EPR systems and concerns about patient safety (Patient Safety Learning, 30 May 2024)

Summary

An investigation published by BBC News has revealed that Electronic patient record (EPR) system failures have been linked to the death of three patients and more than 100 instances of serious harm at NHS hospitals trusts in England. In this short blog, Patient Safety Learning reflects of these issues and the importance of patient safety being at the heart of the development and implementation of EPRs.

Content

EPR systems are a way of managing clinical information with the intention of making this information more easily accessible for use by healthcare professionals. In A plan for digital health and social care published in June 2022, the Department of Health and Social Care set a target that all NHS Trusts should have an EPR system by March 2025.[1] In November last year, NHS England announced it was on course to meet this target, stating that 90% of NHS trusts have now introduced these new systems.[2]

When implemented safely, EPRs can support and improve care and treatment by:

• Enabling staff to have a complete overview of patients’ care in real time.
• Removing the need for patients to have to share the same information multiple times.
• Freeing up healthcare professional time and resources.

However, there are also a number of patient safety risks associated with their implementation and use, as highlighted in a blog by our Chief Digital Officer Clive Flashman in January.[3]

In their investigation, BBC News found from a Freedom of Information (FOI) request sent to all acute hospital trusts in England (of which 116 responded) that:[4]

• 89 trusts confirmed they monitored and logged instances when patients could be harmed as a result of problems with their EPR systems.
• almost half recorded instances of potential patient harm linked to their systems.
• nearly 60 trusts reported IT problems that could affect patient care.
• more than 200,000 letters were not sent across 21 trusts.
• there were 126 instances of serious harm linked to IT issues, across 31 trusts.
• and three deaths across two trusts related to EPR problems.

Commenting the findings of this FOI request, our Chief Digital Officer Clive Flashman said:

“Poor implementations of EPR systems can lead to direct and indirect harm to patients. Often this is not associated with the IT system and goes unreported, so we have no data to show the true scale of the issue.

We need more transparency in reporting and sharing knowledge so we can avoid patient safety problems and harm. This is a priority issue that must be addressed by those leading EPR implementations.”

At Patient Safety Learning we believe that patient safety needs to be a core purpose of health and social care. Patient safety considerations need to be embedded through each stage of the process when organisations introduce EPRs:

• Development – patient safety must be at the heart of the initial creation and development of EPR systems. Consideration should be given to interoperability (the ability to work with other computer systems or software used by the organisation to exchange and make use of information).
• Rollout – it is vital as EPRs are introduced into organisations that the appropriate training is provided to staff. There also needs to be sufficient usability testing (testing how easy these systems are to use with a group of staff who will ordinarily be using them).
• Implementation – once an EPR is in place, monitoring how these are operating in practice and learning and acting on any incidents or near misses that take place relating to this.

Reflecting on this, our Chief Executive Helen Hughes said:

“We must invest in proper implementation so that the benefits of EPRs and health technology are realised and do not lead to avoidable and unintentional harm. Actively involving healthcare professionals is essential to ensure we are designing for safety in often very complex workflow processes, so we better understand and respond to risks and manage the mitigations.”

References

1. Department of Health and Social Care. A plan for digital health and social care; 29 June 2022.
2. NHS Digital, 90% of NHS trusts now have electronic patient records; 16 November 2023.
3. Clive Flashman, NHS England warns electronic patient records could pose ‘serious risks to patient safety’: what can we learn?, 10 January 2024.
4. BBC News, NHS computer issues linked to patient harm, 30 May 2024.