In the UK, the national effort to build an electronic health record (EHR) system has taken the form of the National Programme for IT (NPfIT). That program, set up in 2002, has been marked by controversy and delays; and in September, the British Department of Health issued a press release that announced the centralized approach under NPfIT has concluded, giving way to a more “locally led plural system of procurement.”
Nearly two years prior to that announcement, Rotherham NHS Foundation Trust, a hospital system about 300 miles north of London, made a decision that it would opt for alternative solutions to NPfIT, and explore best-of-breed solutions, one of the first hospital systems in Britain to do so. It selected an electronic patient record (EPR) system in March 2009. David Brown, Rotherham’s head of information and communication technology, and Ken Dobson, systems and infrastructure manager, recently spoke with HCI managing editor John DeGaspari on the hospital’s decision to go it alone.
Healthcare Informatics: Explain what Rotherham NHS Foundation Trust has done to implement its electronic patient record (EPR) system.
David Brown: In the UK, we have the NPfIT [National Programme for IT] program, the national program for IT, which was supposed to deliver a National Health Service EPR, and didn’t. So our chief executive took the view that an EPR was so important to the success or continued success to the organization, that we should go outside the national program and procure our own, which led us through the tendering process, to [the Westwood, Mass.-based] Meditech.
HCI: So you went with the Meditech system, but it was customized for your own purposes?
Brown: It’s been ”Anglicized” to take into account the NHS [National Health Service], the English way of dealing with healthcare, and dealing with some of the critical elements that a U.S. system needs before it will get sanctioned [for use in the UK]. It’s been going on for nearly two years; we are going live June of next year. Our teams have done a lot of Anglicization and we are introducing SNOMED [Systemized Nomenclature of Medicine—Clinical Terms] into the system, which is new to Meditech and quite new to the NHS. So that is being embedded in the product.
There is a lot of user acceptance testing around the Anglicized [product], and that is in the process of concluding this side of Christmas. And what they are doing currently is beginning to configure it as per our process groups, we are obviously process mapping everything and working out what the future stage should look like, and creating that within the configuration.
HCI: How do you expect it to conform to clinicians’ workflow?
Brown: I suspect that is something that will become more apparent next year. We are trying to configure the system to the point where the impact on the clinician is minimal. They are looking at all sorts of things, like voice to text, so voice recognition, handwriting recognition, the use of tablet devices, etc. And we’re trying to tailor it very closely to the processes that the clinical workflow in this country.
I think that there is a very big piece of work yet to come about exposing the clinicians to the system, [which] will be done in field trials. The desire here is to go very much as paperless as possible from day one [in] the [inpatient] and outpatient clinics. We don’t want to be carrying on with the paper records, paper case notes, for very much after go-live. So it is a very aggressive proposal, and has the potential to be very impactful on clinicians. So there is a very big piece work to be done, and constantly we are worried about clinical risk and those sorts of things. So we have a whole team delivering risk impact and analysis of the system.
Ken Dobson: It’s been a great opportunity for us as well to induce standards across the trust, to use elements within the system to make sure that doctors are following the same guidelines and procedures to benefit. It’s to make sure that standards are consistent as possible across the trust and are used appropriately. [We are] matching the workflow that standard procedures are followed as much as possible, and where there is variation, it can be audited and assessed whether it needs adjusting.
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