Mike Fisher
Royal Liverpool and Broadgreen University Hospitals
NHS Trust
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* Critical factors for success
* Why an EPR at all
* The Portal approach to EPR
* Strengths and Weaknesses
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The primary driver for whatever approach is chosen to create the
technology stack must be clinician ownership and buy-in.
If the doctors and nurses won’t use it then it doesn’t matter what
technical functionality and capability has been introduced.”
SAFER HOSPITALS, SAFER WARDS: ACHIEVING AN INTEGRATED
DIGITAL CARE RECORD, NHS England 2013
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* “Best of Breed” approach using the investment
and experience in existing systems
* Launch of Underlying systems from a button
bar when an action is needed
* Held together by a clinical portal, to provide
integration and patient context
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Portal Approach
Deployment
Business change
Integrated Approach
Readily supports incremental
addition of functions.
More suited to “big-bang”
deployment
Takes much longer to implement
and results in a mixed system of
electronic and paper for longer
Produces a completely or largely
electronic system quite rapidly
Cost savings take longer to be
realised. But upfront costs tend to
be lower.
High upfront costs. More rapid cost
benefit realisation.
Incremental approach leads to more
gradual impact on business as usual
and lower risk of complete failure.
Pain is over more quickly and the
rapid pace of change may focus the
organisation more on getting the
project done
Ability to leverage existing trusted
Necessity for “rip and replace” of all
and accepted systems by integrating known and existing systems
these into the portal.
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(Perceived advantages are show in black, disadvantages in red)
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Clinician Acceptance
Flexibility
Ability to integrate familiar systems
that clinicians are happy using.
Entirely new system to be learned.
Major training issues.
Inconsistent design and slower
performance in moving from one
system to another
Consistent look and better
performance, at least potentially
Potentially easier to introduce and
new function into the system by
adding an outside module
Addition of new functionality
requires new development by the
company with all the associated time
and cost
Adding new module requires ongoing integration work to ensure
that data silos are not created
within the new module
An integrated system will have a
single underlying database, usually
removing issues of compatibility,
sharing of data between different
modules and consistency of
database structures
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Managability
Additional Functions
Interoperability
Requires on-going management of all the
Much more straightforward to manage.
components, particularly upgrades to ensure
no loss of compatibility with the portal
Upgrades may be more cost effective, as
only the individual components need to be
upgraded, BUT overall costs could be higher
due to having to maintain individual
contracts and licenses for all of the
component applications as well as the portal
itself.
Not currently supported by the portal, but
could in principal be added on, however this
would require substantial development to
the data warehouse before this would be
possible.
Very dependent on the system selected.
None (to my knowledge) support the required
UK audit data sets. Functionality to support
research tends to be very limited. Decision
support tends to limited to prescribing on
most systems.
If data warehouse issues could be solved,
would allow extensive in-house queries and
business intelligence tools without the
necessity to involve outside companies.
Some systems do offer decision support and
clinical pathways – usually the very expensive
ones.
Interoperability is an intrinsic part of a
portal system and thus is built into the
architecture from the outset.
Varies substantially from system to
system, but in most cases is limited and
making the system interoperable with
third party applications is expensive and in
many cases may be actively obstructed by
the vendor who has an interest in tying
customers into their products.
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* Clinical Engagement First
* Clinicians means more than consultants
* Consider what you have already
* Does it work and is it liked
* Have you got the board behind you
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Questions?
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