Eamonn Gorman, Chief Nursing Information Officer and Deputy Director of Digital at Royal Papworth Hospital NHS Foundation Trust, examines the issue of Electronic Patient Record (EPR) connectivity in the UK, including its challenges, solutions, and future potential.
What are the key challenges faced by hospitals wanting to connect their EPR systems with their medical devices?
One of the main challenges posed by integration is having to combine multiple data sources and formats, which may have originally been created for different standards or processes, into one cohesive system.
Often data is delivered in a way that supports a particular workflow and as we move towards digitisation, workflows are changing dramatically. There are also the issues of time and authentication which add more complexity, because for certain parameters we don’t just need the measurements themselves, we also need to know when they were recorded and by whom.
Then there are issues surrounding data travelling between different hospitals, which can place unforeseen demands on old IT infrastructure and require lengthy reformatting to accommodate the differences across both systems. This can often be seen in hospitals that send their data to another site for analysis before uploading into an EPR. Royal Papworth sends its bloodwork to the laboratory at Cambridge University Hospitals (CUH) for analysis, a project that initially required reformatting work so that manual parameters could be filled across both databases.
Having a comprehensive implementation plan can certainly help hospitals manage their integration projects, and with Global Digital Exemplars (GDEs) leading the way, there is plenty of information out there for hospitals wondering what is possible.
The challenges of integration projects are often intricate and uniquely specific to the hospital itself, which is why suppliers and EPR vendors must do all they can to educate our medical institutions. Many healthcare professionals have an idea of how to improve their workflow, but it is up to suppliers to demonstrate how much their products can achieve – which is often far more than expected. Suppliers and EPR providers that become too focused on the technical capabilities of their products will get left behind, as medical professionals are thinking about the clinical benefits of their informatics systems above all else. Clinical input from both sides must be present as often as possible to ensure a system that will ultimately help improve patient outcomes. This is not always easy to achieve across an entire project, with internal staff resources often stretched very thin.
There are growing numbers of medical professionals that take up chief nursing information officer (CNIO) positions or clinical informatics roles, but this will need to increase if all our hospitals are to have the digital support they need. Suppliers must step up in the meantime, offering clear solutions that have tangible benefits to patients and improve clinical outcomes.
After the integration process there is still a responsibility with staff to learn and work with the new system. In some cases, this can be a steep learning curve, including hospital-wide workflow and culture changes that come with digital working. This can of course be mitigated by a clear and careful implementation roadmap, but both internal training and external support teams must mitigate any unforeseen issues and make sure the new system delivers on its promises.
During our own high-acuity EPR integration project at Royal Papworth, our equipment supplier, Mindray, showed us a vision of what was possible and supported us throughout the entire process. An EPR connection works both ways, empowering both the bedside devices with greater functionality and the EPR with more accurate and real-time data. As a result, our caregivers in theatres have more time to care for patients, with less time spent on manual transcriptions, and patients can be identified, admitted, monitored, and discharged using the bedside monitors, with an uninterrupted flow of data sent to the EPR.
When weighing up these benefits against the challenges, some hospitals hit an economic stumbling block. EPR integrations can be expensive when done across whole hospitals or multiple departments, and in some cases these projects can take a long time to pay for themselves. With a limited budget it can be a difficult commitment to make, but as with all these challenges, the eventual benefits are worth the investment.
What is the current state of EPR integration in the UK?
One particular benefit of integration the UK is focused on currently, is the ability to share more timely and accurate data for connected local and regional healthcare records. EPR integration allows hospitals and trusts to quickly collate more accurate and timely data, meaning a more effective examination of a patient’s full medical history at any point in the care system. This can help improve decision-making, treatments and discharge times when a patient comes into contact with any part of their local healthcare network.
There is a definite desire to provide point-of-care records that are shareable and accessible locally or regionally, with several trusts already creating holistic records that are accessible for caregivers across a patient’s entire healthcare journey. The difficulty a lot of trusts are having is the level of regulation can be intimidating and confusing; the privacy and integrity of data is vital if patients are to have confidence in their healthcare providers. However, the benefits of easily accessible records are clearly evident to the public and in my experience, when asked, the majority are happy for their details to be used as part of a network that complies with current safety guidelines.
The current NHS target of all shared care records at a local level being completed by September this year is ambitious but not entirely unrealistic for some areas. Across the country there are healthcare professionals and suppliers working hard to achieve that target, and while EPR connectivity inside some hospitals may still feel a long way away off, it is encouraging to see the NHS prioritising shareable data.
What does the future of EPR connectivity look like?
As more and more trusts achieve EPR integration for their regions, the data pool we have to draw on expands, presenting a range of opportunities. At present, most large-scale data collection is purely collection, rather than interrogation.
Once investments are geared towards using the data rather than simply collecting it, then as a nation we will be better equipped to deal with large-scale public health situations. By comparing bedside data for entire regions, we can search for trends, make detailed comparisons, and gain insights that were previously impossible to see. These capabilities will only grow as more hospitals connect their bedside devices to their EPR systems, creating more efficient, timely, and accurate data sets than manual transcription can provide. Of course, there are hospitals already using this form of data integration on a smaller scale within their own departments; at Royal Papworth we graph data on blood glucose and insulin levels against each other for greater clinical insights.
Successful population health management requires this Big Data, in a format that can be used and reused, not just stored, and viewed. Therefore, the standardisation of Fast Healthcare Interoperability Resources (FHIR) may go a long way to help us achieve our integration goals. Building systems and device networks that use FHIR interfaces allows users to access data no matter their operating systems, enabling networks of usually disparate systems. If suppliers and EPR providers can accommodate new FHIR standards into their products, then integration will be a lot easier.
Once we have these large data sets to draw on, artificially intelligent tools will become far more prevalent. AI has already found its way into EPR systems and bedside devices, generally providing an in-depth trend or image analysis to bolster decision-making across different clinical scenarios. With the continued rise of Big Data, AI will be deployed to gather insights at a national level, helping multi-centre healthcare studies, rare disease research and improving overall levels of cursory care.
Conclusion
While we can look to the GDEs as blueprints of what can be achieved, the speed of innovation will likely mean that new and later adopters of integration technology will see benefits and tools that will provide even greater benefits. NHS targets on digitisation and connected local care records may still seem daunting to many, but the wealth of knowledge now available from both suppliers and hospitals will ensure that EPR connectivity is achievable for our entire national healthcare service.