Implementing Electronic Patient Records

The spread of electronic health records in the NHS represents a well-crafted innovation process, which starts with the design and digital workflow decisions, followed by testing, training, adoption, and embedding systems into practice, what we call ‘implementation’.

It takes organisations a few years to prepare for this innovation process, which includes decisions to procure, selection of the right technology, business case completion, and the final procurement. The implementation of such complex digital innovations also takes between months and years to complete and therefore requires considerable leadership skills at the organisational level, including individual leader perseverance and resilience.

Leadership Qualities for Successful EPR Implementation

The qualities of individual leaders in the implementation of EPRs have to be diverse and leaders should be able to combine people and communication skills so as to enthuse the different stakeholders, but also analytical and director skills to ensure attention to detail, digital safety, and programme coordination. Shifting between vision formulation and goal setting, to active engagement and user-centred design, to data governance and risk management is what makes this complex innovation process so challenging and so rewarding at the same time.

Organisational Transformation

At the organisational level, the transformation process is palpable and visible from the early stages of the EPR implementation. Whether it is IT infrastructures, digital governance structures, or workflow redesign, there is considerable organisational change happening at a fast pace which needs to be balanced by the continuous delivery of organisational targets. Such ambidextrous skills at the organisational level, balancing delivery and continuous improvement with rapid change, require robust leadership from the chief sponsor of the programme at Board level to the ward leaders and EPR champions.

Integrated Care System Framework

NHS organisations operate within an integrated care system framework and therefore, EPR implementations should represent a whole system change. There is a need for a whole enterprise digital architecture to be crafted to support community, primary, and secondary care services. This is also an opportunity for more joined-up working between system partners and the development of digital leadership structures that serve the system as a whole.

EPR benefit realisation and optimisation has to be approached from a healthcare system perspective and not only from an organisational or individual perspective. The evaluation of EPR implementation has to start early in the innovation process, from the time of system procurement and throughout the innovation journey. EPR optimisation takes years to complete and involves a continuous and iterative process of improvement.

The Marathon of EPR Implementation

There is no doubt that the implementation of EPR systems within NHS organisations is a complex innovation process, involves multiple stakeholders, affects complex adaptive systems, and requires considerable change management, directed by skilful leaders. As a result, the process can be characterised as a marathon rather than a sprint, due to the length of its different stages, from preparation to design, to adoption and implementation which takes years to complete.

Investing in the right organisational and system infrastructures, which includes people, processes, and platforms will increase the chances of a successful EPR implementation whose benefits are realised and sustained.

NHS England’s Role in Supporting EPR Implementation

The role of NHS England’s transformation unit is key in supporting frontline digitisation programmes. NHS England’s investment in levelling up NHS organisation digital capabilities means that organisations can have access to a wealth of resources during their EPR implementation journeys to maximise digital excellence and reach the required level of digital maturity.

The support is extended to integrated care systems to enable integrated care through the convergence of digital infrastructures. For individual leaders, this support has a great positive impact on the morale of the teams when implementing EPRs and also provides the opportunity for knowledge sharing across organisations and integrated care systems.

Find out more about EPR Implementation at HETT Show

At the Healthcare Excellence Through Technology event on the 24th of September, the session on EPR implementation will touch on all of the above points, from convergence to optimisation. The panel leading those conversations is multidisciplinary and will discuss challenges and lessons learned, dive into specific areas of interest, and provide tools for organisations and systems looking to implement or are in the process of implementing EPRs.

Examples of discussion areas include how to maximise system usability, creating a training programme that optimises adoption at go-live, what structures and processes are needed to ensure digital clinical safety, targeting difficult areas such as reporting, end-user-centred design, and building sustainable leadership structures.

This is an excellent opportunity to bring digital leaders together and discuss real-life experiences from EPR implementations across the country. Frontline digitisation teams bring considerable knowledge and expertise to the table and the event aims at collecting this knowledge in one space which can then be shared through videos, blogs, and publications back out into the organisations.