In 2021 the NHS Transformation Directorate initiated the first national electronic patient record (EPR) usability survey, to gather a complete view of how effectively clinical IT systems are supporting frontline healthcare professionals across the NHS. The NHS partnered with Ethical Healthcare Consulting and KLAS Research to conduct the survey.
The first phase of the survey ran across mental health, community and ambulance services and was completed last year, with the second phase covering acute services.
Recently, techUK held a forum session exploring the findings – here, we’ll take a look at some of the key points raised.
The session began by outlining the frontline digitisation ambitions for coverage (that 90 percent of providers will have an EPR in place, with all remaining in implementation, by December 2023, and 100 percent will have an EPR by March 2025); capability (as many providers as possible will meet the minimum capability standard for digitisation by March 2025); and convergence (that all ICSs will develop a convergence strategy in digital investment plans).
Currently, the session showed, 49 trusts (23 percent) have an existing EPR that meets the required standard. The majority of trusts – 132, or 63 percent – have an existing EPR that requires extension or optimisation. 11 trusts, making up five percent, have no EPR but are in procurement or implementation, whilst 19 trusts or nine percent have no EPR and are in the business case development stage.
The survey was sent to 147 trusts and focused on acute care clinicians, receiving a total of 4,852 responses. It asked whether they agreed that the EPR was available when needed; had the expected fast system response time; provided expected integration inside and outside the organisation; had functionality for specific specialities; was easy to learn; made staff efficient as possible; enabled staff to deliver high-quality care; kept patients safe; features alerts that prevent care delivery mistakes; and allowed staff to deliver patient-centred care.
Interesting results highlighted in the session showed:
- extreme polarisation between different organisations using the same EPR on the topic of whether the EPR enables the delivery of quality care, with some organisations rating it very highly and others rating the same EPR much lower
- EPR users at acute level are more frustrated than they are satisfied, with acute users scoring -2.7 percent on the scale versus the collaborative average of 35.7 percent
- a collaborative average of 76 percent agreed that their EPR was reliable, whilst 56 percent agreed that it had a fast response time
- respondents highlighted technical issues such as log-on complexities and frequent reboots; as one respondent commented, “the system is functional and does what it should on the whole, but it slow, clunky and needs too many clicks”
- 57 percent of clinicians agreed that their EPR enabled patient safety, with their view of system response time and reliability factoring into this
- internal and external integration across trusts is lacking, with an average of 67 percent of respondents stating that the EPR needed internal integration and 43 percent stating that it needed external integration
The session pointed out some lessons to learn from the survey results; for example, when one organisation states that their EPR system enables quality care but an another organisation does not experience success with the same EPR, what can that organisation learn from the first? What is the first organisation doing differently?
When it comes to advice for suppliers, the session says that “improving shared ownership is foundational to improving overall satisfaction – end users need to feel a sense of partnership with IS departments who support the EPR and the EPR supplier whose technology they are using. Clinicians desire a voice in the prioritisation of enhancements and updates.”
Additionally, it noted that “lack of training across most trusts hurts overall satisfaction… particular attention should be on training for personalisations available within each EPR.”
Infrastructure was also noted to be damaging satisfaction rates; “there are things NHSX can do to help improve reliability [and] response time,” the presentation said. “These are the foundation of EPR usability and satisfaction, moving these from detractors of satisfaction to commodities is crucial for building a strong technical foundation.”
The session rounded up by sharing the next steps, which included working with digital nurses to increase understanding of usability and engaging with NHS England and Improvement to increase clinical engagement.
If you would like to read the presentation in full, you can do so here.