Can EPRs Save Time? Yes, But…

Tentative evidence that electronic patient records can save time has emerged from a survey of users at Poole Hospital, Dorset – but the hospital’s head of IT counsels caution in interpreting the results, especially in terms of cash savings.

The survey’s findings presented to the Graphnet Users Group by Poole’s head of IT, Andy Hadley, indicated that some medical secretaries were saving between one and two hours a week. A consultant and a registrar said the EPR system was saving them four or more hours a week and other medical and nursing staff estimated more modest time savings of one to two hours a week. A radiographer said the system reduced risk.

The hospital’s cancer audit office estimated that the EPR had saved them pulling 2,000 sets of records annually, a service for which they are charged £2.50 per record.

But Mr Hadley was cautious in interpreting the results. He told E-Health Insider, “I think it is very important that we are not seen to be saying we can save any whole posts as this time saving is, in many cases, time that can be more profitably spent with patients, increasing the quality of care or allowing better research or audit to be performed. In some cases it is time that people currently spend above and beyond their contracted hours to get the job done.”

In the case of the cancer audit office, Mr Hadley pointed out that the pressure to deliver records was burgeoning with the growth of clinical governance, audit and the requirement to comply with national service frameworks. Requests for paper records had doubled in the past five years.

“The electronic record is helping to put a lid on a fast expanding new requirement, which is not funded, rather than reducing demand. People who need to access to records can be more selective about which paper records are pulled,” he explained.

“In business case terms we are very conscious of the balance between cash releasing, quality improvement or efficiency gain classification of benefits – and the danger of promising cash in error.

“Even areas such as health records, where there should be cash savings or at least a major redefinition of the roles, the legal need to keep records for eight years and the variety of information in the case note would make me very cautious about saying when cash savings can start to flow, or what new costs replace them.”

Poole’s approach has been to support clinical staff at the point of patient care and support the rest of the organisation’s information needs from there. The central rush for information to support NSFs has made this difficult, but the ethos remains.

Working through the junior doctors’ “wish list” of functionality, Mr Hadley reported that the system currently provided access to radiology reports; ward and consultant lists; scanned referral letters and some discharge summaries.

A facility for ordering pathology and radiology tests was being introduced slowly and there were outstanding requirements for pathology results to be presented in a “graph and trends” format, the provision of a phlebotomy list and an ordering facility for blood products.

In January, the system had 124 users: 20 consultants, 28 secretaries, 24 junior doctors, 6 nurse practitioners and 46 others.

Mr Hadley concluded that the clinicians were generally keen to use the system and the hospital’s capacity to train was the constraining factor on wider use of the system. There was a clamour to use worthwhile features and no tolerance for cumbersome ones.

“For busy clinical staff this is entirely understandable,” he said.