About half of the UK’s National Health Service (NHS) Trusts claim to have an electronic patient record (EPR*). However, of those who claim they do, 50% do not. What they have instead is a Patient Administration System (PAS) and point-clinical solutions, such as ePrescribing or order comms. This means that three out of four Trusts are not running as efficiently, effectively and safely as they could with a fully-functioning EPR.
There has been a national push toward digital maturity over the last several years, including an overarching objective to make the NHS paperless by 2020. Most people recognise the value of the information revolution, but financial and operational challenges are hampering Trusts’ ability to implement a digital maturity strategy.
Here are the most common approaches NHS Trusts take, along with risks and benefits to consider:
1) Rip and Replace
This is the implementation of a single end-to-end EPR, bringing a wealth of previously absent digital capability, whilst also replacing existing systems such as the PAS, LIMS etc. Most healthcare organisations that elect for this method do so because it’s believed that functionality is better within a single ecosystem, database and user interface. It also potentially enables clinical benefit to reach across the entire enterprise more quickly.
But this strategy poses challenges for our large, complex NHS Trusts. The biggest challenge? It requires huge, up-front investments of both time and money. Changing everything at once – implementing an EPR, changing your PAS and driving a clinical transformation program – is often too much for resource-constrained Trusts. One of these efforts is inevitably de-prioritized, putting adoption and overall success at risk.
Another significant limitation with the rip-and-replace approach is that it doesn’t acknowledge the reality that there will always be solutions that sit outside that single ecosystem. There must be a way to interface with dozens, maybe a hundred other key systems – such as departmental programs, payroll, devices, workforce management and more. An EPR must be able to work well with other technologies, to enable the collaboration and coordination health care requires.
2) Best of Breed
Once a Trust realises it cannot afford the rip-and-replace approach, it often decides to use a collection of products, known as Best of Breed (“BoB” sometimes disparagingly referred to as Bag of Bits). This path avoids major capital outlay and disruption in a single year and can move forward in incremental, manageable implementations.
It appears to be a quick fix for near-term problems, but unfortunately, organisations lose all economies of scale with Best of Breed. They will find themselves with additional long-term costs of having a larger in-house team to manage multiple vendors and technologies.
Perhaps most distressing is the best-of-breed approach inhibits an enterprise’s ability to create a comprehensive, end-to-end patient record. A disconnected, or loosely connected, collection of systems will ultimately lead to the detriment of data quality and clinical decision making. Today we are starting to see Trusts, who embarked on this path 3-5 years ago, shift strategy toward an integrated EPR, having concluded that BoB was a costly error.
In this approach, the Trust’s IT team engineers its own EPR to be a tailored fit for the organisation’s needs. While this strategy is far less common today than it was 10 years ago, it does still hold appeal to some Trusts who are struggling to identify commercial solutions that meet their unique needs.
A comprehensive EPR solution is phenomenally expensive to build, and ultimately will not have the robust capabilities of EPRs that vendor organisations have spent decades and millions of pounds or dollars to create. Self-built options typically consume most of the budget to reach minimal functionality and never reach the advanced features of commercial offerings. The business case assumption that the product will someday generate revenue from other Trusts rarely comes to fruition.
There is an approach the combines strengths of the previous three, whilst reducing the risks represented there. Trusts can achieve speed to clinical value by implementing a core EPR for better patient data and clinical decision support. If that EPR is truly open and interoperable, they can modernize their PAS and other departmental solutions at a later time, freeing up enough resource to successfully handle a clinical transformation.
Placing a priority on the clinical transformation provides the basic functions every clinical team should have, such as evidence-based care plans, automation, order entry and decision support tools..
This model avoids cost pitfalls buried within other approaches, and it builds a more sound case for total cost of ownership. (Read more: What does your EHR really cost?)
Ultimately, Trusts will take a variety of paths to reach digital maturity. I joined Allscripts because I truly believe we have the best strategy and portfolio to help NHS Trusts with this process. And not just for today – Allscripts is pushing to new edges of technology in population health and precision medicine to provide ever more effective treatment.
* Editor’s Note: Electronic Patient Record (EPR) is another term for Electronic Medical Record (EMR) or Electronic Health Record (EHR).