure a far more streamlined workflow and a better patient experience – not to mention it becoming a government requirement. However, EPR rollout is easier said than done. Participating organisations must therefore assess how much change they can take on alongside caring for patients and then factor this into their plans. As well as giving providers as much information as possible, so they can help to minimise any disruption to their services.
By Jon Payne, Manager of Sales Engineering and Education, InterSystems
