To realise beneficial service change and use the data we can access to best effect, we need to change how we look at electronic patient records, says Michael Thick

As a clinician who has been closely involved in clinical IT for all my working life, my first observation is that very few organisations have an electronic patient record (EPR) working properly.

Professor Michael Thick

Michael Thick

My second is that, unless we use technology to enable a transformation in service delivery, we are whistling in the wind as far as filling the £30bn funding gap goes.

My third observation is just how few people truly understand this.

If there was one thing we all should have learned from NHS Connecting for Health’s National Programme for IT, where I was chief clinical information officer from 2006 to 2011, it is that you cannot use technology to force a change in behaviour.

‘You cannot use technology to force a change in behaviour’

One person who does grasp this is Beverley Bryant, director of strategic systems and technology for NHS England.

Ms Bryant’s major thrust is interoperability to maximise the investment that has already been made by getting systems to work together and enabling people to come up with solutions of their own that work for them. That might be within an organisation but, increasingly, it will be across organisations and across health and social care. We need to get the right information to the right place at the right time.

Who do you trust?

The other changing dynamic is the public’s experience of technology.

Smartphones with health and fitness apps, as well as wearable devices, mean more and more people are producing their own data. What kind of place does such data have in an “official” EPR?

‘The public won’t accept a central authority making a land grab for information to do with as they please’

Some health professionals say this data cannot be trusted.

We have to change that attitude and we have to start to answer some questions around the ownership of data. Because if there was a second thing we learned from the IT programme, it was that the public will not accept a central authority making a land grab for information to do with as they please. We are still living with the consequences of that attitude today.

All of this raises a question: where does an EPR really belong? It is a question that is philosophical, practical and commercial.

In an NHS with organisations merging and morphing, there is considerable uncertainty about the place of the typical 10-15 year, organisation centric EPR contract. Vendors need to come up with something useful and cost effective for the NHS in its current financial situation.

Technology as a service

We need a new way of thinking about an EPR – the EPR as a service. Not only could this transform the business model of deploying organisational-wide IT projects but also the way the NHS thinks about technology.

A good example of technology as a service is Coordinate my Care, the end of life shared care record I helped deliver in London with the Royal Marsden Hospital. It is now expanding to deliver a long term condition shared record.

‘Coordinate my Care is like a mini EPR. It records the patient’s wishes, consent and care plan’

The clinical engagement gelled around the shocking statistic that 80 per cent of patients wanted to die in their own home but fewer than 25 per cent achieved it. Once the service knew and understood that fact, it was easy to mobilise a response enabled by technology.

You could regard the Coordinate my Care record as a mini EPR. It records the patient’s wishes, their consent and their care plan and is available to all the services looking after them. It is true that not every GP in London has signed up, but that reflects the inherent conservatism of doctors.

This is a truly disruptive deployment of technology that disturbs their current status quo – you can’t please all the people all the time.

Software anarchy

Which brings me to another type of technology that is disturbing the status quo: open source.

This is where the coding behind a piece of software is open and available for anyone to use and improve. And it is building momentum to the NHS. Moorfields Open Eyes EPR is open source, as is the new NHS e-Referral Service, which replaced Choose and Book this summer.

This is not software anarchy, as some suggest, nor is it a dictatorial top down directive. It is about working with people to gain a consensus about improving a system through collaboration. With the right governance in place, it is a way of offering clinicians an input into a system while maintaining its integrity.

‘When you trust data and the story it tells, it can lead you to the right response’

Taunton and Somerset Foundation Trust has signed a contract with IMS Maxims, which will provide it with an open source EPR; together they explore some of these new dynamics. The EPR is due to go live later this year. It is going to be a journey and one that will require new kinds of relationships, both between executives and clinicians and with the data.

It is not just health professionals who do not trust data; I have seen hospital boards reject data that showed the number of patients who did not need to be under its care.

Instead of acting on the insights, the technology was dismissed as inaccurate.

When you introduce technology, there will always be surprises. When you trust the data and the story it tells, it can lead you to the right response – and that’s when you start to get technology enabled change.

Michael Thick is chief clinical information officer at IMS Maxims

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