{"id":6222,"date":"2021-12-02T13:41:06","date_gmt":"2021-12-02T12:41:06","guid":{"rendered":"https:\/\/www.gpsj.co.uk\/?p=6222"},"modified":"2021-12-02T13:41:06","modified_gmt":"2021-12-02T12:41:06","slug":"the-epr-debate","status":"publish","type":"post","link":"https:\/\/www.gpsj.co.uk\/?p=6222","title":{"rendered":"The EPR debate"},"content":{"rendered":"

\"\"Digitising hospitals was the focus of NHS IT policy for twenty years. The job is still unfinished: so what are the options for trusts \u2013 and the integrated care systems that are planned to take over health tech strategy and funding next April? The Highland Marketing advisory board asked three leading chief information officers for their views. <\/strong><\/p>\n

\u00a0<\/strong>Covid-19 and the latest reforms of the NHS have focused attention on health tech to an unusual degree. The first few months of the pandemic saw a rapid roll-out of remote working, virtual clinics and digital-first primary care and triggered a lively political and media debate about their future role in healthcare.<\/p>\n

Meanwhile, the health tech market has been focused on integrated care systems and the shared care records, data platforms, and apps they will need to join-up services, introduce population health management, and create a new \u2018offer\u2019 for places and citizens.<\/p>\n

In the middle of all this, the digitisation of hospitals seems to be in danger of being overlooked. Which is odd, because for 20-years it was the focus of NHS IT policy, and it is still far from complete.<\/p>\n

In comments to the HETT show at Olympia, reported by the Health Service Journal<\/a>, NHSX chief executive Matthew Gould around 10% of trusts remain \u201clargely paper-based\u201d while there are \u201ca whole lot more that are only semi-digitised.\u201d<\/p>\n

With the global digital exemplar programme<\/a> wound down, the Unified Tech Fund<\/a> planning to allocate the last of Jeremy Hunt\u2019s tech money by March, and ICSs due to take over IT strategy and funding in April, it doesn\u2019t look like there\u2019s a central strategy to improve things.<\/p>\n

Yet, as the \u2018What Good Looks Like<\/a>\u2019 document for ICSs acknowledges, there is a need to \u2018level up\u2019 trust electronic patient record provision, if hospitals are to work efficiently, support their staff, and feed into those shared care record and data platforms.<\/p>\n

So, the Highland Marketing advisory board asked three leading chief information officers what their trusts are doing, to inform a debate about the challenges and opportunities ahead.<\/p>\n

Big box? Best of breed? Ecosystem? Or new thinking? <\/strong><\/p>\n

Adrian Byrne, the chief information officer of University Hospitals of Southampton NHS Foundation Trust, started by challenging some of the terminology that is used around hospital systems.<\/p>\n

Traditionally, he noted, people have contrasted \u2018big box\u2019 or single supplier with \u2018best of breed\u2019 models for rolling out EPR functionality, such as patient administration, order comms, e-prescribing and, more recently, e-noting and e-observations. But this may be unhelpful and outdated.<\/p>\n

Unhelpful, because even the biggest of \u2018big box\u2019 EPRs don\u2019t do everything, so trusts are going to have to integrate them with other systems at some point; and the real question may be how much integration they want to handle.<\/p>\n

\u201cThere seems to be an idea that it\u2019s \u2018go with one of the big boys\u2019 or \u2018let chaos reign\u2019, but I don\u2019t subscribe to that,\u201d Byrne said. \u201cWe are said to have a best of breed approach, but we want to integrate where we can and get down to as few systems as possible.\u201d<\/p>\n

Outdated, because most of the current discussion about EPRs is focused on how they are evolving into platforms that can collect and then flow data into different systems, including patient-facing apps.<\/p>\n

\u201cI spoke to Will Smart [the former CIO of NHS England, who now works for Dedalus] a couple of weeks ago,\u201d Byrne said, \u201cand he didn\u2019t want to talk about EPRs anymore. He wanted to talk about platform, flowing data, and patients: and I think that\u2019s right.\u201d \u00a0(Highland Marketing also spoke to Will recently, and there\u2019s more on his views here<\/a>).<\/p>\n

Hospital IT is like an onion\u2026 \u00a0<\/strong><\/p>\n

In practice, the basic distinction is well understood. Martin Sadler, the chief information officer at Sandwell and West Birmingham NHS Trust, said his organisation \u201cput in an EPR 18-months ago\u201d and \u201cit has given us a platform to say: \u2018this is what we have done to the patient\u2019 and \u2018this is where they are in our system\u2019.\u201d<\/p>\n

