The universal electronic patient record – possible but improbable

I was recently at the DAPS Global Summit and heard Dr Gyles Morrison speak on the user experience of technology in healthcare – the ‘Healthcare UX’. When asked if he could envisage an electronic universal patient healthcare record in the NHS, he asserted this could only happen if mandated and implemented centrally.

Despite technology being ubiquitous within the NHS, I must confess that, like many of my colleagues, I had simply accepted that IT was slow and cumbersome. Furthermore, I would readily indulge in ranting on its fallacies in the safety of the doctors’ mess. But then I thought about my personal approach to quality improvement where, if I see something that could work better, I always ask the question ‘why is this ok?’. How are IT solutions any different?

The local problem

Dr Morrison, who is a medical doctor working within the healthcare technology sector, asked the audience if any of them had read the manual for their smartphone. The point he was making is that they are designed to be intuitive, so you don’t have to. I must admit that I was unaware that my smartphone even had a manual.

Using the example of syringe drivers in a clinical setting, he explained that there are so many variations and all seem to require different forms of training. Surely patient safety would benefit if these were standardised and where training would actually involve knowing the basics so you can operate all types in the ‘real world’? He argued that the user experience - the ‘UX’ – is neglected in healthcare, both from the healthcare professional and patient’s points of view.

The last (mental health) trust I worked in implemented an electronic patient record whilst I was there. It was a big project that was several years in the making. The moment it went live it was slammed by the healthcare professionals who used it. Personally, I too felt it was terrible and continued to rant about it, along with colleagues, for months. In hindsight, following Dr Morrison’s talk, I want to know why it was allowed to be so terrible.

Several fixes were put in place during its first few months, spurred on by healthcare professional outrage. Slowly, this made it bearable to use. We later discovered that IT had wanted input from healthcare professionals during its design and conception. It was not forthcoming, but I imagine several teething problems could have been avoided if it had been. Were we our own worst enemies? We could argue that IT did not engage us sufficiently or work around our schedules, but that is a self-serving view to take. We knew it was being developed and should have made sure we were involved in its design and testing, rather than let its ultimate failings be to the detriment of patient care.

The national problem

Described as “one of the worst and most expensive contracting fiascos in the history of the public sector”, the last time the government attempted to instigate a national patient record system it 1) failed and 2) cost in excess of £10 billion. However, this monumental failure has not deterred the Department of Health. The Five Year Forward View calls for “fully interoperable electronic health records so that patient records are largely paperless” by 2020. The Secretary of State for Health’s speech at the HSJ’s Annual Lecture focused on patient-owned paperless electronic healthcare records and a recent paper by the Academy of Medical Royal Colleges calls for a single integrated healthcare record for those with complex multiple medical comorbidities.

Will it ever be realised?

The problems facing this IT challenge for the NHS do not lie in capability. I am convinced a workable and usable universal electronic patient record can be designed. The problem lies in the system. Trusts are facing the most challenging financial context of the NHS in recent history. They are locked into IT contracts with software and hardware that is out-dated and expensive. There doesn’t seem to be much money for transformational projects in IT, nor is there appropriate engagement of their healthcare workforce to shape such infrastructure.

Nationally, the track record of the Department of Health in implementing large IT infrastructure leaves a lot to be desired. The money available is tied up in ‘vanguards’ and the seven-day service urgent and emergency care organisational transformational work – if any of this finds its way into IT, it is likely to be on a local basis only.

I would have to agree with Dr Morrison on this. There is the appetite from the government for a universal electronic patient record: it, therefore, remains a possibility. But without the money, engagement from all parties or a mandate for implementation on a national basis, it remains highly improbable.

Conflict of interest: Dr Kaanthan Jawahar is seconded to the NHS Trust Development Authority as part of the National Medical Director’s Clinical Fellow Scheme. This article expresses his personal views and do not reflect the views held by the NHS Trust Development Authority.