Electronic health records in England

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In 2005 the National Health Service (NHS) in the United Kingdom began deployment of electronic health record systems in NHS Trusts. The goal was to have all patients with a centralized electronic health record by 2010. [1] Lorenzo patient record systems were adopted in a number of NHS trusts. While many hospitals acquired electronic patient records systems in this process, there was no national healthcare information exchange. [2] Ultimately, the program was dismantled after a cost to the UK taxpayer was over $24 billion (£12 billion), and is considered one of the most expensive healthcare IT failures. [3]

Contents

In November 2013 NHS England launched a clinical digital maturity index to measure the digital maturity of NHS providers [4] but 40% of NHS managers surveyed by the Health Service Journal did not know their ranking, and the same proportion said improving their ranking was of low or very low priority. [5] in 2022 the 211 trusts progress was assessed. 43 trusts had an EPR meeting NHSE’s required standard, 138 had an EPR requiring “extension/optimisation” and 30 trusts did not have an EPR. Of those 30, 23 were procuring or developing plans to procure new EPRs and 7 were in the process of rolling out record systems. [6]

Electronic palliative care coordination systems have been developed by Marie Curie Cancer Care and the Royal College of General Practitioners which mean that terminally ill patients no longer have to explain their circumstances afresh to every new professional they meet and are less likely to be inappropriately taken to hospital. [7]

Personalised Health and Care 2020

The publication of Personalised Health and Care 2020 by the Department of Health elaborated a new attempt to integrate patient records. [8] Its stated ambition was that every citizen would be able securely to access their health records online by 2018 and make real time data available to paramedics, doctors and nurses. [9] A real time record across health and social care is seen as the key to the provision of integrated care. [10]

Hospital systems

Transferring hospital records to electronic systems has generally been much slower and more difficult than in primary care, apart from clinical imaging, which has been largely electronic for several years. In 2019 only 10% of NHS trusts claimed to be fully digitised. The NHS Long Term Plan requires all hospitals to move to digital records by 2023, so clinicians can access and interact with patient records and care plans wherever they are. 62% of trusts have plans to digitise all their patient records. [11]

GP Systems

GP2GP is an NHS Connecting for Health project in the United Kingdom. It enables GPs to transfer a patient's electronic medical record to another practice when the patient moves onto the list. [12] In General Practice in the UK the medical record has been computerized for many years; in fact, the UK is probably one of the world leaders in this field. There are very few General Practices in the UK which are not computerized. Unlike those in the USA, UK GPs have not had to deal with billing, and thus have been able to concentrate on clinical care. The GP record is separate from the national Care Record and contains far more data. Shaun O'Hanlon, EMIS's Chief Clinical Officer says that the legal framework around data sharing is the main problem in integrating patient data because the Data Protection Act 1998 puts responsibilities on GPs to protect the confidentiality of patient data, but at the same time they have a "duty to share" when it is in the best interests of the patient. He says the quickest, easiest route to large scale record sharing is to put patients in the driving seat using smartphone technology. He quotes a YouGov poll, which found that 85% of the population wanted any medical professional directly responsible for their treatment to have secure electronic access to key data from their GP record, such as long term conditions, medication history or allergies. [13]

Clinical IT suppliers are moving towards greater interoperability, already achieved with the GP2GP project, allowing different systems to exchange complete medical records between practices. There are projects allowing access between hospitals & GP practices. The main Primary Care systems are EMIS Health, SystmOne, iSOFT, and INPS Vision. The NHS in Scotland widely used GPASS until 2012. From April 2014 practices are contractually required to promote and offer patients the opportunity to book appointments online, order repeat prescriptions online and provide online patient record access. [14]

The assistant coroner for inner north London has twice written to Jeremy Hunt warning that “future deaths could occur [if] further action is not taken to facilitate secondary care access to GP records”. [15]

Leeds was the first city to implement the NHS Digital programme GP Connect. This makes patient records available across care settings, including social care, general practice, community, mental health and hospitals. [16]

Patient access

It has been possible for patients to access their own medical records online for some time. By 2013, the debates had moved onto discussing the impact of patient access on patient care. [17]

Research

Prescription errors

A study in the UK tested the Salford Medication Safety Dashboard (SMASH), a web application to help GPs and pharmacists find people in their electronic health records who might face safety hazards due to prescription errors. The dashboard was successfully used in identifying and helping patients with already registered unsafe prescriptions and later it helped monitoring new cases as they appeared. [18] [19]

See also

Related Research Articles

General practice is the name given in various nations, such as the United Kingdom, India, Australia, New Zealand and South Africa to the services provided by general practitioners. In some nations, such as the US, similar services may be described as family medicine or primary care. The term Primary Care in the UK may also include services provided by community pharmacy, optometrist, dental surgery and community hearing care providers. The balance of care between primary care and secondary care - which usually refers to hospital based services - varies from place to place, and with time. In many countries there are initiatives to move services out of hospitals into the community, in the expectation that this will save money and be more convenient.

