Electronic patient records (EPRs) are the essential business system of any modern healthcare provider – a necessary first step which will underpin some of the more ambitious digital developments the NHS requires. It is only when NHS organisations can interact successfully internally and with healthcare partners that can we empower patient self-care and involvement, and move away from a silo-approach to healthcare.
And yet, EPR implementation has a habit of going wrong. Despite the best of intentions, many providers have invested in systems that have failed to deliver the outcomes envisaged. To avoid further failures, we must understand the scale of the task, move out of the ‘IT project’ mentality and prepare to engage fully with staff.
EPRs provide one consistent, instantly accessible patient record which can be made available in all care settings, as well as to the patient. They also enable a much more transparent service, with robust reporting on public health, performance, and costs. Fundamentally, EPRs improve safety and quality of care.
But as a programme with the potential to deliver such considerable benefits, it shouldn’t come as a surprise that EPRs will be equally complex to deliver. EPR projects impact most areas of an organization. Historically, poor implementations have impacted negatively on reporting, performance and tracking patient flow, resulting in new systems which are not being properly used, with paper-based workarounds being developed by clinicians who are struggling to use the system.
While the temptation maybe to blame the technology, underestimating the challenge is often the real cause. Delivering EPR should not be an IT project – it is a major business transformation and should be planned for and implemented as such.
Plans to move to an EPR should consider:
- Clinical Systems and Processes: Understand the scope of clinical processes that will change, and how that will impact existing systems and future processes, and those that use them.
- Administration Systems and Processes: How will you track patients? Who and what will be impacted by any changes?
- Technology Systems and Processes: What are the dependant aspects of technology that will underpin your EPR, from Wi-Fi through printing, security, access controls to the service desk that your staff will rely upon in the future?
- Data Systems and Processes: How will you ensure new data quality and reporting is to a sufficient standard, that information needs are understood and that the project can meet these needs?
- Programme Management and Governance: Clear KPI’s and Outcomes should be established to allow for transparent oversight and assurance through organisation governance. Given the many aspects of an EPR programme, and the short-term risks created by large scale change, appropriate governance, oversight and assurance is essential from day one.
Successful EPR adoption requires organisations to invest quality time in planning, scoping and engaging all areas of the business. Led from the top, it should incorporate a re-engineering of clinical and administrative processes.
Staff buy-in and understanding is absolutely key, both in the design of the programme and in its implementation. Clinicians and administrative staff will be the principal users of the new system and it must therefore match how they work.
Without clinical and administrative engagement, even the finest IT team is likely to create a system with limitations – however good it may look on paper. While there is a growing amount of good practice, one size doesn’t fit all. Engaging with your teams will help scope the system – understanding and adjusting for your own organisational requirements is best done at the outset if you want the system to be fully utilised.
Naturally, clinicians are busy and organisations need to work hard to make technology change relevant. In our experience, the level of technology acceptance rises dramatically if you can demonstrate that your intent is to increase time for clinical care – not to put a greater administrative burden on clinicians. Staff need to be informed and excited about the change – they need to see how it will help them provide better healthcare, not just business efficiency.
EPRs offer a single version of the ‘truth’ and open the door to significantly improved quality of care, safety, efficiency in operations, integration and digital engagement with our patients. Done correctly, EPR implementation provides an opportunity to rethink and redesign your pathways and workflows, cutting out unnecessary duplication and ensuring nothing falls through the gaps. It’s not a quick fix, but the benefits will long outstrip the time and financial investment required to make it work.
Brian Gorman is managing partner at Channel 3 Consulting