Our electronic patient record (EPR) theme this week continues, following exploring EPR implementation with Ideal Health and the EPR programme at Medway NHS Foundation Trust, here we focus on different strategies and models.
The largest panel at HTN Now April 2021 saw seven presenters join the debate on all things digital, including different EPR strategies and ideas on how these might impact the integrated care systems (ICSs) that have recently been rolled out nationwide.
Our panel team consisted of:
David Kwo, Ex-CIO of UCLH and the NHS in London
Nick Beard, MD Co-Founder and President at Brightplate Inc
Jagdip Grewal, MBA, Digital Transformation Director
Alec Price-Forbes, MD, Consultant Rheumatologist, University Hospital of Coventry and Warwickshire NHS Foundation Trust, CCIO for Better Health, Better Care, Better Value (Coventry and Warwickshire STP)
Robin Stern, Executive Chair, Future Perfect (Healthcare) Ltd
Jon Reed, Chief Digital Officer, Future Perfect (Healthcare) Ltd
Dr Ian McNicoll, CEO, freshEHR Clinical Informatics Ltd., Director, openEHR International.
Beginning with a bit of background about the group and its interests, David Kwo explained: “Who are we? We are a group of clinicians and IT workers who are very passionate about digital strategies for the NHS. We meet as a group to have conversations – and we’re very pleased to be able to have a discussion today.”
Alec Price-Forbes started the first session section off with a look at ICS requirements, stating: “I’m a rheumatologist and I was doing a clinic this morning – that will be salient in what I’m going to talk about. I think we all recognise…that one of the greatest opportunities of the 21st century is to safely harness the power of the technology revolution which has fundamentally changed our lives – arguably for the better – to safely deliver higher quality, safe, sustainable care.”
“I’m a Chief Information Officer for Coventry and Warwickshire STP, [which is] now called a healthcare partnership and is moving towards an integrated health system. I think we all recognise that the system is incredibly complex, there are many, many players. We all are still working in our own silos…whilst trying to forge ahead with new models of care which probably are unsustainable with the current infrastructure we have.”
“An integrated care system,” he continued, “needs to be holistic, system-wide in its approach – considering the health and wellbeing of the population we serve, as well as reacting and responding to those with disease. So we need to be able to include in that the ability to promote self-care, prevention of disease – and digital has got to be at the forefront.”
However, Alec added, “It’s incredibly complicated…I want to make no apology for saying we mustn’t forget what the purpose is. We’re in the business of healthcare – and healthcare is about…patients who have problems and us trying to help them.
“We must make sure that the data flow creates meaningful information that we can utilise, that adds value and enriches those interactions.”
After illustrating issues surrounding paper documentation and how current information is utilised and collated – as well as discussing how it could be simplified – Alec also touched on the frustrations and challenges surrounding prescription forms. He stated: “The famous outpatient prescription form – why do I have this? I have to complete, by hand, 30 of these every week. And this is the sort of information I’m having to input in the 21st century. Which, ladies and gentleman, is a significant waste of my time…these have to be sent manually and the whole process is fraught with danger.”
He concluded his portion of the webinar by highlighting the need for unified codes for units of measure and summing up his learnings from the last year and emphasising that “we need better.”
“Data quality is front and centre…but, most critically, we lack integrated information systems. The real challenge is, can an ICS strategy avoid poor data quality being sourced from disparate legacy systems?…how do we take the current alphabet soup, that’s a real jumble, and actually create structured data?,” he said.
Picking up on that thread, Jagdip, asked the audience to consider: “How do we move the operating models that we have to deal with some of the challenges?”
Jagdip focused on the changes required and the challenges that ICSs will face, focusing on patient empowerment over education and on agile care models.
“What I’ve seen a lot of,” he commented, “actually, the health system needs to move away from understanding not just the health data but what are the other wider patient needs. How do we help patients become more empowered and take more control of themselves and be supported in that?”
“The other thing we’ve seen is a lot of new care models being created. But actually, what we need is an agile care model around the patients’ needs. We have seen a huge amount of digital-type journeys starting to appear…but we need to do those for the patients who are not so digitally [enabled] – how do we support those people?”
Taking us through a brief presentation, he presented issues around shared care records – including data duplication, quality and integration, as well as questioning how the huge number of apps and mobile health platforms will fit in.
He also suggested using spaces like libraries and pharmacies to support people who are “not so digitally native”.
On EPRs and how they may helps ICSs, David Kwo stepped in to share his views on the ‘different schools of thought’.
In terms of EPRs, he said, “my fundamental view today is that I don’t think there is enough evidence yet to pick a winner, in terms of EPRs for ICSs, but…my key message is that we need to have more and wider open conversations based on collaboration values.”
After running through what he believed to be the ‘three schools of thought’ and their pros and cons – including shared care records, open standards, and single core integrated EPRs – David handed over to Robin, to delve further into the topic of ICSs and open standards.
Robin touched first on the problem of silos in patient data: “The silo problem is that each silo invests in digital to benefit its own services. Of course – why wouldn’t they?”
“The problem is people are not that disciplined and they trample across those silos and they aren’t best served by this model; if the record-keeping is discontinuous, so is their care,” he said.
“The consequences are clear: there are limits to improving the safety and timeliness of that care, because it can only be improved within the boundaries of the organisation. Being able to innovate across the pathway is, and will remain, difficult.”
After highlighting two use cases – locally integrated care services and non-local specialist clinical network services, such as cancer alliances and stroke services, as well as the need to share information for innovations nationally and internationally – he moved on to look at open clinical depositories.
“The whole essence of it is to be able to create a unifying workload of continuous care across the patient journey. Three outcomes flow from this: the first is that that we will have achieved, to do this, the movement of control of people’s data and of clinicians’ data from system vendor to the healthcare provider; secondly, it means that the whole patient journey can be innovated; and it does mean then that the safety and timeliness of care can truly be transformed.”
Considering the whole session and three distinct approaches to EPRs, David explained, “this is the way I see the world with respect to EPRs, particularly with respect to ICSs, is that some of these EPR solutions tend to address the data side, as opposed to functionality.”
Using diagrams to illustrate the benefits and issues with each form of EPR solution, he gave a final overarching visual summary of the three approaches, before concluding: “I happen to believe, very strongly, that the key to digital success – not least in ICSs – is dependent on new culture changes…collaboration not competition, conversation etc.”
The rest of the group then joined for an in-depth Q&A session with the audience, which you can watch in full, along with the entire session, below:
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