Conference Report;

Towards EPR: clinical issues & practical steps.

(This report appeared in ITIN 10.1 March 98 pp15-17

Weds 11 Feb 98

This was a well attended, one day conference organised by the British Journal of Health Care computing & Information Management.

Attendees ranged from clinical practitioners, including an encouraging number of nurses, to trust heads of IT and chief executives.

Sean Brennan, the Electronic Patient Record (EPR) Programme manager for the NHS Executive opened the program with a historical view, including the original aims of the project and discussed the work achieved, so far, at the 2 demonstrator sites, Queens Hospital, Burton and Wirral Hospital Trust. These 2 sites have taken different approaches to the development of their EPR, one a single supplier solution the other an incremental approach incorporating legacy systems.

He showed a now familiar slide representing 6 levels of hospital's IT development and moves towards EPR. This is represented in table 1. Most hospitals are still at levels 1 to 3, but examples were given at the conference of those who are working, largely at the pilot level towards levels 4 to 6.

Table 1. The 6 levels of EPR

The importance of a clinical focus for the EPR was mentioned, but this was less apparent during the rest of the conference.

A CD Rom about the EPR project is being produced, paid for by the suppliers. This will be released, probably in March, although applications for a free copy are already being taken.

The next two speakers were chief executives, David Wood from Aintree Hospital and Philip Chubb from Southmead. Both described their hospitals and the work they have undertaken so far towards EPR, particularly cost analysis and building a business case. The Aintree presentation was supported by a short demonstration of their system which was intended to illustrate the clinical benefits of such a system, and how easy it was to use, however I doubt if many nurses would have considered it easy to use.

The next presentation was by Carina Birt a consultant who described potential benefits form a workflow system to track information through a series of contacts within an organisation, and Alan Jones, Head of Information & Technology at Winchester, who attempted to show how workflow processes could be applied to GP referral letters entering the acute hospital system. The difference between workflow and process re-engineering escaped me, although we were assured there was one, what was illustrated was a system of using semi-structured templates for letters to include patient clinical information.

The next presentation by Colin Gummer (Bull Information Systems) and Robin Hopkins (GP Exmouth) examined the protocols and standards relating to information transfer systems linking primary care, community care and acute systems, and gave an overview of their "Panacea" project on the development of patient held card cards with staff holding cards to provide security. This card is designed to enable GP, pharmacy and hospital systems to communicate and update information whenever the patient comes into contact with a health professional.

Following lunch a lawyer Michael Jennings, was invited to talk about the EPR from a legal perspective, however this really was a more general look at health care litigation with an emphasis on the poor quality of record keeping, difficulties of lost records and the importance of audit trials when records are to be used in evidence.

Don Hughes (principal pharmacist) and Peter Marsh (deputy head of IT) from the Wirral Hospital then discussed electronic prescribing and the potential of rule based systems. This gives warnings about drug dosage errors and highlights potential interactions or contraindications with multiple prescriptions. It can also be used to advise doctors of generic or cheaper preferred alternatives to brand name drugs, and showed the financial saving this had made.

The next presentation looked at a system introduced at Leicester Royal Infirmary to handle images called Picture Archiving and Communication System (PACS). Wendy Clark (IM&T Director) examined the human impact of this, particularly on doctors and nurses rather than considering technical aspects. Organisational ownership and current working practices were as big or bigger hurdles than the technical capability of the hospital network to carry these large quantities of data.

Chris Dark from BUPA tried to illustrate what is happening in the private sector with his presentation about the way in which they have approached the planning, building and development of integrated care pathways, for use by staff in all their hospitals around the country. This is largely paper based at present, enabling them to be kept at the bedside, and has provided core pathways for common operations, which are then agreed at a local level before adoption. All clinical guidelines and care pathways have been written on templates to provide a consistent format which can then be stored in a database. Work is underway to carry out analysis of variations to the agreed pathways. Integration of care pathways into EPR is seen as the future direction to take.

The final presentation was given by Iain Marsland (Information Management Director, Southmead hospital) for Alan Spours who was unable to attend. This described the setting up of an Acute Hospital IT benchmarking group to share data about costs and benefits of IT services in a range of acute hospitals.

In general it was an interesting day, however it seemed short of the clinical issues and practical steps described in the title. Many of the presentations were more built around institutional strategies at Chief Executive or Information Manager level and were glossy advertisements for the systems, many at pilot stage that they were introducing.

Several speakers commented about difficulties in using components such as the Reed codes and as a result people have built their own coding systems. But apart from this little was said about the problems encountered & how they had been overcome.

Everyone is still at an early stage with EPR development and their are few "mature" sites. Those considering the introduction of these need to overcome much of the hype around IT, which has made many NHS staff cynical about the potential benefits, and share the lessons they have learnt. This conference went a small way to achieving this, but more may be gained to a visit to an open day at Burton and Wirral pilot sites. 

Any comments to Rod@RodSpace.co.uk
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Last Updated: 30.8.03