NHS England has shared a series of updates towards digital-by-default, drawing on findings from the digital maturity assessment and the EPR usability survey, to outline next steps as the focus shifts from deployment to optimisation.
Latest findings from the DMA suggest “real progress” is being made across the system in terms of core digital capabilities, NHSE highlights. “However, there is more to be gained — particularly through better integration, optimisation, and developing skills and governance.” Likewise, although the EPR usability survey demonstrates high rates of EPR adoption, it considers there is “room to improve” for measures such as usability, training, and workflow integration.
Large acute trusts placing in the top quartile for digital maturity are eight percent more productive overall in cost-weighted activity per pound spent, NHSE calculates, delivering a four percent shorter average length of stay, and an eight percent better performance against 18-week referral to treatment standards. These trusts also reportedly score 20-30 percent higher on the NHS oversight framework for elements including productivity, access, safety, and workforce.
Whilst 93 percent of trusts have an EPR in place, only 30 percent report having fully integrated, bi-directional data flows, which NHSE identifies as an opportunity to strengthen system-wide connectivity and information sharing. Three quarters of trusts understand their current technical debt, it continues, with the opportunity to further address this through targeted investment and capability development.
90 percent of providers now have a central data repository, according to NHSE, and “almost all” providers can now access shared care records, although these are yet to be embedded into everyday workflows and often require staff to access multiple systems. Similarly, 86 percent of providers now deliver hospital at home, but data sharing across organisational boundaries remains inconsistent.
The EPR survey shows that 60 percent of doctors and 70 percent of nurses would welcome additional EPR training, with 44 percent reporting they had received no further training after joining their organisation. NHSE also points to reports from many clinicians that they are still spending “significant” amounts of time on administrative tasks within EPRs, “particularly where workflows are not fully optimised”. Taken together, these results demonstrate an opportunity to reduce low-value digital administration work and improve staff experience, it concludes.
The focus now needs to move from deployment to optimisation, NHSE explains, dependent largely on staff confidence with digital tools and embedding them into everyday practice. “This next phase is less about implementing new technology and more about getting more from what is already in place,” it states. “With EPRs now widely deployed, the opportunity lies in improving configuration, simplifying high-volume workflows, and making better use of existing data. Improving usability and staff experience will also be critical — digital tools only deliver impact when they are intuitive, well-supported and embedded into frontline practice.”
As well as more care being delivered across organisational boundaries, enabled by interoperability, shared records, and real-time data; the next phase will require a renewed focus on leadership, workforce capability, and service redesign, according to NHSE. “Aligning digital, operational and workforce priorities — alongside sustained investment in skills, training and change management — will be essential to turning digital capability into real improvements in care.”
Wider trend: NHS digital transformation
With the help of a panel of experts from across the health sector, HTN recently took a deep dive into EPRs, looking at approaches to implementation, lessons learned, challenges, and future directions. Panellists included Ian Mackenzie, CIO at Surrey and Borders Partnership; Ciara Moore, EPR operations director at Bath, Salisbury and Great Western Group; Keltie Jamieson, CIO at Bermuda Hospitals Board; and Michael Hardman, practice lead for software development at Aire Logic.
NHS England’s medium term planning framework has outlined the priority deliverables ICBs and providers should focus on for the next three-to-five years. The framework places an emphasis on the “major opportunities” offered by tech for productivity, looking to accelerate the adoption of a digital-by-default approach. A digital-first UEC model featuring clinical prioritisation and scheduling, and the expansion of digital and telephony-based triage and booking mechanisms plays a central role in improving patient experience and reducing “avoidable demand”. For outpatients, a digital-first model also points to the use of digital triage tools, along with remote consultations and digital monitoring.
In its most recent meeting, the NHS England board offered a series of updates around cyber resilience, single patient record, neighbourhood technology, the genomics programme, and 10-Year Plan acceleration programmes, citing “a number of concerns” that need to be addressed prior to investment commitments. On the single patient record and neighbourhood technology, Mark Bailie, non-executive director notes that “current plans show benefits realising in 2030, which is inconsistent with publicly stated ambitions and needs to be reconciled” and adds that there is no clear vision for neighbourhood technology.
