A personal review by Rod Ward


This report appeared in ITIN 10(3) p 7-8


This program is designed to raise awareness about the development of the Electronic Patient Record (EPR) within the NHS.
The CD brings together results of the NHS Executive's three year EPR programme in acute hospitals and is designed to help individuals or trusts in developing their own EPR strategy.

It is important to bear in mind that the EPR is a concept not a product and therefore this is not a product demonstration but a collection of materials (Papers, Power point presentations, video clips & links to further resources) exploring the meaning and implementation of EPR.

Because of the group the CD is aimed at some prior knowledge of the EPR appears to be assumed.


Once the installation has been achieved (see below) the actual content is divided into 6 sections, representing the 6 levels of EPR implementation;

  1. Clinical & Administrative Support
  2. Integrated Clinical & diagnostic treatment support
  3. Clinical activities support
  4. Clinical knowledge & decision support
  5. Speciality specific support
  6. Advanced multimedia & telematics

This shows the development most trusts are working through, with almost all having achieved levels 1 or 2 and a range of pilot projects being undertaken at the higher levels.

Figure 1. The 6 levels of EPR

Each of the 6 sections is accessed via the screen shown in Figure 1.

Within each section a range of options are available file a "file tab" analogy (see Fig 2), which is easy to use.

Provides a brief introduction to the level and key functions. Fairly good but requiring some knowledge of terminology & abbreviations relevant to the field.
A short description and a short video clip with a "piece to camera" by Frank Burns Head of IM&T for the NHS. This requires video for windows (included with CD). The video clips were clear, and, for visual learners, they added to understanding of the issues.
Computer Simulation
A Microsoft camcorder movie (included on CD - Win 95 only) showing screens used in one or more suppliers software, which is currently in use or development for the EPR functions at this level. I found some of these difficult to follow without commentary or notes - many of the systems were already familiar to me.
This is a link to reports, generally of implementations in pilot sites of systems which operate at this level. These have obviously been written in Word 97 and require a microsoft word viewer if not already installed (included on CD). Many of these have been previously published elsewhere, however it is useful to have them gathered together in one place - it would be nice to have a hypertext link to the documents which are referenced in the report.
Development sites
This provides contacts names and contact details for many of the pilot sites. It would be nice to see more email addresses in this section - and to have these as "click able links".
Power Point presentation
One or more power point presentations related to the level are presented - generally form papers previously given at conferences etc. An attempt is made to give a consistent front end to these and index them, however it is very obvious that they have come from a variety of sources and the changes in format can be disconcerting. These could be useful for teaching purposes, however without the commentary or notes they are likely to need interpretation because of changing contexts.
System suppliers
This provides a list of software/systems suppliers who have products related to this level of the EPR. The suppliers were involved in the production of the CD. Click able links to email addresses & web sites were available in this section.
Figure 2. Contents of each section (level 6 is shown here)

Program navigation, installation etc.

On the left hand side of each screen are icons linking you to the information about the CD and a thermometer to enable you to move between the different levels.

At the top of the screen is a button bar, which provides access to other functions. To activate the button bar you must first click on a small arrow in the top right hand corner of the screen - this is not intuitive. The functions available enable you to; exit the programme, restart the CD - useful if you need to install further plugin/helper software, and gain further information about the operation of the CD.

The next link is to a program overview. In my view it would have been useful to have this appear as a first screen. Others enable you to print (only available on some screens), and a section on security - this is a power point presentation from the IM&T security pack for nurses, midwives and health visitors, but is also relevant to others clinicians and NHS staff.

Another icon links to a collection of papers produced during the life of the EPR program. These are divided into;

The final two buttons launch a web browser and connect to the EPR web site (either NHS net or Internet), and the final one launches an sgml browser for the program bibliography. Although an sgml viewer is included with the CD insufficient instructions on how to include this and make it seamlessly link with the CD were insufficient in the installation instructions.

When any of the plugin/helper programs are used to access material on the CD and then exited a rather extra button is need to link back to the main screen (Fig 2)

Because of the number of additional pieces of software required for supplementary information on the CD installation is complex and takes a while. Both installation and running the software will be enhanced by a high specification machine (at least P166, 32 Mb Ram etc.).


This CD contains important material for a wide range of staff within the NHS and gives some insight into the directions the EPR is likely to take in a wide variety of trusts.

The program is fairly well put together, starting with a flashy graphics sequence which can get annoying if you have to restart more than once or twice. The range of sources for material, and plugin/helper programs needed to view them mean that full integration of the material has not been achieved.

I believe it would certainly be useful for management & IT staff, but could also be of interest to others & excerpts could be used for groups in initial and post graduate education.

Price: £ Free of charge

Contact: Sean Brennan, EPR Programme Office, Room 1N 35C, Quarry House, Quarry Hill, Leeds LS2 7UE, UK EMail: epr@doh.gov.uk or sbrennan@doh.gov.uk

Spec: 486/66 MHz Processor (Pentium recommended), Windows 3.11 or Win 95, 16 Mb RAM, Dual Speed CD-ROM drive, VGA display supporting 256 colours at 640x480 resolution, 16-bit sound card & speakers, Microsoft Word and Power point viewer software (included on CD), SGML viewer (included on CD), 30Mb of free disc space. (Recommended: Internet connection and web browser to access on-line information)

Reviewer: Rod Ward, Lecturer in Nursing, School of Nursing & Midwifery, University of Sheffield, Winter St, Sheffield S3 7ND, tel 0114 222 9778, Fax: 0114 222 9712 EMail: Rod.Ward@Sheffield.ac.uk  

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Page Created: 14.6.98
Last Updated: 30.8.03