The government has announced that it has met its target of 90% of NHS trusts having an electronic patient record (EPR) in place, but are efforts to hit 100% of trusts too slow?

Thanks to go-lives at Hillingdon Hospitals and Sheffield Health and Social Care NHS trusts, the target has been met ahead of the original December 2023 deadline.

Amanda Pritchard, NHS England chief executive, said at the NHS Providers National Conference and Exhibition in Liverpool last week: “Thanks to the teams at Sheffield Health and Social Care and Hillingdon Hospitals, who completed their go-lives over the last couple of weeks, you have now delivered on the target for 90% of trusts to have this capability in place ahead of winter.

“Delivering that switch isn’t easy but it’s worth it because that’s the underpinning work that will enable us to benefit from new technologies.”

In 2022, the government invested over £400 million in supporting 150 NHS trusts to digitise their records, while a further £500 million will reach trusts by the end of this year.

The use of EPRs is drastically changing the way NHS organisations are able to operate. It improves the flow of information and ensures clinicians have the right information, on the right patient at the right time to ensure timely interventions, improved patient care and efficient processes. According to NHSE, the most digitised trusts have also been shown to operate with approximately 10% improved efficiency, in comparison to less digitally mature trusts.

Is it enough?

With the 90% target met, the remainder of the trusts are set to go live in the coming years. By March 2025 the government aims to have 95% of hospitals with an EPR, hitting 100% by the following year. Earlier this year the government’s Infrastructure and Projects Authority (IPA) annual report declared that it was ‘unachievable’ for all trusts to have an EPR in place by March 2025.

However, Mark Hutchinson, VP health care strategy and transformation for Altera, believes it’s possible to get those remaining trusts live with an EPR considerably quicker.

Speaking to Digital Health, Hutchinson said: “There’s no doubt it could be done much quicker, with a different approach you could do all of those organisations much more quickly. The key to doing that, I think, is taking a modular approach, focusing on the clinical functionality first, but also making sure that we are supporting the market and the NHS to share the digital resources.”

He continued: “The national programme is running out of time and appears to be running out of money. And we are desperately short of staff across the NHS. So finding solutions that you can implement quickly, that are affordable, and that impact less on the clinical front line, are the things we need to be considering as a way of ensuring everybody has an EPR to help them support and care for their patients.”

EPR obstacles

While working as CIO at Gloucestershire Hospitals NHS Foundation Trust, Hutchinson was responsible for rolling out the Altera EPR in just five months. He cites a phased, modular approach as being part of the success story – along with a collaborative outlook.

He believes co-designing with the people who will be using the EPR is a really powerful engagement tool. “Nobody is going to push back on a system that they’ve helped design, they’ve helped to configure,” said Hutchinson. “And if you look back at some of the recent problems with EPR implementation, it’s often because people haven’t been able to co-design their documents. It’s a really big, but easy-to-make mistake.”

The speed of deployment, according to Hutchinson, is another key factor to securing clinician buy-in.

He explained: “To be a clinician who’s under the sort of pressure that they’re under at the moment in a hospital and be told you need to engage actively in a project that you’re not to see any benefits for at least two years is a really tough ask.

“Whereas if you can sit down with someone now and say that in five months we’re going to be helping you improve the safety and reliability of care for your patients that’s a much easier kind of time frame for people to be able to concentrate across and then you build up enthusiasm within the organisation.”

The final obstacle for many of the remaining trusts is often financial, according to Hutchinson. He said: “I think that for a lot of those organisations already financially challenged, already understaffed, this isn’t the time to take on massive go lives that change the way an organisation works overnight.

“Even now if they went out about and bought an expensive system, they need to be able to afford to run it going forwards… If your system provider is going to charge you every time you want a change making it becomes a really expensive system to maintain. A lot of group 0 and 1 organisations are financially challenged already. It needs to be not only something that can be implemented in a way that they can cope with. But also needs to be sustainable.”