The evolution of Electronic Patient Records in the NHS, 1988-2003

1
The evolution of Electronic Patient Records in
the NHS, 1988-2003

• Matthew Jones
• Judge Institute of Management
• University of Cambridge

2
An EPR by any other name

• 1988
• Hospital Information Support Systems (HISS)
• 1994
• Electronic Patient Record
• 1999
• Electronic Health Record
• 2002
• Integrated Care Record
• 2/12/2003
• NHS care record

3
NHS IT strategy

• 1992
• Getting Better with Information
• 1996
• Implementing the infrastructure for IMT in the
  NHS
• 1998
• Information for Health
• 2002
• Delivering 21st Century IT support for the NHS

4
1988 HISS programme

• 56 million on the Initiative
• 48 million in financial support to 16 projects
  at 25 hospitals
• 32 million on 3 main pilot projects, at
  Nottingham, Darlington and Greenwich.
• Significant delays in implementing key systems
• National Audit Office inquiry

5
1992 Getting Better with Information

• Linked to White Paper The Health of the Nation
• Strategy guided by key principles
• Information will be person-based
• Systems may be integrated
• Information will be derived from operational
  systems
• Information will be secure and confidential
• Information will be shared across the NHS
• Strategic initiative
• Developing an IMT infrastructure

6
1994-1997 EPR programme

• Demonstrator Projects, notably Queens Hospital,
  Burton and Wirral Hospital achieved successful
  hospital-wide implementation of EPR
• Clinical focus
• Strong management
• Management/clinician partnership

7
1998 Information for Health

• Lifelong electronic health records for every
  person in the country
• Round-the-clock on-line access to patient
  records and information about best clinical
  practice, for all NHS clinicians
• Genuinely seamless care for patients through
  GPs, hospitals and community services sharing
  information across the NHS information highway

8
Specific Targets

• Developing and implementing a first generation of
  person-based Electronic Health Records, providing
  the basis of lifelong core clinical information
  with electronic transfer of patient records
  between GPs
• Ensuring that all acute hospitals have the
  ability to undertake patient administration,
  including booking for planned admissions, with an
  integrated patient index linked to departmental
  systems, and capable of supporting clinical
  orders, results reporting, prescribing and
  multi-professional care pathways
• All acute hospitals to have level 3 EPR by 2005
  (35 by 2003)

9
2000-2003 Electronic Record Development and
Implementation Programme (ERDIP)

• Demonstrator sites
• Key projects include
• 24 hr care, patient access, EHR
• level 6 EPR
• integrated primary community care
• direct booking, referrals, discharge, pathology
  messages   
• technical standards

10
2002 Delivering 21st Century IT support for the
NHS

• Patient centred delivery of services
• Effective electronic communications, cut the
  time to find essential information (notes, test
  results) and make specialised expertise more
  accessible for staff
• Improve management and delivery of services by
  providing good quality data to support NSFs,
  clinical audit, governance and management
  information

11
Integrated Care Record System

• Cross setting (including social care),
  multidisciplinary
• no more silos
• National programme
• Emphasis on infrastructure and ruthless
  standardisation
• 700-page comprehensive specification for ICRS
• Single system for whole SHA
• Efforts focused on letting contracts for National
  Application Service Provider and Local Service
  Providers

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Discussion 1

• Onwards and upwards?
• Progressively wider scope

HISS EPR EHR ICRS
Hospital admini-stration Hospital Primary Secondary Community NHS ( social care)

• Does this mean that EPR use has
  evolved in practice?

13

• Difficult to see much evidence of progress for
  the NHS as a whole
• Big differences in EPR use between hospitals
• Not necessarily related to quality of management
• Investment decisions made by individual Trusts
• Some successful initiatives, but usually highly
  localised
• Rarely diffused more widely

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Why?

• Priorities distorted by other initiatives (and IT
  low on the list)
• Performance measurement/ League tables
• Clinical governance/Clinical Audit
• Modernisation/E-government
• Lack of consistency
• Implementation approaches
• Strategy focus
• Competing healthcare IT functions
• Information Authority
• Information Policy Unit

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HISS EPR EHR ICRS
Implementation approach Pilot projects Decentralised Pilot projects Centralised
Strategy focus Infra-structure (data model) Developing working record Developing working record Infra-structure (standard hardware)
Lead organisation Information Management Group Information Policy Unit Information Authority National Programme for IT
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Issues

• Build it and they will come
• Organisational change neglected
• Lack of communication
• Experience not shared
• NIH syndrome
• Unrealistic targets
• Aiming for the impossible, by tomorrow
• Little evidence of learning from failure to meet
• The best may be the enemy of the good
• Speed of response
• vs technology change
• vs policy change