EPR implementation led to ‘catastrophic loss of confidence’

Problems with the introduction of the Epic electronic patient record at Cambridge University Hospitals NHS Foundation Trust led to a catastrophic loss of confidence in the system that took months and a “huge amount of effort to rebuild”, the president of the Royal College of Surgeons has said.

Clare Marx, who is also chair of the strategic clinical advisory group to the National Information Board, was speaking about a visit to Cambridge at a Westminster Forum on electronic patient records this month.

Cambridge went live with Epic in October 2014 as part of a £200 million eHospital programme. It is the first and only trust in the country to have deployed the EPR, which is widely used in the US.

Marx said the trust had made a real effort to improve its services with its eHospital programme, but: “When they went live problems arose and staff, patients and management rapidly and catastrophically lost confidence in the system. That took months and a huge amount of effort to rebuild."

She told the forum that clinicians suffered phenomenally because of the time taken to access and input information into Epic, which was sometimes longer than the time allocated for the appointment or patient interaction itself. This ultimately interfered with the clinician patient relationship.

Marx also said the trust had invested a lot in clinical champions for the IT implementation, but that not all users had the same experience of the system.

“It’s really important that the clinicians required to use these systems have really robust training beforehand and that carries on after the system goes live,” she said.

Also, access to mobile personal terminals rather than static devices would get way from the problem of doctors queuing to sit down and enter data, as at Cambridge. This is reliant on good hospital-wide wi-fi, she added.

Cambridge was put into special measures by Monitor last October following a Care Quality Commission report which highlighted serious safety and quality issues at the trust, including several related to its eHospital programme.

The IT overhaul was also said to be contributing to problems with the trust’s finances, with an average weekly overspend of £1.2 million.

A number of staff at Cambridge recently responded to questions from Digital Health about the go-live of Epic and how the system is being used now, 16 months later.

A consultant, who asked to remain anonymous, said the initial deployment plunged the hospital into chaos. While things have certainly improved, they said progress is much slower than staff would like.

“Most of us would not go back to a paper based system, because of the ease of reviewing information, but our journey to where we are has not been an easy one,” the consultant said.

Another consultant described drug prescribing as an “ongoing challenge” with aspects that are “not as safe as pre-Epic”. An administrator also said there are remaining issues with data collection.

Both of these issues were also raised in the CQC report.

Read more staff insight into the Epic deployment at Cambridge in Features.