Big EPR Survey backs ‘meaningful use’

EHI readers have backed payments for the ‘meaningful use’ of electronic patient records, as part of a ‘roadmap’ for their implementation in NHS trusts in England.

Respondents to The Big EPR Survey, which EHI has been running as the next stage of The Big EPR Debate, were overwhelmingly in favour of NHS England issuing a “road map or road maps for trusts at different stages of digital development.

They also indicated support for the roadmap to include incentives for trusts that reach key milestones, including payments for ‘meaningful use’ on the US model.

President Barack Obama’s American Recovery and Reinvestment Act of 2009 triggered $30 billion for incentives for using clinical records to improve care. Although the meaningful use criteria are complex, it is credited with triggering a big uptake in EPRs in the US.

Eight out of ten (80%) of the 269 readers who responded to the survey said a roadmap should form part of the guidance that NHS England is due to issue in June on how trusts should prepare to implement electronic records by 2015 on the way to becoming paperless by 2018.

Six out of ten (58.5%) respondents also said that the guidance should “add targets for reaching different implementation milestones.” A similar proportion (55%) backed the idea of “incentives” for reaching them.

There was more support for the idea of ‘meaningful use’ payments, with six out of ten respondents (63.2%) saying the guidance should “add incentives (eg payment) for the ‘meaningful’ clinical use of systems (not just their implementation).”

However, EHI readers effectively warned NHS England against making the mistakes of IT strategies in the 1990s by adding penalties, as national director of patients and information Tim Kelsey has suggested that it might.

Six out of ten respondents answered “no” when asked “should any road map penalise trusts that fail to achieve implementation milestones.

Interestingly, though, they were almost evenly divided when asked if there should be penalties for failing to achieve ‘meaningful use’, with 52.1% of all respondents saying there shouldn’t, and 47.9% saying there should.

EHI editor Jon Hoeksma said: “The impressive response that we received to the survey – almost 300 responses in just ten days – shows how deeply those involved in healthcare IT care about the crucial question of how to get EPRs into hospitals, where there is most work to be done post-NPfIT.

“NHS England has a small but clear window of opportunity to make EPRs happen this time. Our survey shows that trusts want better guidance from the centre on definition and direction on electronic records.

“The results indicate that an effective roadmap would be warmly welcomed by EHI readers; and that they are looking for support for trusts that hit key targets. Almost two-thirds back the idea of linking incentive payments to achieving clinically meaningful use of electronic records.”

Comments submitted as part of The Big EPR Survey show many readers believe that the ‘ladder’ to EPR models developed by the NHS IT strategies of the 1990s still have validity. One said: “A roadmap or a level could be used. This has been done in the NHS, before NPfIT.”

Another said that “it should not be too prescriptive” but that something that said “if you have a lot of legacy investment you need to do X, if you have limited legacy investment then you do Y” would be valuable.

This commenter added the “aim [should be] to reach Utopia eventually” in the form of “a fully integrated solution with full interoperability (standards) to join up to other EPRs, such as GP, community, mental health and social care.”

A number of comments argued that incentives are an important part of the picture. One said that without them “you’ll end up with organisational silos” while another said “there needs to be some incentive for trusts to progress.”

However, a number warned that incentives would mean finding money for EPR implementation, and that there were potential downsides to ‘meaningful use’ if it meant “too many rules resulting in gaming, rather than meaningful activity.”

Some commenters also felt that penalties should be applied to bring home the importance of adopting new technology. One wrote: “IT can be a Cinderella service and needs support via penalties.”

In general, however, commenters were very clear about why NHS England should not try to impose penalties on ‘missed’ implementation or usage milestones.

One reader wrote: “Fining tax funded organisations is pointless, the taxpayer pays the fine” while others said that struggling trusts needed “extra support” rather than “another contribution to their financial difficulties.”