Government Urged to be Patient on Patient Records

The Government should accept that the 2005 target for electronic patient records will be missed and not be panicked into a national big bang approach that could have disastrous consequences for the health service, leading IT suppliers have warned.

Having already accepted that the 2002 target for 35% of NHS trusts to have level three EPR in place will be missed, suppliers are urging the government to take the next logical step and accept that given the current position the 2005 target is also unachievable.

Some of those contacted also expressed concerns that the new approach signalled in the LIS toolkit for 2002-3, with its new focus on systems to support National Service Frameworks (NSFs) and condition specific care may create a degree of complexity too far, when the acute hospital EPR agenda is at last understood and being tackled within the NHS.

Suppliers argue that the 1998 NHS IT strategy Information for Health (IfH) has succeeded in getting clinical IT on the agenda of most trusts, many of which are now working on EPR business cases or procurements.

Mike Singer, chief executive of Elan Technologies, believes that crucially IfH has provided a valuable route map. "The strategy is now understood and has given us common targets and goals."

"It’s taken a while to get going, but things are beginning to pick up," says Jim Middleton, IT solutions business manager with Siemens Healthcare.

Five hospitals so far have level three EPR, another 35 are in the middle of implementation or procurement and a similar number are working on business cases, estimates Markus Bolton, founding director of System C.

"By 2004-5 I think we’ll get to about the 35% target, the 100% target just isn’t achievable," says Bolton. He stresses that the processes take time. It takes trusts about two years to get to OJEC and another two to implement.

"The 1998 strategy got IT on hospital’s agendas, the fact that we’ve now got about 35-40 working to level 3 EPR is a major step forward," says Bolton.

Roger Wallhouse, corporate development director at iSoft, also believes the 2005 target will be missed, he predicts trusts will increasingly follow an a la carte approach to EPR implementing the components that support local clinical priorities.

This bolt together model is set out in the latest LIS implementation guidance from the Information Policy Unit (IPU), which says trusts should follow local priorities on EPR. The new approach represents a marked shift away from the staged, six levels of EPR set out in IfH.

Sean Brennan of Northgate Systems, one of the main authors of six stage EPR model, now believes the very term EPR was a mistake: "It should have come with a health warning, instead you should be able to do it in any order you want as long as you have the business case."

Some within the industry believe that timescales for EPR contracts are likely to lengthen rather than shorten as the NHS goes through another wave of organisational change following the publication of Shifting the Balance of Power.

According Singer the latest wave of organisational upheaval is resulting in a stagnation of decision making: "The organisations that are meant to be signing off procurements are being closed down".

Peter Dyke, head of market development for BT Health, meanwhile expresses concern about the impact on existing trust EPR programmes the new emphasis on delivering disease state specific systems, spanning an entire health community will have.

“This changes the picture and puts it in the context of developing systems around NSFs that covers the whole health community,” notes Dyke. "The levels of complexity in all this are starting to amaze me."

He voices concern that the new approach will create a level of complexity NHS organisations will be simply unable to cope with. “EPR is just about manageable within a single trust,” says Dyke. "But EHR is by definition a far harder thing to do."

Dyke points out that the new Strategic Health Authorities (stHAs) will be expected to co-ordinate the procurement and implementation of highly complex clinical information systems across 20-30 local NHS organisations.

The LIS toolkit acknowledges that the need to implement NSF information strategies and support clinical governance creates "tensions" with the IfH implementation timetable.

Though EPR is only fleetingly mentioned once, the Information Policy Unit’s Mark Freeman, author of the LIS toolkit, stresses that the EPR targets have not been revised. "There has not been any revision in their status and they remain at the heart of the National IM&T Strategy."

But according to Wallhouse the tide is beginning to turn against acute EPRs as described in IfH. He argues that with the creation of 300 Primary Care Trusts and increased emphasis on delivering information systems to support NSFs. "The emphasis is now moving away from electronic patient records to electronic health records".

Wallhouse believes a new modular vision of EHR is emerging from the centre. "The view of the DH is that the integrated EHR is a composite of the acute EPR, mental health EHR, social care electronic record and its equivalent in primary care."

One final concern expressed by system suppliers was that with the government in a hurry to deliver results by 2005, it may contemplate national procurements for EPR and EHR systems.

"I think there is a desire for a national solution, but I worry as I don’t that a national solution will ever work," comments Brennan.

“The political pressure will be stepped up to meet the 2005 deadline,” adds Bolton. But he warns that "any central approach will wind up as a disaster", as each hospital is so different.

Instead Bolton argues that the government should keep its nerve, recognise local achievements and "by 2008-9" it will reach the 100% EPR target for acute hospitals.