Whereas Neil Perry, director of digital transformation at Dartford and Gravesham NHS Trust, said that in 2017, when his organisation refreshed its IT strategy, it first \u201cdecided what it wanted to do\u201d and then decided that \u201cbest of breed was the way to get there, fastest.\u201d<\/p>\n

But there was agreement between presenters and advisory board members that it is not enough.<\/p>\n

Since then, his trust has adopted a modern approach to integrating data from its different systems and re-exporting it to apps that \u2018fill gaps\u2019 in its EPR functionality, working with an open platform from Alcidion.<\/p>\n

However, there was agreement between presenters and advisory board members that an EPR, however, developed, is not enough.<\/p>\n

Sadler said that while his trust had deployed Cerner Millennium, this was not the end of its IT strategy. Perry showed a slide that set out his strategy as an \u2018onion\u2019 with core functionality at its centre, and open, innovative systems for e-prescribing, analysis, and remote patient monitoring in the outer layers.<\/p>\n

\u201cAn EPR is important, but to my mind, in our onion, it will be doing the core stuff and around the edge will be all the really exciting stuff: and that\u2019s more or less what Will says,\u201d he said.<\/p>\n

Options, pros and cons <\/strong><\/p>\n

Bearing this in mind, the presenters and advisory board members felt there were pros and cons to the two approaches that less mature trusts will need to consider. A single supplier approach can get trusts a long way fast: one vendor pitches its system as \u201cHIMSS 4\/5 out of the box.\u201d<\/p>\n

There is a perception that this makes \u2018big box\u2019 the preferred option for NHS England, which picked a lot of single supplier trusts for the GDE programme, and NHSX, which has structured the digital aspirant funding and the UTF around a PAS plus EPR modules approach.<\/p>\n

It\u2019s also understood by boards. Neil Perry said one of his challenges was getting new leaders to understand his strategy. \u201cYou get the board asking why we don\u2019t have an EPR, or why we don\u2019t go and buy Cerner or Epic,\u201d he said. \u201cRegulators can also be a challenge.\u201d<\/p>\n

\u00a0<\/em>On the other hand, a single supplier approach is expensive. Sadler said his trust chose to retain its patient administration system and running Cerner Millennium still costs half his IT budget.<\/p>\n

There is also a danger of trusts deploying their \u2018out of the box\u2019 EPR functionality and getting stuck at its level. The GDE programme was set up to take trusts in this position to the top of the HIMSS EMRAM maturity model and to create a \u2018blueprint\u2019 for others to follow.<\/p>\n

It worked for the trusts involved; but many of Gould\u2019s \u201csemi-digitised\u201d hospitals will be running systems they got around the time of the National Programme for IT, with a bit of e-prescribing and e-observations, for which there has been national money.<\/p>\n

So, perhaps the biggest argument for \u2018best of breed\u2019 these days is that it can encourage innovation. Perry said that as part of its 2017 strategy reset, his trust decided that \u201cwe didn\u2019t just want to be an early adopter, we wanted to be right on the left-hand side of the adoption curve, in the red zone, working with start-ups and innovators.\u201d<\/p>\n

Byrne\u2019s team has developed its own technology, including the My Medical Record<\/a> personal health record that is being quite widely adopted, particularly for prostate cancer follow-up (the Highland Marketing advisory board has been following the progress of MyMR, and there\u2019s more information here<\/a>).<\/p>\n

Challenges and opportunities <\/strong><\/p>\n

Parking the current lack of national focus, why haven\u2019t more trusts made similar progress? Board-level support and funding are definitely issues. Sadler said that in his previous CIO role, at young fashion website Missguided, his IT budget was 22% of turnover. The three presenters estimated their budgets at 2-4% and said they needed 6-10%.<\/p>\n

But it\u2019s not just money. Cindy Fedell, a former NHS CIO who now works in Ontario, said people were also an issue. \u201cYou need a good CIO, who can understand strategy and understand their options,\u201d she said; arguing that more should be done to support professionalism and certification initiatives.\"\"<\/p>\n

Then, there\u2019s local politics. James Norman, another former NHS CIO who now works for Dell Technologies, said when it comes to collaboration across a health economy, two of the potential reasons trusts go out to tender are that they\u2019ve been formed in a merger, and it\u2019s easier to pick a \u201ccompromise\u201d system than it is to get people to work with each other\u2019s IT, or they want to be on a different system to their neighbour\/s to stop a merger happening.<\/p>\n

Although Sadler said he\u2019d have been happy to use a neighbour\u2019s technology; if they weren\u2019t trying to charge so much that it wasn\u2019t an option. \u201cAll of that needs to stop,\u201d Norman argued. \u201cWe should be working together as one NHS and sharing ideas and skills and systems.\u201d<\/p>\n

