At HTN Now we welcomed back the team from Apira for a discussion on the frontline digitisation programme, with focus on the growing challenges of EPR procurement, strategies for the NHS App and patient health records, and more. The conversation included managing consultants Phill James and Kiran Dave, and senior consultant Sharon Hunt.
Phill began by introducing Apira, a specialist digital healthcare consultancy supporting health and care organisations on their digital transformation journeys. Established over 25 years ago, Apira has helped more than 100 organisations to benefit from technology and information, providing independent advice to the NHS and working locally, regionally and centrally to provide insights to NHS clients and national bodies.
Phill presented Apira’s delivery pathway, which features a no-bias approach to suppliers and covers the steps from strategy development through to adoption and optimisation. Phill noted that Apira remain “very much patient and benefits-focused” and added “whilst we often support clients all the way through the process, we can also offer support with any part of the pathway.”
He also commented on the increasing number of multi-organisational programmes emerging and noted that Apira’s team help clients benefit from and deal with the challenges of collaboration.
The growing challenges of EPR procurement
On the topic of electronic patient record procurement, Phill and the team looked at how procurement and funding regimes would cope with re-procurement cycles alongside the growing complexity of EPRs deploying at increasing geographical scale.
Phill emphasised that “this is not about those who are still aiming to get rid of the bulk of paper; this is where you’ve got an embedded solution and you’ve got to do that difficult business case where the low-hanging fruit no longer exists”.
He noted the legal implications surrounding re-procurement, which can mean that “even if a customer is happy with the product, they can’t just sit on their hands and continue to use it; they’ve got to show their due diligence in the procurement space”.
Phill iterated the increasing complexity of EPR solutions. “We’re seeing this now in the procurement specifications which have been developed over many years,” he said. “I’m not sure anybody would ever attempt to write a procurement specification in this day and age from a blank sheet of paper, you’re always adding on or amending something that has already been given to you as a donor document and tailoring to local needs.”
This complexity, according to Phill, reflects the complex needs that the multi-organisational approach has brought with it, as well as changing features relating to things like artificial intelligence and robotic process automation.
One of the major difficulties surrounding re-procurement can involve funding, Phill noted. He drew attention to the issues that can often be faced when it comes to attracting funding and providing return on investment that isn’t always easy to identify, “especially since funding is prioritised to lower-maturity trusts, at least for the time being.”
Kiran joined the conversation here, commenting that one of the reasons for the increasing complexity is that “EPRs must now accommodate a more extensive range of medical data, increasing data integration from a variety of sources, and the shift toward more patient-centred care. This means that EPRs are evolving to include more patient-generated data, patient-reported outcomes and care preferences.”
In addition, Kiran pointed out, there is the challenge of interoperability. “As EPRs become more feature-rich, usability and user experience become more critical. Designing intuitive interfaces that cater to the needs of different healthcare professionals, while maintaining functionality, can be quite complex as well.”
Sharon added her perspective from the maternity space. “Maternity is not always given the same attention that the full EPR receives, and yet we know that they’ve got their own level of complexity,” she said. She added that on top of the features already listed, maternity records are required at the point of care regardless of location, which adds to the complexity.
On the subject of process mapping, Phill and the team considered how often this is overlooked or underestimated, recommending that some of the work should be done before procurement, and that “whilst you’re in procurement there should be a stage where you start process mapping”.
“This is a good starting point,” suggested Kiran, “since it gives you a foundation that shows you your current digital maturity, and how you can get to where you need to go.”
Patient Health Records and NHS App: approach and strategy
The next topic for discussion focused on the question: “Is there a lack of a coherent strategy and consistent approach across the nation when it comes to Patient Health Records and the NHS App?”
Phill compared the fragmentation of available functionality and services for patients in different geographical areas to “a postcode lottery”, noting that “it’s no wonder that we’re probably struggling to get citizens to engage with some of these solutions”.
Responding to this, Sharon said: “What suppliers need to remember is that at a minimum, PHR should be a patient-centric solution that should provide access to the patient record and the data that is available through the EPR, such as results, advice and guidance from external sources”. A key feature, she noted, “is the ability to have any synchronised communication with clinicians.” In the case of a maternity PHR, “that should also allow women to submit pre-booking information or upload information contributing to their personalised care plan”.
She added that an “optimal solution” would be “to align the NHS App with all of the various PHRs in existence, until true consolidation can take place”.
Kiran agreed. “If we broaden that, all patients should have access to their records in a single platform”, she said, rather than patients having multiple logins under the present system.
The team agreed that the EPR procurement landscape was an opportunity to take PHRs on the same journey, with Phill adding that “a PHR is far less effective unless it’s got a good EPR behind it, anyway.”