Informing Healthcare was set up by the Welsh Assembly Government in December 2003, to improve healthcare services for people in Wales by introducing modern ways of sharing and using information. It is one of the key enablers for 'Designed For Life'; the national ten year strategy to deliver better health and social care for Wales.

<span class="mw-page-title-main">NHS Digital</span>

NHS Digital is the trading name of the Health and Social Care Information Centre, which is the national provider of information, data and IT systems for commissioners, analysts and clinicians in health and social care in England, particularly those involved with the National Health Service of England. The organisation is an executive non-departmental public body of the Department of Health and Social Care.

Cambridge University Hospitals NHS Foundation Trust is a British public sector healthcare provider located in Cambridge, England. It was established on 4 November 1992 as Addenbrooke's National Health Service Trust, and authorised as an NHS foundation trust under its current name on 1 July 2004.

<span class="mw-page-title-main">NHS Scotland</span> Publicly-funded healthcare system in Scotland

NHS Scotland, sometimes styled NHSScotland, is the publicly funded healthcare system in Scotland and one of the four systems that make up the National Health Service in the United Kingdom. It operates 14 territorial NHS boards across Scotland, supported by seven special non-geographic health boards, and Public Health Scotland.

Health and Social Care (HSC) is the publicly funded healthcare system in Northern Ireland. Although having been created separately to the National Health Service (NHS), it is nonetheless considered a part of the overall national health service in the United Kingdom. The Northern Ireland Executive through its Department of Health is responsible for its funding, while the Public Health Agency is the executive agency responsible for the provision of public health and social care services across Northern Ireland. It is free of charge to all citizens of Northern Ireland and the rest of the United Kingdom.

A virtual ward allows patients to get the care they need at home safely and conveniently, rather than being in hospital.

The Clinical Practice Research Datalink (CPRD) is an observational and interventional research service that operates as part of the UK Department of Health. It is jointly funded by the National Institute for Health and Care Research(NIHR) and the Medicines and Healthcare products Regulatory Agency (MHRA). CPRD is working closely with the extensive primary care, topic specific and comprehensive NIHR research networks and with NHS Digital.

<span class="mw-page-title-main">National Health Service (England)</span> Publicly-funded healthcare system in England

The National Health Service (NHS) is the publicly funded healthcare system in England, and one of the four National Health Service systems in the United Kingdom. It is the second largest single-payer healthcare system in the world after the Brazilian Sistema Único de Saúde. Primarily funded by the government from general taxation, and overseen by the Department of Health and Social Care, the NHS provides healthcare to all legal English residents and residents from other regions of the UK, with most services free at the point of use for most people. The NHS also conducts research through the National Institute for Health and Care Research (NIHR).

SystmOne is a centrally hosted clinical computer system developed by Horsforth-based The Phoenix Partnership (TPP). It is used by healthcare professionals in the UK predominantly in primary care. The system is being deployed as one of the accredited systems in the government's programme of modernising IT in the NHS.

Healthcare in England is mainly provided by the National Health Service (NHS), a public body that provides healthcare to all permanent residents in England, that is free at the point of use. The body is one of four forming the UK National Health Service as health is a devolved matter; there are differences with the provisions for healthcare elsewhere in the United Kingdom, and in England it is overseen by NHS England. Though the public system dominates healthcare provision in England, private health care and a wide variety of alternative and complementary treatments are available for those willing and able to pay.

A Summary Care Record (SCR) is an electronic patient record, a summary of National Health Service patient data held on a central database covering England, part of the NHS National Programme for IT. The purpose of the database is to make patient data readily available anywhere that the patient seeks treatment, for example if they are staying away from their home town or if they are unable to give information for themselves. Despite opposition from some quarters, by September 2010, 424 GP practices across at least 36 primary care trusts had uploaded 2.7 million Summary Care Records. On 10 October 2010, the Health Secretary announced that the coalition government would continue with the introduction, but that the records would 'hold only the essential medical information needed in an emergency – that is medication, allergen and [drug] reactions'. By March 2013, more than 24 million SCRs had been created across England.

<span class="mw-page-title-main">Clinical commissioning group</span> Healthcare organisation in the United Kingdom

Clinical commissioning groups (CCGs) were National Health Service (NHS) organisations set up by the Health and Social Care Act 2012 to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022 they were abolished, and replaced by Integrated care systems as a result of the Health and Care Act 2022.

Out-of-hours services are the arrangements to provide access to healthcare at times when General Practitioner surgeries are closed; in the United Kingdom this is normally between 6.30pm and 8am, at weekends, at Bank Holidays and sometimes if the practice is closed for educational sessions.

The Five Year Forward View was produced by NHS England in October 2014 under the leadership of Simon Stevens as a planning document.

