For our November focus on electronic patient record systems, we spoke to Paul Volkaerts, CEO of Nervecentre, to find out more about his thoughts on the EPR market, some of the key challenges, Nervecentre’s software in practice, and more.
On the requirements of the EPR market
EPR requirements have changed because of the position the NHS is in. Our hospitals are full. For the last decade, we have seen increasing demand, but demand not surpassing capacity. We now have more demand than capacity, and that’s a line we’ll never go back over. Because of that, I believe there will be more change in the NHS in the next five years than we’ve seen over the past twenty-five, and the NHS desperately needs to take a five-year view of the world. A fundamental restructuring is needed that looks at prevention, virtualisation and completely different models of access to the health service’s most valuable asset, its people, to find more efficient ways for them to provide their expertise.
As we move forwards, the boundaries between inpatients and outpatients will blur. Some patients will still need to attend hospital, but there will be others who will receive care from disparate teams of people across many different settings. Some of that care will be managed by the hospital even though the patient isn’t there, and some will be managed by people outside the hospital. The most important factor here is integrating pathways across these care teams to create a continuum of care, allowing the availability of care to grow beyond the hospital’s capacity.
Technology is the only thing that can do that. We’re moving towards a world where technology will be the differentiating factor between hospitals that perform well and those that don’t. It will affect operational and safety performance at the macro level, and that’s not been the case before.
I believe suppliers must focus on what the NHS needs from them over the next five years.
On challenges…
So if we bring this back to EPRs – the market isn’t really set up to deal with these changes, and my concern is that people are in the habit of buying EPRs based on the specifications that have been around for a decade because procurements are being run in a way that closes off anything new. That approach works well in a slow-moving market, but in the highly transformative NHS market, it is the worst thing to do because suppliers are rewarded for not improving their products – when the NHS desperately needs innovation and rapid progress.
If trusts prioritise maturity when choosing an EPR, they shouldn’t be surprised when they get something mature, that meets yesterday’s needs well but cannot meet tomorrow’s needs. In a market with evolving requirements, agility is king. Some suppliers will struggle to keep pace, and those trusts that have deployed such EPRs in order to have a single point of truth will be pulled back towards disparate systems in order to deliver upon new challenges.
Rather than thinking about which EPR system was the best ten years ago, procurements should carefully consider what must be achieved over the next five years and have an open attitude that encourages the selection of the EPR that is best placed to support and enable the required digital transformation at pace.
… and how to tackle them
In order to best meet the growing demands on acute care, trusts will need much more integration between inpatient and outpatient, face-to-face and virtual, and primary and secondary care. This challenge is unique to the structure of the NHS. In the US, where the profit of individual healthcare providers drives such decisions, there is no requirement to restructure care across providers in a geographic area. It is incumbent upon software suppliers to step up, provide solutions that excel at the challenges facing the NHS, as well as meeting the baseline digital requirements of HIMSS.
With its modern cloud EPR platform, Nervecentre is now as agile as the world’s leading software suppliers, allowing us to be adaptable and accommodate the rapidly changing world of the NHS. If a trust or the whole NHS has a need, we are in the best possible position to turn that around from a development point of view really quickly, but we can also deploy it with velocity so all of our customers benefit from it quickly too.
On usability and deployment methodology
Nervecentre recently scored really highly in the NHS England acute EPR usability survey. The usability scores have a positive and negative end to the spectrum, so some trusts had scores that were net positive – on average, clinicians liked the software, and some had net negative where the software was not liked on average.
The crossover point was about halfway on the spectrum, so that means that in over half of NHS acute trusts, on average, clinicians dislike their EPR. It’s really difficult for a trust to meet its business case for buying an expensive piece of software when clinicians don’t like using it. They’ll resist using it, and compliance will be poor.
We were the only supplier exclusively to get positive scores in the survey, and all trusts using Nervecentre were within the top third of the results. Four of the top eight trusts ranked by the overall EPR experience use Nervecentre.
What we find when we go to a hospital that uses Nervecentre is that the software is adopted really well. There’s evidence that doctors and nurses like it, and I think that encourages clinician adoption – and because they use it well, the trust benefits.
We also need to challenge the destructive “big bang” deployment model that suits suppliers but can cause untold damage to hospital operational performance and directly impairs patient safety. There is growing evidence, including a recent NHS England report that assessed the impact of big bang EPR deployments over the past five years, that suggests this approach is fundamentally flawed. The inevitable disruption this deployment model causes runs deeper and lasts longer than was originally thought. It is normal for patient safety and operational efficiencies to be compromised. It can take as long as two years after the go-live for care to return to pre-deployment levels, and that has a negative impact on the hospital workforce. Hospitals are running too hot to be able to accommodate 12-24 months of “stabilisation” following an EPR go-live, and the idea that a trust procuring an EPR in 2023 will not see benefit until 2028 should cause concern to those trusts embarking on such a journey. We have to get out of this mindset that it is okay to break a hospital that’s running at 99 per cent capacity for a period of time when it gets a new EPR.
At Nervecentre, we find that the progressive deployment model, by contrast, really works well because there is a focus on delivering the customer’s targeted transformational benefits. We’ve seen trusts deploying progressively take their staff on a journey with them. They become really strong users of the software, and it is normal to see benefits being realised from day one.
Looking to the future
Looking ahead to how I would like the EPR market to look in five years is tricky, partly because of the nature and speed of change. Ideally, I’d see different models of care becoming commonplace and more of a blend between inpatients and outpatients, or acute care and secondary, mental health, primary, and community care. EPRs need to support those integrated and blended care pathways so that hospitals are not defined by their four walls, but by the skills of the people inside them. That would mean that we can leverage those skills in a more efficient way.
Nervecentre’s focus on the NHS combined with its agility and ability to develop and deploy software updates with velocity puts us at the front of the pack for supporting those changes – whatever the future holds for the NHS.
Many thanks to Paul for taking the time to share his thoughts with us.
