EPRs in the NHS

EPRs in the NHS present a unique challenge as many hospitals currently use older American systems like EPIC or Cerner without a standard back-end data architecture. This begs why these outdated mega-systems, often built around laboratory or billing systems, are favoured over UK-developed systems with standardised data architecture.

Here’s a breakdown of the current situation and a look at what a “gold-standard” UK EPR could entail:

Why US Systems Persist:

・ Historical Dominance & Network Effects: Cerner and Epic established themselves early, building large customer bases and feature sets. This makes it hard for new competitors to emerge, especially in a complex sector like healthcare.

・ Perceived Maturity & Features: US systems are often seen as more “feature-rich,” particularly around billing and revenue cycle management, historically less emphasised in the NHS.

・ Integration Challenges: Replacing a core system like an EPR is incredibly disruptive and costly. Hospitals have often invested heavily in customisation and integrations, making a switch daunting.

・ Lack of a Compelling UK Alternative: While some UK-developed systems exist, none have reached the scale and market penetration to challenge the US giants truly. This is partly due to a lack of consistent government support and investment in a national solution.

Drawbacks of US Systems in the UK:

・ Cost: US systems are notoriously expensive in initial implementation and ongoing maintenance.

・ Adaptability to UK Practices: US systems often require significant customisation to align with UK clinical workflows, coding systems (e.g., SNOMED CT vs. ICD-10), and regulatory requirements.

・ Interoperability Challenges: The lack of a standardised data architecture across NHS trusts hinders seamless data sharing, even between hospitals using the same EPR vendor.

A “Gold Standard” UK EPR:

Building a gold standard UK EPR would require a multi-faceted approach:

・ National Strategy & Funding: The government must champion a cohesive vision and provide dedicated funding for a national EPR program.

・ Open Standards & Interoperability: The system should be built on open standards (like FHIR) to ensure seamless data exchange between healthcare providers and systems.

・ UK-Specific Requirements: It must be designed from the ground up to meet UK clinical needs, regulatory frameworks, and coding systems.

・ Modular & Scalable: The system should allow trusts to adopt modules based on their specific needs and scale their deployment over time.

・ Cloud-Based & Secure: A modern, cloud-based architecture would ensure data security, scalability, and accessibility.

・ Focus on User Experience: The system needs an intuitive and user-friendly interface designed in collaboration with clinicians.

・ Patient Empowerment: Patients should have secure access to their health records and be able to participate in their care actively.

Challenges and Considerations:

・ Political Will & Collaboration: Achieving consensus and collaboration across the NHS can be challenging.

・ Procurement & Vendor Engagement: A transparent and fair procurement process, as is finding the right technology partners, is crucial.

・ Change Management: Implementing a new national EPR system would require significant cultural and operational changes across the NHS.

While the dominance of US EPR systems in the UK NHS presents challenges, it also presents an opportunity to reimagine and build a truly world-class, patient-centric digital health ecosystem. A gold-standard UK EPR, built on the principles outlined above, has the potential to transform healthcare delivery and improve patient outcomes. However, to realise this vision will require strong leadership, collaboration, and a long-term commitment.

What would a UK NHS patient-centric, user-centred, modular, scalable, interoperable with standard data architecture and using unified data standards look like? Are there any products currently on the market that meet these requirements?

This is an ideal scenario for the NHS, and while no single product currently ticks all the boxes, the vision is achievable with the right approach. Here’s how a UK NHS EPR system reflecting those principles could function:

Patient-Centric Features:

・ Unified Patient Portal: A single, secure online portal (app or website) allowing patients to:

・ Access their medical records, including test results, medications, and care plans.

・ Book appointments, order repeat prescriptions and communicate securely with healthcare providers.

・ Manage consent preferences for data sharing.

・ Contribute to their health records with self-tracked data (wearables, etc.)

・ Personalised Health Information: Tailored health information and educational resources based on their medical history and conditions, promoting self-management.

・ Integrated Care Coordination: The portal connects patients seamlessly with all their care providers (GPs, specialists, community services), ensuring smooth transitions and avoiding duplicate tests.

User-Centred Design:

・ Clinician Input From the Start: Design driven by the needs and workflows of doctors, nurses, and other healthcare professionals.

・ Intuitive Interfaces: Clean, modern, and easy-to-navigate interfaces, minimising clicks and data entry burden.

・ Mobile-First Approach: Recognising clinicians often work on the go, the system should be fully functional and optimised for tablets and smartphones.

・ Voice Recognition and AI Assistance: Integrating voice commands and AI-powered tools to streamline tasks (e.g., note-taking, data entry, alerts).

Modular, Scalable, and Interoperable:

・ Micro-services Architecture: Built on a modern, modular architecture, allowing individual components (e.g., appointment scheduling, lab results) to be added or scaled as needed.

・ Cloud-Based Infrastructure: Leveraging secure cloud technologies for flexibility, scalability, and cost-effectiveness.

・ Open Standards (FHIR): Full adherence to FHIR (Fast Healthcare Interoperability Resources) standards for seamless data exchange with other systems and devices.

・ API-First Development: Exposing functionality through well-documented APIs (Application Programming Interfaces) to encourage innovation and integration with third-party apps and services.

Unified Data Standards:

・ National Data Dictionary: Adopting a comprehensive data dictionary and terminology system (e.g., SNOMED CT) to ensure consistent data capture and interpretation across the NHS.

・ Data Governance Framework: Clear policies and procedures for data governance, security, privacy, and consent management, complying with GDPR and NHS data protection standards.

Products and Approaches in the Market:

While no single solution perfectly embodies all these elements, here are some notable players and trends:

・ Emerging US Cloud-Based EPRs: NextGen Healthcare, eClinicalWorks, and athenahealth are moving towards more modern, cloud-based architectures and exploring FHIR interoperability.

・ Best-of-Breed Approach: Some NHS Trusts are adopting a best-of-breed approach, integrating specialised solutions from different vendors using interoperability platforms like InterSystems HealthShare.

・ Open Source Initiatives: Open-source projects like OpenEHR promote open standards and vendor-neutral approaches to EPR development.

Challenges Remain:

・ Funding and Procurement: The NHS needs a clear national strategy and funding model to support such a transformation.

・ Legacy System Integration: Integrating new systems with legacy infrastructure will be a significant technical and logistical challenge.

・ Data Migration and Quality: Ensuring the accuracy and completeness of migrated data will be crucial.

・ Change Management: Implementing this vision will require significant cultural and operational changes across the NHS.

The good news is that the technology and the momentum are shifting towards more patient-centric, interoperable, and modular healthcare IT systems. With a focused effort and continued investment in innovation, the vision of a truly modern and effective EPR system for the NHS is within reach.