We must make EPRs work better for patients and staff 

The NHS needs a strategy to turn EPRs into real assets for health, writes Alex Lawrence, improvement fellow at the Health Foundation    

Electronic patient records (EPRs) are an example of a much wider challenge we see with attempts to introduce technology into the NHS: a focus on having the tech rather than using it well.

To date, most of the funding and resources for EPRs in the NHS has been directed toward getting EPRs into place, and in many ways this is understandable.

This journey alone continues to prove challenging, as evidenced by a recent spate of fraught or delayed EPR procurements. But, until recently, comparatively little attention has been paid to how well these systems are being used.

The first year of the Digital Maturity Assessment found that although 90% of trusts have an EPR in place, only 10–30% are using more advanced functions like integrated prescriptions or record sharing with other hospitals.

Introducing new technologies and realising their potential benefits can be highly complex

We should not be surprised that implementing EPRs has proved difficult – no-one said it would be easy. Introducing new technologies and realising their potential benefits can be highly complex.

Even in the US, where EPRs are now yielding impressive returns, this has taken some providers as long as fifteen years and cost hundreds of millions of dollars.

But well-used EPRs are a goal worth pursuing and, armed with learnings from providers that have already trodden this path, there is much that can be done to get EPRs working better for staff and patients.

Training and culture

Several types of training are needed to fully realise the benefits of EPRs. For staff who are entering information, training is needed on basic, day-to-day use of the system – for example, general functionality, how to use shortcuts and how to code medical conditions. This will help ensure that data are high quality.

Another type of training is on ‘why’ to do things, not just ‘how’. This can help give staff more ownership and awareness of the benefits that EPRs can bring when used in the right way, both for individual patient care and the wider system, ensuring higher levels of buy-in.

Additionally, training is needed on how to use more advanced functionalities to generate insights. Guidance on using more complex tools (such as for quality improvement) and interpret outputs is essential to get more out of EPRs and to engage clinicians in shaping care.

After decades of investment, the challenge is no longer acquiring these systems but making sure they deliver long-awaited benefits

Above training sits the question of culture. The goal should be one in which staff query and interact with the system, continually bettering their understanding of how digital tools can help.

An environment that fosters better partnerships between the NHS and EPR suppliers is needed to achieve this.

Data extraction

Data within EPRs can be used not only for direct care but also service planning, improvement, and research.

However, this requires that data be structured and extracted and assumes that trusts have ready access to their own data. This is often not the case – data can be stored in offsite warehouses that are hard to access.

The Data (Use and Access) Act should provide an opportunity to address some of these issues.

In addition, a more detailed understanding of the data access agreements between trusts and EPR providers will be key to ensuring these systems can be used to their full potential.

Focus on maximising benefits

A general sense that EPRs will improve productivity simply by digitising records is not enough to extract transformative gains.

Optimising these systems requires a clear plan and investment in resources such as operational research and quality improvement teams. Currently, the trusts that have enhanced their EPR usage have been able to do so due to funding from charitable arms or private partnerships with industry.

A general sense that EPRs will improve productivity simply by digitising records is not enough to extract transformative gains

The current approach within the NHS means that most resources dedicated to EPRs focus on day-to-day upkeep.

This is essential but does not begin to gather insights or intelligence from the system or develop new ways of working through more sophisticated functionalities, such as appointment management or automatic triaging of patients who don’t need to be seen in person.

Increasingly, this also includes integrated AI tools. Focusing additional resource on these areas could allow the NHS to draw out further benefits from EPRs relatively quickly.

Despite challenges, there are reasons to be optimistic.

In a Health Foundation survey, clinical staff named EPRs as one of the technologies most likely to deliver time savings over the next five years and expressed frustration that they are not yet being used to their full potential.

Building on this potential is urgent. After decades of investment, the challenge is no longer acquiring these systems but making sure they deliver long-awaited benefits to efficiency, care quality, and staff and patient experience.

The NHS must not delay in setting out a strategy that will turn EPRs into real assets for the health of the UK.

This should be as important as any digitisation plan of the last decade and will provide the essential digital foundation for the litany of ideas in the 10 year health plan.