Study questions value of large EPRs

Local electronic patient record systems are often more effective than larger scale projects, according to a new study by the academic leading the independent evaluation of the Summary Care Record.

Professor Trish Greenhalgh and colleagues from University College London’s Department of Open Learning analysed 24 previous systematic reviews and 94 primary studies on EPRs all over the world.

The study, published in Milbank Quarterly, concluded that larger scale EPR projects promise much but sometimes deliver little.

It also suggested that researchers and policymakers need to do much more work on how to get EPRs to work in the real world and called for an interdisciplinary debate on priorities for the EPR research and policy.

Professor Greenhalgh said that while EPRs are often depicted as the cornerstone of a modern health service, clinicians and managers all over the world struggle to implement them.

She added: “Depressingly, outside the world of the carefully-controlled trial, between 50 and 80% of EPR projects fail – and the larger the project, the more likely it is to fail.”

The researchers said they found no evidence that large-scale commercial IT systems in health care produce the benefits anticipated by their architects, and that a few high quality studies suggest that they did not.

However they added: “We also found recent evidence that if EPR systems are developed organically and in-house, scale per se may not be a bar to their success.”

The study says the National Programme for IT in the NHS in England is based on six assumptions: that the EPR is primarily a container for information about the patient; that it can be integrated seamlessly and unproblematically into clinical work; that it will increase the effectiveness and efficiency of clinical work; that it will drive changes in how staff interact with the patient and one another; that it should replace most if not all forms of paper record; and that the more comprehensive and widely distributed it is, the more value it will add.

It says much of the literature covered in the review ran contrary to these assumptions.

In particular, the study found that while secondary work like audit and billing could be made more efficient by EPRs, primary clinical work could be made less efficient.

It said paper could offer greater flexibility for many aspects of clinical work and concluded that seamless integration between systems was unlikely ever to happen “as human input will probably always be required to re-contextualise information for different uses.”

Professor Greenhalgh said the results provided no simple solutions and did not support an anti-technology policy.

Instead, she added: “They suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world.”

The UCL team led by Professor Greenhalgh that is evaluating the SCR is due to present its final conclusions in May next year.

A report presented to NHS Connecting for Health in September showed that the SCR sometimes adds value in out-of-hours consultations, but that it had so far had made a limited contribution in secondary care.