As healthcare evolves, so too must the electronic patient records at its heart. This means addressing barriers to progress – including the concerns of users, writes InterSystems’ Mike Fuller

Digital transformation is reshaping industries worldwide, and healthcare is at the forefront of this shift. As technology evolves, the introduction of digital solutions into healthcare systems is changing care delivery and experience. Digital transformation in the healthcare market is projected to grow from US$ 219.6 billion in 2023 to US$ 1183.2 billion by 2030, exhibiting a compound annual growth rate of 32.40% during 2023-2030.

Central to this evolution and growth is the electronic health record, usually referred to in the USA as the electronic medical record or in UK as the electronic patient record (EPR). Whatever you call it, it acts as a dynamic tool widely used in modern healthcare settings to record problems, conditions, observations, and coordinate care plans.

Initially conceived as digital equivalents of paper records, EPRs have transcended their original function to become comprehensive platforms that aggregate patient data across various care settings. Today, rather than being simple digital records, they are typically complex systems, integrating AI, telehealth, and personalised medicine. This shift is critical in a digital health environment that demands real-time, accurate patient data accessibility to deliver high-quality care.

In line with this, usage levels are growing. Back in November 2023, it was announced that the NHS had met the government’s target for 90% of trusts adopting electronic patient records in hospitals ahead of schedule, and a total of 189 NHS trusts have now introduced new systems.

Adoption, acceptance and change management

However, the adoption and effective use of EPRs are not without challenges. The NHS may have made significant strides in digital adoption yet hurdles such as user acceptance remain. Long-standing industry professionals and those feeling the strain of workloads may be reluctant to embrace modern technologies that promise, but do not guarantee, to ease their burdens.

Implementing an EPR is a series of adaptive change steps, rather than just technical and operational change. It can entail significant differences to the way healthcare professionals work every day – changes that they might potentially disagree with or find uncomfortable to work with.

Furthermore, public concern about data privacy and cyber threats hampers willingness to share and store personal health information in EPRs. In a 2022 survey, conducted by the American Medical Association (AMA) in the US, 75% of 1,000 patients who participated said they were concerned about privacy protection and more than 92% believed privacy is a right that should extend to health data.

Addressing these challenges requires a multi-faceted approach focusing on implementation, training, and user engagement. Hospital employees must understand the potential of EPRs to enhance healthcare quality and efficiency from the onset. Clear communication about the benefits and functionality of EPRs can foster acceptance and adoption, creating advocates within hospitals. These internal champions can then inspire confidence among patients and end users, bridging the trust gap through authentic reassurance.

Collaborative change delivers the biggest benefits overall. This does not mean a few wards adopting a departmental point solution. True adoption that brings digital maturity involves contributing to the shared, overall care of the patient. The EPR can be the one place for an enriched collective understanding of the patient’s needs, informing decisions for their timely, safe, and optimised care.

Evolving in line with a changing landscape

The evolution of EPRs mirrors the changing definition and functionality of hospitals themselves. From physical infrastructures to digital community hubs, hospitals are expanding their roles, necessitating EPRs to adapt and integrate new forms of patient care, such as virtual wards and integrated care teams. This transition underscores the need for EPRs to provide a unified, detailed patient story, encapsulating time, conditions, and care settings. They need to go beyond their initial role as information repositories for hospital episodic encounters, to become agile and extensible platforms that support care triage, patient flow management, early detection, and integrated care.

The commercial, organisational, and operational aspects of EPR adoption further complicate its landscape. Decisions around standardisation, consolidation, and management across different health care settings require strategic leadership and investment. Digital transformation, driven by better infrastructure, cybersecurity, and user-friendly design, demands a balance between innovation and regulatory compliance.

Moreover, EPRs are evolving to support patients who want empowerment. It allows them to give consent for who sees their data and how it’s used and understand health decisions about their care. Governments are investing in these options as a ‘digital front door’ – think the NHS App, which in December 2023 was used to book more than four million appointments. They want to offer improved service user experience and they believe it will improve health outcomes while lowering costs. The emphasis is on self-service for appointment booking, referrals, and patient generated data upload to central records. EPR vendors are providing open secure access for patients to see their health records on their phones and through patient portals. Ideally, both app and web-based access should be available to offer patients the most comprehensive and flexible options for them to become proactively involved in their care or care for others.

Looking to the future

Despite the broad spectrum of functionalities and expectations, the core purpose of EPRs – as comprehensive, interoperable systems of record – remains a topic for debate. Specialists and generalists alike grapple with the balance between narrow specificity and broad applicability, highlighting the importance of a platform approach that integrates various technology layers and applications.

The move towards open-source solutions, while advocated by some, faces challenges in keeping pace with commercial providers who drive innovation and ensure clinical safety. The financial and time investments required for high-quality EPR systems are significant, underscoring the need for a long-term partnership between healthcare providers and technology vendors. This partnership is crucial for navigating the complexities of regulatory reporting, technology updates, and changing user needs over the lifespan of an EPR system.

Clinical safety compliance is perhaps one of the least understood inflection points in the digital health market. In the UK there is a responsibility to attain software and a medical device compliance for DB0129 (for suppliers) and DB0160 (for care providers), or the wider and more rigorous industry ISO standard of 13485. This requires work and significant levels of comprehension and investment on both sides of the care provider and supplier partnership.

As healthcare continues to evolve, so too must the EPRs at its heart. Their ability to adapt and integrate new digital technologies, and accurately capture patient data in real-time, is critical for enhancing patient care. Overcoming the hurdles of user acceptance and public trust, while embracing the opportunities presented by digital transformation, requires a concerted effort from all stakeholders.

The future of healthcare is digital, and EPRs are pivotal in ensuring that this future is realised in a manner that is efficient, secure, and patient-centred. Through collaboration, innovation, and a commitment to quality, the healthcare sector can navigate the changing landscape, ensuring that EPRs remain at the forefront of this digital revolution.

Mike Fuller is regional director of marketing, InterSystems UK and Ireland.