At this point, the team explored a question from the audience, which asked: “What is the future for electronic documents and records management solutions (EDRMS) and challenger EPRs, as larger EPRs are implemented?”
Phill answered first, stating, “I don’t see any reason why an electronic document management system can’t scale up to an ICS-level, with functionality that still respects the privacy of the patient, but allows for a deeper, richer, more historical record can be available. With all the features in the marketplace now, why wouldn’t you do that?”
Sharon said: “I think there are use cases for ICS-level EDRMS. For example, if you look at a scenario where you have a safeguarding responsibility and you need to have the associated documents stored on the system so that the right information is available at the right time in the right location; having a centralised EDRMS lends itself to that.”
Referring to the question of challenger EPRs, Phill considered: “We’d want to see open data and records, so that we don’t hit the same barriers we’ve seen before with PHRs.” He also commented on the relationship between challengers and buyers, noting, “I would expect blueprinting collateral to be made available to these companies – they cannot guess what’s required.”
A second question from the audience centred around whether PHRs could, or should, build on regional shared care records. Phill suggested that this “should follow on the coattails of an EPR procurement, which we do see as being a more regional piece that’s going to break down a lot of the barriers that exist.” He added: “If ICSs can agree on a unified strategy, that’s one less challenge that they have to come up against.”
The future of transformation and the potential for convergence of product capabilities
The discussion moved on to explore the future of transformation and the possibility for product capabilities to converge. Phill started by setting the scene: “Imagine a world where all current NHS digitisation objectives had been met, and what a world that would be. Trusts have all the investment they need; AI is commonplace; EPRs and PHR boxes are ticked. What is there left to do?”
There’s still a need for continuous improvement, Phill said. “If we’ve ticked all those boxes, we need to make sure we don’t slip backwards.”
Phill posed the question of “what comes next?” to the team, asking whether product convergence is the future and what the benefits would be.
Sharon replied: “We know that we’ve seen regional single procurements adopted in some parts of the country, particularly in maternity. The reason for this is that the maternity pathway is actually more like three pathways – a woman can present herself to multiple organisations in a regional area, so having a single database is very important in making sure information is available at the point of care.”
Kiran added that there would be benefits for this across the entire patient population – “that means if they get seen at trust A, trust B can also see what happened.”
Phill pointed out differences between settings. “Ambulance services tend to buy their own EPR; acute trusts have their own pathways in terms of admission and discharge; community does it a different way as they tend to be on long-term care pathways; and mental health is different again.”
Sharon picked up that point, acknowledging that it is “a big ask for suppliers to think that way”, but added: “I think the data is there. There are a raft of technologies available to share that information, via APIs and the like. It’s something providers of EPRs should aspire to; thinking outside of their immediate expertise area, to see how we can join up the various different health records that exist.”
Phill noted that to influence this way of thinking would require some “brave” chief digital information officers at ICS level, and added that implementing this sort of thing would probably be more like a 15 – 20 year project. He said, “We’ve seen some at-scale requirements coming through, but none of them have truly gone this far yet and been prepared to actually drive the marketplace.”
The team took another audience question at this point, which asked whether or not convergence would be possible between care settings, and whether mental health, acute and ambulance could share the same system.
Phill answered: “I think they can share the same database, if that database recognises at a minimum the PRSB standards in those care spaces, and any enhancements are supported by the database where those care sectors feel they need to go further than that.”
Kiran added that although differences exist between settings, “from a workflow perspective, it’s nothing that you can’t build”.
Sharon highlighted adult social care as an example of the potential benefits. “In the community, we might have an elderly citizen in a care home, and there could be useful data held on GP systems about them. If that citizen were to be admitted into acute care, there’s a lot of really useful information and data that can follow them into acute, which on discharge would then follow them back out into the community.”
Individual trust digital strategies
Moving on to the final part of their discussion, the team raised a question: why does every NHS trust feel the need to author its own digital strategy?
This can feel like “piling strategy on top of strategy,” Phill commented, and suggested that a more efficient way of approaching it would be “an ICS digital strategy that recognises all organisations within its footprint, since the ICS is pulling the strings on the capital that goes into those plans. Then those organisations can write up their implementation plans to deliver that.”
Sharon agreed, noting that consistency in the approach would be a benefit of this move. The team considered that having one plan would be the best way forward in ensuring shared objectives and system-wide benefits.
Kiran concluded Apira’s session with a comment: having one plan that everyone can work towards would provide trusts with the opportunity to benchmark themselves against that plan, and as such focus a lot more on the delivery aspect.
If you would like to discuss how Apira could help you embark on your journey please get in touch with our Director of Growth, Rory Dennis – [email protected]