ICSs: a chance to level up to where the best are now, not where the GDEs were five years ago? <\/strong><\/p>\n

In the absence of a national strategy, one of the questions for the future is going to be how integrated care systems approach the job of drawing up IT strategies for their trusts and patches.<\/p>\n

Byrne argued there is a danger that some could be tempted to bring in management consultants who will advise buying a new kind of \u2018big box\u2019 \u2013 a single EPR for trusts, with a health information exchange \/ analytics package \/ patient portal attached.<\/p>\n

Which, he argued, was likely to be a bad idea because it would mean swapping out one v1.0 system for another v1.0 system. As an alternative, he outlined a three-pronged approach.<\/p>\n

First, a proper evaluation of the level of digital maturity that trusts have achieved for the money they have spent, to identify best-practice and where best to allocate \u2018levelling up\u2019 funds.<\/p>\n

Second, ICS or ICP-led, system-wide procurements in areas where these make sense: pathology, imaging, areas like maternity that are not covered by EPR functionality and have a strong patient component. And third, system-wide integration of existing IT, so organisations can exchange messages with each other and with patient facing technology.<\/p>\n

\u201cI think it has to be an evolutionary approach,\u201d he said. \u201cIf people have some digital maturity, they should keep going, and keep thinking about how to build on those foundations. And it has to be clinically-led.\u201d<\/p>\n

Nicola Haywood-Alexander, the CIO for the Lincolnshire integrated care system, said she was hoping to develop a strategy around this kind of idea. \u201cI want to build up an architecture across the ICS,\u201d she said. \u201cInstead of asking: \u2018does this hospital need an EPR\u2019 I want to ask: \u2018what do we need across the system?\u2019<\/p>\n

\u201cThat way, we can use investment to support new kinds of thinking. A lot of work that is done in hospital at the moment is going to be done in the community or homes in the future. So, we need to look at what works in hospital and ask how we can get it into the community or homes.<\/p>\n

\u201cThen, with a bit of luck, we can get the aspirants to where the best people are now, and not where the GDEs were five-years ago.\u201d<\/p>\n

\n

\"\"Highland Marketing\u2019s advisory board<\/em><\/strong>: Jeremy Nettle, former global advisor for Health Sciences, Oracle Corporation; Cindy Fedell, former chief digital and information officer at Bradford Teaching Hospitals NHS Foundation Trust; Andy Kinnear, former director of digital transformation at NHS South, Central and West Commissioning Support Unit; James Norman, healthcare CIO, EMEA, at DellEMC; Ravi Kumar, health tech entrepreneur and chair of ZANEC, and Rizwan Malik, divisional medical director of Bolton NHS Foundation Trust and managing director of South Manchester Radiology<\/em>\u00a0<\/em><\/strong><\/p>\n

Highland Marketing <\/em><\/strong>is an integrated communications, PR and marketing consultancy with an unrivalled reputation for supporting UK and international health tech companies and healthcare providers, built over almost 20 years. Read more analysis and interviews on the <\/em>Highland Marketing website<\/em><\/a>, follow us on Twitter @Highlandmarketng, or get in touch on: <\/em>info@highland-marketing.com<\/a><\/em><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Digitising hospitals was the focus of NHS IT policy for twenty years. The job is still unfinished: so what are the options for trusts \u2013 and the integrated care systems that are planned to take over health tech strategy and funding next April? The Highland Marketing advisory board asked three leading chief information officers for <\/p>\n

Continue reading The EPR debate<\/a><\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[1834,1,9],"tags":[1463,1705,1461,25,417,26,264,1877,2167,2629,143,122,310,416,422,1748],"class_list":["post-6222","post","type-post","status-publish","format-standard","hentry","category-covid-19","category-it-it-security","category-nhs-healthcare","tag-alcidion","tag-covid-19","tag-dartford-and-gravesham-nhs-trust","tag-government-public-sector-journal","tag-government-journal","tag-gpsj","tag-gpsj-magazine","tag-highland-marketing","tag-highland-marketing-advisory-board","tag-himss-emram","tag-it","tag-nhs","tag-public-sector","tag-public-sector-journal","tag-public-sector-magazine","tag-secretary-of-state-for-health","odd"],"yoast_head":"\nThe EPR debate - Government & Public Sector Journal<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.gpsj.co.uk\/?p=6222\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The EPR debate - Government & Public Sector Journal\" \/>\n<meta property=\"og:description\" content=\"Digitising hospitals was the focus of NHS IT policy for twenty years. 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