Most trusts now have some form of EPR in place. Often the system has been implemented but is not delivering the full benefits possible. Optimising an EPR is about continuous improvement of the systems and processes that allow the right information to be recorded at the right time, making life easier for staff and care safer and better for patients.
EPR improvement programmes must be clinically driven. Clinical digital leaders (i.e. CCIO, CNIO, digital AHPs) play an important role in translating clinical needs into technical asks. But your clinical leaders also need to understand change and transformation as well as the basics of the underlying technology, to avoid simply digitising inefficient processes.
Plan for optimisation in the business case. EPR programmes do not end at the go-live date. Investing in resources for continuous improvement of the EPR, including multidisciplinary teams, will help ensure that the benefits promised in the original business case can be realised, and you can make the most of future benefits and opportunities you didn't identify in the original business case.
Look for opportunities for collaboration between partners and neighbours
within your ICS or across system footprints. You bring more backing/firepower to the negotiation table with suppliers when providers come together and ask for change requests with one voice. How can you share resources, digital expertise and power of scale to move further faster? Standardise where possible and reduce unwarranted variation.
One of the things we have learnt is there are always going to be commonalities between trusts. When you start talking to other trusts you find they dislike a particular pain point as much as you do. So we’ve agreed that rather than us always doing our change requests individually, there are common requests that we can submit together. We all chip in and reduce the load.
Product Manager – EPCR, London
Usability is key. If the system doesn't make the lives of staff easier then well intentioned clinicians will develop workarounds and shadow IT to get their job done. Nothing else matters down the line if staff aren't using the system. Do the simple things first, for example reducing the number of clicks it takes to accomplish everyday tasks.
Why optimising is important
A well implemented and optimised EPR improves patient safety, staff satisfaction, patient flow and data quality. But this can only be achieved through continuous optimisation and investment in your EPR and the business changes needed. A poor EPR implementation, followed by a lack of investment in its ongoing development, can frustrate staff and create disillusionment. This in turn leads to poor usage and unsafe workarounds. In time this will negatively impact productivity and result in substandard data informing clinical and strategic decision making.
Hear from a trust leader
Watch the video below for reflections on EPR optimisation from Jim Austin, chief information and technology officer at Derbyshire Community Health Services NHS Foundation Trust; chief digital information officer, Joined Up Care Derbyshire ICS.
Optimising your EPR – Reflections from the EPR journey of Derbyshire Community Health Services NHS Foundation Trust
Common pitfalls
- Benefits realisation promises made in the original EPR business case that are unrealistic and out of date.
- Business cases that focus only on procurement and implementation, failing to recognise the sustained funding needed for optimisation and improvement.
- Overengineering of the EPR system – for example too many mandatory fields for staff to fill in – which reduces both usability and adoption, and therefore potential benefits.
- A lack of understanding at board level of the data flow into and out of your EPR, which makes the data less useful, less trusted and less shareable.
- EPR becomes the only priority when it comes to digital.
Questions to ask
When you come together as a board to discuss how your EPR can be improved, these key questions can help you assure whether you are setting the right conditions for success:
- What are the key issues your clinicians currently face when using the EPR? What is the organisation doing to address them?
- Is your board discussing your EPR as an investment opportunity rather than an
ongoing cost? - How is your EPR enabling your trust's organisational strategy? How can you help teams using the EPR reimagine the way they deliver services?
- Do you have a data plan that will help your trust to fully utilise information from your EPR both within your organisation and across your system?
To learn more, read our longer guide to EPR optimisation – in it you'll find more about how to create the conditions for success in your trust.
Three more things you could read on this subject
- Design principles – NHS Digital service manual
- Moving toward a sociotechnical systems approach to continuous health information technology design: the path forward for improving electronic health record usability and reducing clinician burnout – PMC
- techUK explores results of NHS EPR usability survey – Health Tech Newspaper