Patient choice is a concept introduced into the NHS in England. Most patients are supposed to be able to choose the clinician whom they want to provide them with healthcare and that money to pay for the service should follow their choice. Before the advent of the internal market, in principle, a GP could refer a patient to any specialist in the UK. When contracts were introduced in 1990 these were called extracontractual referrals. From 1999 the concept of Out of Area Treatments was developed. These referrals were not necessarily related to choice made by a patient. Specialised treatments were not, and are not, available in every area.

Patient record access in the United Kingdom has developed most fully in respect of the GP record, because computerisation in that field is almost universal. British hospitals were slower to move into electronic records. From 1 April 2015 all GP practices in England have to provide online services to patients, including access to summary electronic medical records.

EMIS Health, formerly known as Egton Medical Information Systems, supplies electronic patient record systems and software used in primary care, acute care and community pharmacy in the United Kingdom. The company is based in Leeds. It claims that more than half of GP practices across the UK use EMIS Health software and holds number one or two market positions in its main markets. In June 2022 the company was acquired by Bordeaux UK Holdings II Limited, an affiliate of UnitedHealth’s Optum business for a 49% premium on EMIS’s closing share price.

Healthcare in the West Midlands was, until July 2022, the responsibility of five integrated care groups: Birmingham and Solihull, Sandwell and West Birmingham, Dudley, Wolverhampton, and Walsall.

IMS MAXIMS is a supplier of electronic health record software to the public and private sectors in UK and the Republic of Ireland.

References

  1. ↑ "NHS Connecting for Health:Delivering the National Programme for IT". Archived from the original on 10 August 2006. Retrieved 4 August 2006.
  2. ↑
  3. ↑ Say M (26 September 2011). "Cabinet Office review pleads stay of execution for NHS IT". London: Guardian. Retrieved 29 September 2011.
  4. ↑ Evenstad, Lis (3 November 2015). "NHS trusts to self-assess their digital maturity". Computer Weekly. Retrieved 14 November 2015.
  5. ↑ Read, Claire (13 October 2015). "Survey: Funding pressures are holding up the paperless NHS". Health Service Journal. Retrieved 14 November 2015.
  6. ↑ "Revealed: The 35 trusts looking to replace their electronic patient records". Health Service Journal. 5 September 2022. Retrieved 27 October 2022.
  7. ↑ Nightingale P (21 November 2014). "Coordinated systems help ensure people die where they choose". Health Service Jpurnal. Retrieved 14 December 2014.
  8. ↑ National Information Board; Department of Health (13 November 2014). "Personalised Health and Care 2020". Gov.UK. Government Digital Service.
  9. ↑ Heywood J (12 December 2014). "How developments in technology and data in the NHS are improving outcomes for patients". Blog Civil Service. Gov.uk. Retrieved 14 December 2014.
  10. ↑ Read C (21 November 2014). "Roundtable: A new charter for integrated care". Health Service Journal. London: EMAP Publishing. Retrieved 14 December 2014.
  11. ↑ "Majority of NHS trusts yet to fully embrace digital patient records". Building Better Healthcare. 29 May 2019. Retrieved 8 July 2019.
  12. ↑ "GP2GP". NHS Connecting for Health. Archived from the original on 9 April 2010.
  13. ↑ O'Hanlon S (24 November 2014). "Data sharing: step out of the technological dark ages". Health Service Journal. Wilmington plc. Retrieved 18 December 2014.
  14. ↑ "Will your IT system support the requirements of the new contract?". Pulse. Cogora Limited. 14 April 2014. Retrieved 17 April 2014.
  15. ↑ Thomas R (23 August 2017). "Health secretary warned again over hospital access to GP records" . Health Service Journal. Wilmington plc. Retrieved 6 October 2017.
  16. ↑ "First city adopts new system for sharing GP patient records across services". Pulse. 15 October 2018. Retrieved 17 October 2018.
  17. ↑ Davis Giardina T, Menon S, Parrish DE, Sittig DF, Singh H (2013). "Patient access to medical records and healthcare outcomes: a systematic review". Journal of the American Medical Informatics Association. 21 (4): 737–41. doi:10.1136/amiajnl-2013-002239. PMC   4078277 . PMID   24154835.
  18. ↑ "Interactive dashboard identifies patients at risk of unsafe prescribing in a flexible and sustainable way". NIHR Evidence (Plain English summary). National Institute for Health and Care Research. 22 June 2020. doi:10.3310/alert_40404.
  19. ↑ Jeffries, Mark; Gude, Wouter T.; Keers, Richard N.; Phipps, Denham L.; Williams, Richard; Kontopantelis, Evangelos; Brown, Benjamin; Avery, Anthony J.; Peek, Niels; Ashcroft, Darren M. (17 April 2020). "Understanding the utilisation of a novel interactive electronic medication safety dashboard in general practice: a mixed methods study". BMC Medical Informatics and Decision Making. 20 (1): 69. doi: 10.1186/s12911-020-1084-5 . ISSN   1472-6947. PMC   7164282 . PMID   32303219.
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