EPR Series: How to decide the right EPR for your staff and patients

By Hadleigh Stollar, CEO, Healthcare Innovation Consortium

Electronic Patient Records (EPRs) are at the forefront of the NHS’s digital transformation, serving as a cornerstone for care coordination, data management, and operational efficiency. The 2023 mandate from NHS England underscores the urgency of adopting the right EPR system. This guide aims to assist Integrated Care Systems (ICSs) in selecting an EPR system that meets their specific needs and secures a sustainable technological future for NHS Trusts.

 

Understanding your needs

 

Effective EPR selection starts with understanding the unique requirements of staff and patients in your health and care systems. This is determined by involving key stakeholders in the design and evaluation process. This extends beyond basic system features, probing into the complexities of clinical workflows and the strategic objectives of patient care. To highlight existing administrative challenges and reveal the potential impact of the system: 

  • Engage with staff across departments (Clinical, Nursing, Administrative, Pharmacy, Management) to identify administrative hurdles and understand their existing system’s impact on daily operations and what they want to replicate or change.  
  • Utilise group interviews or workshops to understand information flow among stakeholders, including patients, and any blockers.  
  • Consult with Integrated Care Board (ICB) leaders to coordinate the EPR strategy with overarching plans and budgets. 

The ‘5 Rights’ framework provides a valuable decision support tool to allow you to reflect your stakeholders’ needs and requirements. For an EPR system, it suggests the following is needed: 

  1. The right information (e.g. patient history or treatment plans) 
  2. In the right format (e.g. a user-friendly interface on a clinical workstation) 
  3. To the right person (e.g. healthcare professionals, administrative staff, or patients) 
  4. At the right time (e.g. during patient admission, treatment, or discharge) 
  5. Through the right channel (e.g. within the EPR system, via secure messaging, or through mobile access for on-the-go consultation) 

At Norfolk and Waveney Integrated Care Board, more than 270 members of staff from their three hospitals took part in a rigorous evaluation process for the procurement of a new EPR system. Staff evaluated tender responses and contributed to more than 700 requirement evaluation worksheets. Engaging staff from diverse backgrounds allowed them to incorporate a wide range of perspectives and experiences into the evaluation process and ensure the chosen supplier could meet their distinct requirements, including integrating with existing technology.  

 

 

Exploring EPR Options

 

An EPR system must resonate with the ethos of the health and care organisations within your system. It should reflect the size of your hospitals, the specialty areas you serve, and the existing IT infrastructure. Many ICSs face a pivotal decision when adopting EPRs: opt for a trust-wide system or a ‘best of breed’ approach: 

Best of Breed 

The ‘best of breed’ approach selects the ‘best’ system for each specific function or specialty, integrating them for a cohesive solution. It supports modular integration, maintains existing effective systems, and prevents vendor lock-in, with decisions based on user needs and existing infrastructure. The ability to ‘bolt-on’ modules to existing NHS systems has proved popular in the past. 

Trusts often use an integration engine to facilitate module communication and may employ smart-cards or Single Sign-On (SSO) for streamlined access. Despite its specialised functionality, this approach can complicate accountability due to multiple suppliers, increasing oversight demands for system managers. 

All-in-one (Integrated) 

Integrated trust-wide EPRs offer a comprehensive suite of functionalities, from patient records to analytics, on a unified database developed by a single team. This centralisation streamlines staff access to clinical records and improves interdepartmental communication, key factors in system adoption and use. 

Major EPR vendors operating in the UK like Cerner, System C, Dedalus, Altera, and Epic provide a range of integrated solutions, from commercial to in-house or open source. While these EPRs address broad organisational needs, they often integrate with specialised systems, such as PACS for radiology, to ensure full healthcare service coverage. 

Furthermore, ICSs are exploring the expansion of EPRs beyond single trusts to enable shared care records and bolster collaboration among healthcare providers.

 

Deciding which approach is right for you

 

The concept of sharing EPR systems across hospitals or trusts is gaining traction, as it allows teams to share resources and skillsets and learn from each go-live. University College London Hospitals NHS Foundation Trust (UCLH) implemented the Epic EPR system in 2019, allowing improved patient care continuity and more efficient use of resources across their eight hospitals. 

Chelsea and Westminster Hospital NHS Foundation Trust (CWH) and Imperial College Healthcare NHS Trust (ICHT) implemented the Cerner EPR system at both trusts, offering a unified approach to patient records across a greater catchment area. However, this approach does introduce complexities related to governance and data security. 

