Feature Content

EPR feature: moving from the system of record to the system of transformation

Feature by InterSystems

Electronic Patient Records (EPRs) are one of our featured focus topics this month. This means we’re showcasing expert comment and articles from health tech professionals, in this subject area.

First up, David Hancock, Healthcare Executive Advisor at InterSystems, shares with us his opinions of the main challenges facing EPRs in Integrated Care Systems (ICSs) and Provider Collaboratives, predicts an NHS move away from applications towards platforms, and discusses InterSystems’ own EPR Platform solution and how this can help support trusts, ICSs and Provider Collaboratives

Here’s what he had to say…

The fundamental challenge faced by NHS IT, and now we must include social care AND the charity and voluntary sector in this too, has not changed in 30 years – it is front line digitisation. This includes digitisation of clinical and care records, clinical and operational workflow and communications aided by digital messaging, and electronic health, care and social care record systems. Some organisations are doing very well with this, but are still to reach the summit, while many are still at basecamp and some are still just approaching the foothills. None of this is meant to be critical of organisations, it is very tough to do.

We all know that the needs of frontline digitisation are changing and that they are changing fast. This digitisation needs to be supported by wide-scale digital transformation. I would suggest it has changed even since the GDE programme was created, because the programme, or the organisations, focused on transformation within the four walls of organisations, and interoperability arguably ended up being paid ‘lip-service’.

The most fundamental change I see in the NHS is the need to move away from applications and to move towards platforms – after all, the Enterprise Software Market (SAP, Oracle, SalesForce) did this 15 years ago. In my opinion, any purchasing decisions in digital transformation within health and care, should be looked at through the lens of the platform, and this includes the EPR platform.

Providers, ICS and Provider Collaboratives should be thinking about EPR platforms, rather than EPR applications.

For me, the EPR platform is about delivering scalable frontline digitisation to enable interactions between its end-users and other third party software, alongside open connectivity to data to deliver radical digital transformation. This is about interoperability!

There are many drivers for this, both practical ones internal to organisations and also those that reflect the huge changes coming from the implementation of Integrated Care Systems (ICSs) and Provider Collaboratives. Put simply, I see three challenges that the EPR Platform approach directly addresses…

Digital transformation – best of breed or enterprise EPR?

Some providers have a range of best of breed solutions that clinicians really like, and so resist the prospect of change. Some also struggle to appreciate the value of the huge effort in implementing an enterprise EPR, if they may have to trade some important specialist functionality. However, others do see the benefits of an enterprise EPR, but do not want to be locked into a vendor, where they have to cede some control over implementation strategy and roadmap.

Providers arguably want a solution built on a modern technology platform, where not only can they retain control of their data instead of the EPR vendor, but they may also want to separate the application from the data, so they can innovate and ‘be in control of their destiny’, with an EPR that can support and sustain Bi-Modal delivery.

Bi-Modal delivery is the practice of managing two separate but coherent styles of work: one focused on predictability; the other on exploration and innovation, where the EPR focuses on improving and renovating more well-understood areas – the predictable parts – and there is a separate focus on experimentation and exploration in solving new problems. However, they need to support each other.

The EPR platform should provide bottom-to-top functionality for productivity and patient safety. But it should still allow specialist and other best of breed applications, as well as specific innovative applications, to integrate, along with those from other organisations, such as specialist tertiary centres, so that it enables the necessary Bi- Modal Delivery.

Re-modelling clinical pathways across providers

ICSs are being created because individual organisations working on their own cannot solve all of the issues in health and care today. Individual leaders have to think bigger than themselves and their own organisations, if they are to solve the system problems. One way this is manifested is through the development of Provider Collaboratives, which are designed to help achieve:

•Improvement – introducing innovation and transformation at pace and scale.

•Sustainability – collaboration will keep NHS service delivery sustainable when workforce and other resources are stretched.

