Trusts could lose contracts without EPR

The NHS Commissioning Board is drawing up plans designed to dramatically accelerate the adoption of electronic patient records by NHS hospital trusts.

New guidance outlining ‘severe’ financial consequences, including loss of contracts, for NHS trusts that fail to take action to begin implementing EPRs by April 2014, is due to be published this June.

The plans being prepared are designed to compel trusts to provide the new data flows required to improve quality of services and provide transparency. The NHS CB believes hospitals can only provide the data flows needed with EPRs.

EHI understands that NHS providers will have to show they are taking urgent action and meaningful steps to EPR by 2014, with full implementation a year later.

The NHS CB is likely to warn it may withhold contracts from hospitals if they fail to take steps, an action that would be financially disastrous to a trust. Another option will be to write the requirement to provide new data flows into clinical commissioning group contracts.

At least one source has told EHI that one option being considered is to make penalties so severe that, “they will only have to be imposed once or twice”.

Tim Kelsey, NHS CB national director for patients and information, confirmed to EHI this week that a scheme was being worked on with guidance due in June.

“We do expect the service to take the requirement on data flows seriously, but do recognize this is a real challenge for many. Proportionality will be vital.”

He said a dialogue would be needed between the CB and trusts and that financial sanctions would be a last resort.

Speaking earlier this month alongside health secretary Jeremy Hunt, Kelsey said trusts would face “serious repercussions” if they failed to implement EPRs by 2015.

The need for a renewed effort on EPRs is thought to be backed by Hunt and NHS chief executive Sir David Nicholson.

Hunt has made clear how important he believes EPRs are to NHS reform.

Speaking at the Cambridge Health Network he said interoperable EPRs, the elusive holy grail of the national programme for IT in the NHS, remained the right objective, but Labour’s delivery had been “wholly wrong”.

New EPR systems would be locally bought rather than centrally procured, with great hopes being placed in new technology creating an opportunity for SMEs and enabling a decisive shift from big traditional, expensive systems.

With no new money available for the investment, trusts will have to find the money from existing budgets.

Under the new scheme trusts will not be required to take any particular system, or set of clinical tools, but must be able to provide near real-time data on quality and outcomes to commissioners, regulators and the public.

Massive new flows of patient-level clinical data forms the basis for care.data, which will integrate health and social care data for commissioners. It will also be essential for the publication of consultant-level outcomes data due to start this summer.

The NHS CB has made it clear that the Powere of Information strategy can only be achieved if hospital trusts implement EPRs, now identified as the essential foundation to a digital NHS.

In a January EHI interview Kelsey said: “We’ve said that by April 2014 we are expecting a flow of data out of hospital electronic records, and this clearly implies trusts must have electronic records in place.”

The new ‘implied EPR’ strategy is nothing if not ambitious: in two years it aims to achieve what NPfIT failed to achieve in a decade with the benefit of billions in investment.

To help accelerate roll out efforts EHI understands the NHS CB aims to emulate the US Regional Extension Centres model – a federally funded network of 62 training and education centres that have played a key role in accelerating adoption of EPRs among primary care physicians.