Implementation of an EPR system requires a robust digital, data and technology strategy, as shared by East Suffolk and North Essex NHS Foundation Trust (ESNEFT). Their strategy helped them to address cyber security, threats to confidentiality, and principles for using data more effectively.

 

Do you need a system overhaul or existing system enhancement?

 

The decision between a complete system overhaul and incremental improvements to an existing system is a strategic one. A ‘rip and replace’ approach may promise a fresh start with cutting-edge technology, but it also involves significant investment and potential disruption.  

  • System C launched its ‘ICS ready’ EPR solution in February 2022, investing £200m to develop a full clinical and administration system called CareFlow that can handle every aspect of patient care. Whittington Health NHS Trust opted for this approach which enabled staff to adopt a more holistic view of patients to provide them with the best management plan possible. 

On the other hand, enhancing an existing system can be cost-effective and less disruptive but may limit the scope of innovation. Weighing the benefits and risks of each option is crucial in making a decision that aligns with your hospital’s vision and resources. 

  • For example, Altera’s flexible Sunrise™ EPR system is highly adaptable and built on modular architecture, enabling trusts to choose and implement only the components they need, significantly reducing initial costs and allowing Trusts to time the implementation of subsequent modules around local budgets. 

Developing your own system can be cost-effective and enable you to be flexible and scalable, as seen at Leeds Teaching Hospitals. They originally developed PPM+ as a cancer information system, that evolved into a trust-wide EHR. Having a focused in-house team integrated into the trust alongside clinicians, means they can respond quickly, and build functions around clinical need.

 

 

What are the potential barriers to EPR implementation?

 

Implementing an EPR system is reliant on a strong team that can push forward the project; from discovery, to design, development, testing, and deployment. However, there will be challenges to address along the way, including: 

  • Training: The extensive training required can involve instructing up to 15,000 staff, with the effectiveness often varying due to the training techniques used. It is important to understand how staff learn best, perhaps using a ‘train the trainer’ model. 
  • Data: Varied data models and the absence of a unified data source can compromise data quality and reliability, complicating data ownership. 
  • System acceptance: New EPR systems may face resistance due to perceived increases in data entry or because staff have used ineffective systems in the past. Utilise your communications channels and staff advocates to share the benefits of an EPR system.  
  • Functionality and cost: Fragmented functionality in legacy systems hinders tasks like test ordering or appointment scheduling. Managing diverse IT needs and supplier contracts can drive up costs, despite advancements in interoperability standards like FHIR. 

Despite these barriers, decision makers should consider if the system is already in use by another NHS Trust. For example, when implementing the Epic EPR at UCLH, Cambridge University Hospitals NHS Trust (CUH) provided 30 onsite visits and over 240 hours of support and assistance with the EPR implementation as part of NHS England’s Global Digital Exemplar Fast Follower Programme, allowing UCLH to test and refine the EPR system before full-scale deployment.

 

What is the most cost-effective solution?

 

Navigating the financial landscape of EPR procurement is crucial. This includes understanding the upfront costs, ongoing maintenance expenses, and potential funding avenues, such as government grants or strategic partnerships. A comprehensive grasp of these financial elements is essential for effective budgeting and securing the funds needed for your EPR project. 

In the UK, there’s a growing consensus that adopting shared, integrated EPRs can lead to cost savings, reduce unnecessary variations in care, and elevate the overall quality and safety of patient services. Evidence from a diverse range of trusts and academic studies on IT investments in healthcare and other sectors indicates that economies of scale from shared EPRs are achievable. 

This evidence supports the notion that each ICS should have access to a single integrated EPR system, provided by multiple suppliers to foster competitive pricing and maintain a dynamic supplier market at the ICS level.

 

Paving the way for a more efficient system

 

The journey to digital excellence in the NHS through the adoption of EPRs is a multifaceted process that requires careful consideration of each trust’s unique needs, strategic alignment with system-wide objectives, and a clear understanding of the financial implications. Whether opting for a ‘best of breed’ approach or an integrated trust-wide system, the goal remains the same: to enhance patient care, streamline operations, and ensure a robust, future-proof healthcare infrastructure. By engaging with staff, consulting with ICB leaders, and considering the broader impact on care delivery, NHS trusts can make informed decisions that pave the way for a more efficient, interconnected, and patient-centric healthcare system. 

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HIC is more than just a consultancy. We provide organisations with the know-how and tools to adopt and implement digital solutions for the right reasons. For more information or a conversation on how we can support your ICS or trust with EPR discovery, adoption, and implementation, please contact us today.