Opinion Article by Professor Michael Thick, Chief Clinical Officer at IMS MAXIMS.As a clinician who has been closely involved in clinical IT for all my working life, my first observation is that very few organisations have an electronic patient record (EPR) working properly. My second observation is that unless we use technology to enable a transformation in service delivery, we are whistling in the wind as far as filling the £30bn funding gap goes.
My third observation is just how few people truly understand this. If there was one thing that we all should have learned from NHS Connecting for Health's National Programme for IT, where I was chief clinical information officer from 2006 to 2011 it is that you cannot use technology to force a change in behaviour.
One person who does grasp this is Beverley Bryant, director of strategic systems and technology at NHS England. Her major thrust is interoperability to maximise the investment that has already been made by getting systems to work together and enable people to come up with solutions of their own that work for them.
That might be within an organisation but increasingly it will be across organisations and across health and social care. We need to get the right information to the right place at the right time.
The other changing dynamic is the public's experience of technology. Smartphone with health and fitness Apps as well as wearable devices mean more and more people are producing their own data. What kind of place do these data have in an "official" EPR?
Who do you trust?
Some healthcare professionals are saying that these data cannot be trusted. We have to change that attitude and we have to start to answer some questions around the ownership of data.
Because if there was a second thing we learned from NPfIT, it was that the public will not accept a central authority making a land grab for information to do with as they please. We are still living with the consequences of that attitude today.
All of this raises a question about where an EPR really belongs? It is a question that is philosophical, practical and commercial. In an NHS with organisations merging and morphing, there is considerable uncertainty about the place of the typical 10 to 15 year, organisation-centric EPR contract. Vendors need to come up with something useful and cost effective for the NHS in its current financial situation.
We need a new way of thinking about an EPR - the EPR as a service. Not only could this transform the business model of deploying organisational-wide IT projects but also the way the NHS thinks about technology.
EPR as a service
A good example of technology as a service is Co-ordinate my Care, the end of life shared care record I helped deliver in London with the Royal Marsden Hospital. It is now expanding to deliver a long-term condition shared record.
The clinical engagement gelled around the shocking statistic that 80 per cent of patients wanted to die in their own home but fewer than 25 per cent achieved it. Once the service knew and understood that fact, it was easy to mobilise a response enabled by technology.
You could regard the Coordinate my Care record as a mini EPR. It records the patient's wishes, their consent and their care plan and is available to all the services looking after them.
Yes, it is true that not every GP in London has signed up, but that reflects the inherent conservatism of doctors. This is a truly disruptive deployment of technology that disturbs their current status quo. You can't please all the people all the time.
Which brings me to another type of technology that is disturbing the status quo: open source. This is where the coding behind a piece of software is open and available for anyone to use and improve. And it is building momentum to the NHS. Moorfields Open Eyes EPR is open source; likewise the new e-Referral system that replaced Choose and Book this summer.
Open source dynamics
It's not software anarchy, as some suggest. Nor is it dictatorial top down directive. It is about working with people to gain a consensus about improving a system through collaboration. With the right governance in place, it is a way of offering clinicians an input into a system while maintaining its integrity.
IMS MAXIMS, which provides an open source EPR, has now signed a contract to provide an EPR at Taunton and Somerset NHS Foundation Trust and together we will be exploring some of these new dynamics. We go live later this year.
It is going to be a journey and one that will require new kinds of relationships, both between executives and clinicians and with the data.
It is not just healthcare professionals who do not trust data. I have seen examples of hospital boards rejecting data that showed the number of patients who did not need to be under its care. Instead of acting on the insights, the technology was dismissed as inaccurate.
When you introduce technology, there will always be surprises. When you trust the data and the story it tells, it can lead you to the right response. That's when you start to get technology'enabled change.