The evolution of Electronic Patient
Records in the NHS, 1988-2003
Matthew Jones
Judge Institute of Management
University of Cambridge
An EPR by any other name …
• 1988
– Hospital Information Support Systems (HISS)
• 1994
– Electronic Patient Record
• 1999
– Electronic Health Record
• 2002
– Integrated Care Record
• 2/12/2003
– NHS care record
NHS IT strategy
• 1992
– “Getting Better with Information”
• 1996
– Implementing the infrastructure for IM&T in the
NHS
• 1998
– “Information for Health”
• 2002
– “Delivering 21st Century IT support for the NHS”
1988 HISS programme
• £56 million on the Initiative
• £48 million in financial support to 16
projects at 25 hospitals
• £32 million on 3 main pilot projects, at
Nottingham, Darlington and Greenwich.
• Significant delays in implementing key
systems
• National Audit Office inquiry
1992 “Getting Better with
Information”
• Linked to White Paper “The Health of the
Nation”
• Strategy guided by key principles:
• Information will be person-based
• Systems may be integrated
• Information will be derived from operational
systems
• Information will be secure and confidential
• Information will be shared across the NHS
• Strategic initiative
• Developing an IM&T infrastructure
1994-1997 EPR programme
• Demonstrator Projects, notably Queen’s
Hospital, Burton and Wirral Hospital
achieved successful hospital-wide
implementation of EPR
– Clinical focus
– Strong management
– Management/clinician partnership
1998 “Information for Health”
• “Lifelong electronic health records for every
person in the country”
• “Round-the-clock on-line access to patient
records and information about best clinical
practice, for all NHS clinicians”
• “Genuinely seamless care for patients
through GPs, hospitals and community
services sharing information across the NHS
information highway”
Specific Targets
• Developing and implementing a first generation of
person-based Electronic Health Records, providing
the basis of lifelong core clinical information with
electronic transfer of patient records between GPs
• Ensuring that all acute hospitals have the ability to
undertake patient administration, including booking
for planned admissions, with an integrated patient
index linked to departmental systems, and capable of
supporting clinical orders, results reporting,
prescribing and multi-professional care pathways
• All acute hospitals to have level 3 EPR by 2005 (35%
by 2003)
2000-2003 Electronic Record
Development and Implementation
Programme (ERDIP)
• Demonstrator sites
• Key projects include
– 24 hr care, patient access, EHR
– level 6 EPR
– integrated primary & community care
– direct booking, referrals, discharge,
pathology messages
– technical standards
2002 “Delivering 21st Century
IT support for the NHS”
• Patient centred delivery of services
• Effective electronic communications, … cut
the time to find essential information (notes,
test results) and make specialised expertise
more accessible for staff
• Improve management and delivery of
services by providing good quality data to
support NSFs, clinical audit, governance and
management information
Integrated Care Record
System
• Cross setting (including social care),
multidisciplinary
– “no more silos”
• National programme
– Emphasis on infrastructure and “ruthless”
standardisation
• 700-page comprehensive specification for ICRS
• Single system for whole SHA
– Efforts focused on letting contracts for National
Application Service Provider and Local Service
Providers
Discussion 1
• Onwards and upwards?
– Progressively wider scope
HISS
EPR
EHR
ICRS
Hospital Hospital Primary +
NHS (+
adminiSecondary + social
stration
Community care)
• Does this mean that EPR use
has ‘evolved’ in practice?
• Difficult to see much evidence of
‘progress’ for the NHS as a whole
• Big differences in EPR use between
hospitals
• Not necessarily related to quality of
management
• Investment decisions made by individual Trusts
• Some successful initiatives, but usually
highly localised
• Rarely diffused more widely
Why?
• Priorities distorted by other initiatives (and IT
low on the list)
• Performance measurement/ League tables
• Clinical governance/Clinical Audit
• Modernisation/E-government
• Lack of consistency
• Implementation approaches
• Strategy focus
• Competing healthcare IT functions
• Information Authority
• Information Policy Unit
HISS
EPR
EHR
ICRS
Implementation Pilot projects
approach
Decentralised
Pilot
projects
Centralised
Strategy focus
Infrastructure
(data model)
Developing
Developing
working record working
record
Infrastructure
(standard
hardware)
Lead
organisation
Information
Management
Group
Information
Policy Unit
National
Programme
for IT
Information
Authority
Issues
• Build it and they will come
• Organisational change neglected
• Lack of communication
• Experience not shared
• NIH syndrome
• Unrealistic targets
• Aiming for the impossible, by tomorrow
• Little evidence of learning from failure to meet
• The best may be the enemy of the good
• Speed of response
• vs technology change
• vs policy change