Tim Kelsey, Commissioning Board Director of Informatics, recently warned that some hospitals had little over a year to meet an NHS Commissioning Board deadline for upgrading to electronic patient record (EPR) systems. This is a tough deadline and one that is compounded by Jeremy Hunt’s announcement that the NHS should go paperless by 2018.
The NHS Commissioning Board’s deadline for EPRs seems a little utopian, in our opinion, and Hunt’s nirvana of a paperless NHS seems even further away. But one cannot help but agree with the principle of EPR technology – a single, consolidated view of a patient’s entire medical record – current and past.
It is on this point, ‘a consolidated view of a patient’s ENTIRE medical history’ that I want to dig a little deeper. Surely an EPR should include just that – everything about the patient. Not just clinical notes, MRI, ophthalmology and radiology scans, but also what is commonly referred to as administrative ‘stuff’. By that, I mean email correspondence, scanned documents –– literally everything pertaining to the patient.
I do not profess to be an EPR expert but I am fairly well versed in the area of data management and data processing. For me, data management is key to empowering the EPR. There are upwards of 34 departments in a typical UK hospital. From Accident and Emergency to Urology, many of which are likely to have their own applications and storage facilities.
Disparate multiple departments, and countless data silos, will no doubt add significantly to what is a very complex change management process for any Trust when deploying an EPR. But, from the outset, Trusts should try and make this easier on themselves by getting all the data they want queried by the EPR into a single repository. This would facilitate the presentation of data back to the EPR in a straightforward way.
Placing multiple departments’ data into a single, Enterprise–wide ‘archive’ will present a horizontal view of that data. By getting data in order and in a single place enables the EPR to search for information pertaining to a patient based on any number of things, for example, NHS number, name and date of birth. In theory, querying a single source (or repository) should be much quicker, easier, cheaper and more realistic than having to try and integrate with multiple departments’ systems.
Mike Roberts, IT Director at The London Clinic has spoken at length about the need to get all patient related data – clinical and administrative – in a single location. Mike’s view is ‘If we cannot get everything into a single place, we cannot efficiently interrogate that data and deliver it back to where the clinicians need it.’
Mike also states that the ‘….primary rationales for getting data into a single location is to manage stress. Sometimes one can be guilty of undermining how much stress is caused in trying to locate data from disparate sources. Or how much stress is given to patients while consultants try and find information and explain problems to them at the bedside or in the consulting room.’
A single, holistic view of a patient record is indeed a very ambitious project, and the deadlines the NHS finds itself under might be a little unrealistic, but I am confident that if we can get all the data in one place then that information can be presented back to those that need it, when they need it, in the format they require. This, in my opinion, is fundamental to driving the standards of care we as patients are entitled to.
