Trust warns of ‘significant risk’ to patients over EPR delays

A trust has warned of “significant clinical risk” to patients due to delays in regulator approval for a £35m electronic patient record (EPR) programme.

South Tees Hospitals NHS Foundation Trust says it cannot go ahead with the planned system overhaul as it is still awaiting approval from NHS Improvement (NHSI) and its Integrated Care System (ICS).

Board papers warned the trust is the only major trauma unit in England without an e-prescribing system.

“Due to a lack of investment in IT over a number of years, the trust is not as digitally mature as its peers. It is now critical that investment is made in an EPR and the supporting infrastructure to prevent it from falling further behind and putting patients at risk,” it read.

The trust, working with County Durham and Darlington Foundation Trust, approved the business case for the EPR in December 2018. Due to the total investment needed being more than £35 million, approval was required from NHSI.

Since being approached for approval, NHSI indicated it would not review the programme until local ICS (the North East and North Cumbria) support was granted and funding was identified. The ICS is yet to grant approval, missing the trust’s expected deadline of September 2019.

The trust had planned to have NHSI approval by the end of October 2019 in order for the board to approve the final business case in December 2019, ready for the programme to begin in the first quarter of 2020.

Clinical risk

In a report to the South Tees board the trust’s head of digital programmes, Ian Willis, highlighted the trust was currently the lowest ranked major trauma centre nationally, according to the latest digital maturity index score.

The EPR would replace current systems for patient administration, workflow, emergency department, theatres, maternity, bedside observations, spinal injuries, orthopaedic trauma and cancer information systems.

Willis warned the trust has delayed replacing other systems in favour of the EPR and that failure now to progress the EPR would leave a “gap” in trust infrastructure.

“Without further investment in IT and medical equipment, there is a serious risk that equipment could, and is beginning to, fail. The trust is now in the position of having devices that cannot be upgraded any further to keep step with software/cyber security requirements being released such as Windows 10,” he said.

“Therefore even without the EPR significant investment is still needed to replace aging and obsolete equipment.

“It is now critical that investment is made in an EPR and the supporting infrastructure to prevent it from falling further behind and putting patients at risk.”

A separate clinical risk document, put together by the trust’s CCIO and CNIO, cited increased risk of prescribing and drug administration errors and an inability to share information regionally and sub-regionally due to the lack of EPR.

“Ageing infrastructure and systems including IT and clinical equipment limits the flow of clinical information, reduces clinician’s confidence and impacts patient care,” the report read.

“We cannot share information sub-regionally and regionally via electronic means i.e. Great North Care Record, which will impact patient care when patients present across the region.

“Staff (in particular trainees) are choosing not to come to South Tees due to the lack of electronic records.

“These risks can only perpetuate as the rest of the NHS continues to move forward digitally; we will be putting our patients at risk of harm, harm which could be mitigated or prevented.”

The business case suggests if the trust does not pursue the new EPR now it would have to invest similar amounts to keep current systems running.

A spokesperson for NHSI said the body was working with the trust and ICS to “find a viable solution to accelerate implementation of the electronic patient record programme”.

A spokesperson for North East and North Cumbria ICS said they were currently working with the trust and NHSI to “consider solutions”.