Electronic patient records are an enabler of a solution, not the solution itself, says John Deverill, managing director at Finnamore

Most agree the ever pressing problem in health and social care is the increasing divergence between demand and available resource. The electronic patient record may address this problem, but should be viewed as an enabler of a solution, rather than a solution in its own right.

‘Transforming to a systems view on the patient’s behalf means challenging multiple vested interests’

The solution itself has to be care that is delivered within a system (or system of systems) and designed around patients, service users and carers. Within this, information would be entered only once; it would be clearly owned, accurate and available when and wherever required to serve the needs of its owners – the patients.

What we have now is not a system of systems but a heap of systems, each designed to deliver its own “bit”. IT has been optimised to this end but such optimisation does not generally promote interoperability and, from a patient’s perspective, the resultant heap isn’t great.

Barrier to change

This may be reflected in a finding from the recent Finnamore/HSJ survey of health leaders. IT stood out as a key barrier to implementing change. But it was only ranked as the eighth most valuable enabler from a list of 10.

‘We have to take people with us and the only way to do this is locally’

Transforming to a systems view on the patient’s behalf means challenging the multiple vested interests of clinicians, managers, technological gurus and the shareholders of the multimillion pound organisations that make the IT solutions which support the individual systems within the heap. 

As Mr Sivak notes, systems don’t traditionally talk to each other but attempts to address this have failed due to a widespread partiality for maintaining the status quo.

Aligning incentives

In health and other sectors, offices of interoperability have been established and standards specified. In reality, though, the best solution is to align incentives with patients’ needs. If this can’t be done nationally or globally due to the money and fiendish complexities involved, it can be done locally by creating space for the small and medium-sized enterprises Mr Sivak mentions and supporting the disruptive innovation of cloud-based technologies.

Change management 101 says we have to take people with us, and the only way to do this is locally. I agree with Mr Sivak: the EPR is all about culture change. Achieving this within the NHS will be a tougher challenge than developing the perfect IT solution but this must be our focus.

John Deverill is managing director at Finnamore

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