InLaw: the start of the EPR convergence journey

This article was first published by LaingBuisson.

EPR systems have the potential to bring tremendous benefits to our health and social care systems and indeed patients, says Kay Chand, partner at Browne Jacobson

Electronic Patient Record (EPR) systems have been around for some time in one form or another, with many systems still largely paper based. And while there has been an uptake in the implementation of EPR systems of late, it’s fair to say that some implementations have been more successful (or have been welcomed) with more positivity than others.

Transparency is emerging within the market in terms of implementation success rates among the supplier market, but the success rate isn’t necessarily based on objective criteria but on the experiences and satisfaction of the procuring NHS Trust.

Some health and care organisations are now experiencing first-hand the importance of getting their EPR implementations right and the consequences of getting it wrong.

Benefits of full integration

If implemented with adequate diligence, EPR systems have the potential to provide holistic patient records not only on a local or national scale but also on a global scale – no matter where in the world a patient may require treatment, their patient record will still be accessible.

Implementation complexities

Implementing EPR solutions can be complex especially where health and care organisations are looking to integrate them into an already fragmented legacy information and communications technology (ICT) estate or indeed into other health and care solutions, such as shared care records.

Legacy ICT estates are typically clunky and suffer from performance and reliability issues. Health and care organisations therefore need to be realistic about what can be achieved and by when within the context of legacy ICT estate and procurement budgets. This may require a digital transformation strategy that spans a longer period than initially envisaged and, perhaps, a simpler set of requirements.

Health and care organisations will also need to consider implementation plans in respect of their overall digital strategy and whether certain phases or aspects should be implemented on a staged basis rather than taking a ‘big bang’ approach.

An organisation’s digital strategy should also set out the approach to integration and interoperability of future systems procurements, taking an ‘IT by design’ approach. This ensures the maximisation of efficiencies as part of the procurement process and ensures the relevant health and care organisation’s objectives are met.

Once the EPR system has been implemented, consideration should also be given to the extent to which that solution could also be continuously improved to achieve a state of optimisation.

One of the simplest things that can be put in place to help manage the complexity of the procurement is time. Very often, clients set extremely challenging timescales. This does nothing other than set up the project to fail at the outset.

Procurements take time. Consideration needs to be given to strategy and approach in the context of the current environment and the target operating model. Time also needs to be allocated to the preparation of the tender documentation and to contract documents. Contract documents will then need to be negotiated or clarified and finalised. Tender submissions need to be evaluated. This all takes time.

Health and care organisations should not underestimate the importance of time.

Pre-contractual due diligence

In any change or transformation programme, what can sometimes be forgotten is the people – the workforce. Failure to bring the workforce on the journey (or get their buy-in) can be a key determinant to the programme’s success.

Workforce and stakeholder buy-in should form part of the overall governance model. This needs open communication channels allowing stakeholders to be consulted – and provide feedback – on the procurement and its objectives and to keep them informed and updated. Channels for dialogue with users and stakeholders should be established to ensure their voice is heard throughout the life of the project. Accordingly, timescales should also be set with input from all stakeholders, including external consultants, to ensure that all elements of the project have been factored in.

Consideration of people is also key in terms of the resources to be allocated to manage the procurement and implementation of the EPR system and, indeed, the ongoing contract and service management activities. Having adequate numbers of people with the requisite skills and expertise is fundamental. Without this, procuring entities should consider whether they should be rightfully embarking upon the procurement journey.

Each organisation will have an internal governance framework that should be adhered to. A governance model should also be built into any contract for the implementation of the EPR systems to ensure that the correct lines of communication are in place, issues can be identified early and that the model allows for escalation and resolution at the right level.