Unlocking the Full Potential of Electronic Patient Records: Lessons from Global Innovations

Improving the back-end functionality of Computerised Physician Order Entry

In the ever-evolving field of digital health, Electronic Patient Records (EPRs) have the potential to transform healthcare delivery fundamentally. However, in the UK, enhancing healthcare is not just about digitising the NHS; it’s crucial to consider how we go about this digitisation. With the promise of increased funding for the NHS, Health Secretary Wes Streeting has announced a reform agenda emphasising digitisation as a key component.

After several false starts and significant taxpayer investment in digitisation projects, we must reflect on our approach. Instead of merely implementing digital solutions, we must focus on thoughtful process redesign by asking critical questions such as, “What are we trying to improve?” or “What is the actual problem?” We can genuinely enhance patient care and operational efficiency by aligning backend functionality with front-end usability.

In this discussion, I will focus on improving the backend of Computerised Physician Order Entry (CPOE), which can be more simply understood as “placing an order.”

When we order a takeaway from Deliveroo or purchase an item from Amazon or an online supermarket, the user experience begins with browsing through an inventory or menu of items. Photographs, text descriptions, user reviews, and alternative options enhance this process. Once the user selects their items, they place their order, and the product is delivered to their doorstep.

If only ordering healthcare items — such as diagnostics, medications, and procedures — were as seamless! The front-end process in healthcare is often clunky, filled with errors, and user-unfriendly. However, I want to focus on the back-end processes or what happens after placing the order. In the case of Deliveroo or Amazon, the back-end process is well designed, involving multiple automated and human steps that ultimately ensure your meal or book is delivered to you.

In contrast, my experience with Electronic Patient Record (EPR) and Computerised Physician Order Entry (CPOE) systems is quite different. Occasionally, once an order is placed, it sits on a ledger or work list. A well-designed, configured, and programmed back-end process is needed to deliver the diagnostic test, medication, or procedure. Instead, fulfilling the order may require multiple additional steps to be undertaken by the front-end user.

Learning from the commercial sector, much can be done to improve these back-end processes within EPR systems.

A Vision of Seamless Integration

Healthcare systems that excel — similar to highly digitised commercial industries — have strategically embraced innovative approaches to hospital reconfiguration and streamlined services, significantly enhancing patient care. A vital component of this success is a well-designed and configured Electronic Patient Record (EPR) system, which optimises clinical workflows.

I remember attending a presentation about an exemplary healthcare system overseas. The clinical pathway highlighted during the presentation focused on a patient undergoing surgery. This process became remarkably efficient once a patient was scheduled for surgery. The initial consultation included diagnostics that allowed the surgical pathway to be defined immediately. This enabled the surgeon to place orders for the procedure right away. This in itself is an efficiency often seen in one-stop-shop clinics. However, what happened next was remarkable.

When the Computerised Physician Order Entry (CPOE) order was entered into the EPR, a series of backend processes were activated seamlessly. The patient was promptly assigned a surgery date and informed about their healthcare team. At the same time, the system automatically booked the operating theatre and coordinated the postoperative care, whether in a general ward or an intensive care unit. All necessary surgical equipment and medications were ordered through an integrated logistics solution, ensuring timely delivery right where they were needed.

This level of integration and automation showcased in this exemplary pathway illustrates that EPRs can evolve beyond mere digital filing cabinets. They become vital tools that significantly enhance the efficiency and quality of patient care, but only when supported by effective backend functionalities.

The UK Experience: A Call for Process Redesign

My experience with Electronic Patient Records (EPRs) in the UK reveals a critical shortfall. For example, as a paediatrician, arranging an MRI scan for a young child often involves cumbersome manual processes. These include face-to-face conversations, ad-hoc scheduling, and a reliance on the goodwill of colleagues. Additionally, team members must remember to perform extra tasks such as obtaining consent, ordering blood tests, and even transporting blood bottles to the scanner before delivering specimens to the laboratory.

These inefficiencies frequently lead to delays and cancellations, complicating staff members’ other duties, such as completing ward rounds. This situation underscores a significant failure in the backend configuration and process design of the EPR system. Often, the EPR in the UK acts merely as a digital substitute for outdated paper forms, failing to harness the transformative potential of a well-designed backend system. Unless we address these underlying processes, we risk missing the opportunity to truly enhance the healthcare experience.

A Call to Action: Prioritising Intelligent Design in EPR Implementation

Successful examples of international healthcare systems provide a clear path for improvement: Enhancing the NHS depends on how we digitise it rather than just the act of digitisation itself. It is crucial to focus on backend functionality that supports seamless processes while also ensuring that front-end interfaces are user-friendly. Investing in robust configurations that automate logistics and streamline workflows will be essential for increasing efficiency and effectiveness across UK healthcare systems.

To fully unlock the potential of Electronic Patient Records (EPRs), we must prioritise comprehensive process redesign alongside the digital tools that facilitate it. The journey towards realising the benefits of EPRs requires a commitment to both careful process redesign and thorough system configuration. By adopting best practices from international examples and embracing innovative technologies, we can effectively transform EPRs into powerful tools that enhance the quality and efficiency of healthcare delivery. It is time to rethink our approach and maximise the potential of our EPRs to usher in a new era of digital health excellence in the UK.

This is an opportunity. Let’s hope that Mr Streeting’s reform agenda leads us to realise the potential benefits of digitisation fully. This is only one of many.