All of this needs operational data flowing around the ICS, to help the ICS manage its operation as a whole. The ICSs and Provider Collaboratives must focus on what information is needed in the clinical workflow, as a way to support these new pathways and how they ensure that the information is not blocked, so it flows seamlessly to where it is needed.

One answer may be to standardise on an acute EPR across say, the ICS or the provider collaborative, but not only is this hugely disruptive, many providers may only recently have invested in improving some aspects of their digital maturity. They could be worried that, in setting some consistent digital infrastructure across organisations, there may be more ‘levelling down’ than ‘levelling up’. No provider should be prepared to, or have to, ‘level down’.

Rather than ripping and replacing EPRs across the ICS, an EPR platform should provide side-to-side interoperability across the ICS or Provider Collaborative existing application estate.

Supporting innovation, for example apps and patient-facing apps

Whilst EPR vendors have to support ever increasing regulatory compliance requirements, there are many more agile, unregulated companies, who are able to innovate and deliver attractive trail-blazing healthcare digital applications that both providers and consumers want to buy and use. These need access to data from the EPRs, so an EPR platform must provide access though open APIs, whilst still retaining compliance with regulatory compliance requirements.

This is going to be especially important as the Digital Maternity Programme is going to allow mothers/ parents to choose the maternity personal health application they want to use, irrespective of whatever maternity applications are use in the acute. This is going to rely on all applications supporting the same open APIs.

InterSystems and the EPR platform

At InterSystems, we have been seeing these trends in the UK, and similar ones around the world, for some time and are excited to support health systems needing to respond to these changes. Interoperability has been at the heart of our business for over 40 years – it’s where the InterSystems name comes from.

We are a trusted supplier of integration and interoperability solutions across the NHS, with over 40 per cent of all trusts, of all types, using our software. We also support all open interoperability standards, including the UK FHIR standards, in our interoperability solutions, and these are used by our Trakcare Acute EPR.

TrakCare is an EPR platform. It is a browser-based solution that’s built on a modern, single open technology stack that can be delivered through the cloud – meaning no Citrix farms or equivalent are required. Built on InterSystems!”data platform, IRIS for Health, with a single data model, it simplifies and streamlines data management, and readily supports all interoperability standards.

It contains a comprehensive set of open APIs to ensure that data is accessible from the application and it can seamlessly flow to where it is needed. In addition, it allows organisations to integrate any data from inside and outside their organisation, and simplifies how users can access it to both improve usability and drive adoption of the solution.

We continually invest in this interoperability in the UK, as illustrated by our winning Hack at the October 2021 INTEROPen Medications Hackathon, where we consumed Medication and structured dosing syntax directly into Admissions Reconciliation, using HL7 FHIR. We are working on productising this now.

We are building further on TrakCare as a platform, with the announcement of our TrakCare Innovation Toolkit, which moves the TrakCare EPR from being a system of record to a system of transformation; a proper EPR platform.

It uses the IRIS for Health Community Edition, which is free for developers, and it further unlocks the data in TrakCare by taking data and storing it in a FHIR Repository within IRIS for Health. This means that developers can use that data to build applications, connect to other third party applications, and develop machine learning models etc.

It also allows organisations using TrakCare to truly separate the applications from the data, and it is just the beginning, as the Innovation Toolkit will subsequently support the consumption of data back into TrakCare, too.

In my opinion, the EPR platform is the way forward for ICSs and Provider Collaboratives, so Chief Digital, Technical and Information Officers in ICSs need to consider what it means for them and what they need to put in place to move to an EPR platform-based approach.

As I discussed recently with HTN, they also need to have a plan for managing data in-flight; the operational data from disparate systems to support both digital transformation and real-time operational reporting across the ICS. These two areas of the EPR platform and the Regional Integration Solution are key architectural cornerstones and enablers to move you along your digital journey.

We’d be happy to discuss this with any of you and further share our experience. To do so, please contact InterSystems online.

To read further content about EPRs, including news, features, and more, visit HTN’s dedicated channel.