Rolling out electronic patient record (EPR) systems to replace paper-based workflows is key to achieving the government’s plan of “joined-up” healthcare in the UK, but the current state of digital maturity across the health service is “patchy” at best, say senior NHS officials.
In February 2022, health secretary Sajid Javid outlined the government’s digital transformation priorities for the NHS, which included the ambition to have EPRs up and running in 90% of NHS trusts by December 2023.
Speaking during Digital Health Rewired 2022, an exhibition and conference programme organised by Digital Health, key figures in the NHS outlined how the roll-out of EPR systems will help underpin the organisation’s wider digital transformation efforts.
Tim Ferris, director of transformation at NHS England and Improvement since March 2021, said that in the year since taking on the role, he has been surprised by the discrepancies in digital maturity across the NHS nationally.
“The current state is patchy – there are really amazing examples of digital excellence, but there are also places that actually have very few systems,” he told conference attendees on 16 March. “I think 19% of acute trusts don’t have an EPR. That’s not OK in this day and age.”
Ferris said that while EPR roll-outs and changes were “never pleasant” from his experience as a clinician, all of them were necessary and massively benefited patients by reducing bureaucratic errors as well as improving communication between care providers.
Giving the example of a single EPR that was rolled out to a network of eight acute care hospitals, Ferris said it was “impossible” for them to be described as “on the same team” until the system was implemented.
“Putting us all on a single instance of a single EPR immediately meant that we were all seeing exactly the same information, so there was no delay, there was no interoperability burden of exchanging data – we simply understood what our colleagues were doing with our patients, our shared patients, at a distance immediately,” he said.
“That is the single most powerful thing that I have seen in healthcare for making sure that everyone providing care to patients is on the same page.”
Simon Bolton, interim chief executive of NHS Digital, said in a separate panel discussion that getting EPRs into all trusts, and getting them up to “a certain level of maturity” is foundational to delivering digitally enabled healthcare across the UK.
“We have to stop using paper to manage workflow in hospitals,” he said. “We need to move into systems that enable us to get more efficient and deliver better healthcare.”
In order to move away from paper-based records and achieve better communication between care providers, some NHS organisations have already begun working on EPRs together.
Speaking about the joint EPR project between the King’s College Hospital NHS Foundation Trust and Guy’s and St Thomas’ NHS Foundation Trust – a “moonshot” effort that has been dubbed Apollo – the CEO of the former, Clive Kay, said people will not believe in 10 to 15 years’ time that hospitals were ever run without an EPR system.
“I’m not sure in this day and age how a CEO can run a hospital, or group of hospitals, safely without an EPR,” he said. “There are lots of examples of how an EPR can significantly improve in-hospital care. It feels now that we've made the case, whereas some years back we had to persuade clinicians this is the right thing to do.”
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Beverley Bryant, joint chief digital information officer (CDIO) for both trusts, agreed that most people in the NHS now see the need to get EPRs “for patient safety, for quality”, but said the funding organisations at the centre – including the Department of Health and Social Care and the Treasury – “are cynical and nervous” because of the wider NHS’s poor track record in IT delivery.
“The problem is, we’re not writing it down,” said Bryant. “So we do achieve the benefits, but it’s difficult to point to the piece of paper, to the document that evidences that we’re actually getting your benefits out.” Metrics will be baselined and tracked to gauge the success of the project going forward, she added.
“In our Apollo programme, we are determined to drive through on the benefits. We want to set quality, safety and efficiency targets derived from our three business cases. If we write it down, and we are able to prove it, we create a blueprint for the NHS.”
In another session, Dan West, CDIO for health and care at the Department of Health in Northern Ireland, outlined how his organisation is deploying a single EPR system across acute care, mental health, community services and social care to “create a single, longitudinal data system to support the delivery in all those disciplines of care across all five trusts”.
West said the creation of the system was “our biggest investment” and will help drive more coordinated care across Northern Ireland. He added that an online portal will be created so that patients can access their own care records.
On top of the need to roll out EPR systems to achieve a base level of digital maturity within the NHS, skills were also cited throughout Digital Health Rewired 2022 as a major digital transformation issue.
NHS Digital’s Bolton, for example, said there were opportunities to work with the education sector to ensure digital skills were built into healthcare training in the same way that clinical skills are.
“Collectively, we are 10% of the UK economy – if we can’t fix the pipeline for digital skills in the UK, then nobody can,” he said, adding that the implementation of digital skills “needs to be planned, it needs to be deliberate, and we really need to focus on it”, with a particular emphasis on “cyber and analytics”.
Bolton said boosting digital skills would be a major priority for the NHS going forward.
Matthew Taylor, CEO of the NHS Confederation, also noted the importance of digital skills, pointing out that the introduction of new technologies is often not followed up with adequate training on how to use them effectively.
“Often what we do is we innovate, but we don’t provide the training to people, we don’t provide the professional development,” he said.