MPs call for clarity on electronic patient records in England

The influential Commons’ health select committee has published its report on the future of electronic record systems in England. It backs the development of EPRs, but raises significant questions about the programme set up to deliver them and says more clarity is needed about its scope and timetable for delivery.

The introduction of electronic patient records (EPRs) offers huge benefits to patients, but the NHS IT programme that was set up to deliver them needs to be accelerated and clarified if it is to deliver its potential.
That was the central message from MPs on the Commons’ Health Select Committee, in a report examining the development of EPRs and the progress of the £12bn National Programme for IT (NPfIT) in the NHS.

The Electronic Patient Record report says that EPRs - in the form of the NHS Care Records Service (NHS CRS) - form the heart of NPfIT, accounting for 80 per cent of the value of contracts awarded.

“It is on NPfIT's success in delivering detailed clinical record systems that the programme's ultimate effectiveness should be judged," it adds.

EPRs deliver benefits

Having taken expert evidence and visited examples of EPRs in action in other countries, including the US and France, the MPs made it clear they were fully convinced of the benefits of such systems to the NHS and to patients.

What they were less clear on, particularly after receiving conflicting evidence, is how EPRs – as a national summary care record (SCR) and local, detailed clinical record systems (DCR) – are going to be delivered in England.

Trials of the SCR are now underway in four areas. But the report argues that while the SCR will be useful in some situations, such as unplanned care, some key features to ensure patient privacy have yet to be developed and more needs to be done to inform patients about them.

It also argues that far greater clinical benefit will come from DCR systems, which it describes as the “holy grail” for NPfIT. “We found it difficult to ascertain either the level of information sharing that will be possible when DCR systems are delivered, or how sophisticated local IT applications will be."

Much done, much still to do

Unfortunately, although the committee acknowledges that NPfIT has had some successes, including the creation of a broadband network for the NHS, known as N3, and the roll out of digital radiography systems (PACs), it says its overall progress "has been disappointing.”

In particular, the report says there have been delays in delivering new patient administration systems (PASs) and in developing clinically rich, local DCR systems. The MPs feel that four years after the start of the programme, it is still not clear when DCR systems will be available, what their scope will be or how they will be used.

Although NPfIT published a “clear vision” for local EPR systems in 2003, the MPs argue it is not clear whether this blueprint remains.

“We found it difficult to ascertain either the level of information sharing that will be possible when DCR systems are delivered, or how sophisticated local IT applications will be,” the report says.
The MPs also claim the descriptions given to them by officials and suppliers were “vague and inconsistent”. "NHS CFH is already developing a local ownership programme, but the report says local organisations should be able to negotiate with suppliers and have a choice of system wherever possible."

More clarity needed

To clarify the situation, the report recommends that NHS Connecting for Health, the agency in charge of NPfIT, should publish clear and updated plans for the NHS CRS and that its local service providers (LSPs) should publish timetables for the implementation of DCR systems.

It goes on to argue that one reason for the delays is that hospitals and other NHS organsations have not been closely involved in the programme and that “increasing local ownership” should be a key priority. NHS CFH is already developing a local ownership programme, but the report says local organisations should be able to negotiate with suppliers and have a choice of system wherever possible.

On a brighter note, the MPs conclude that EPRs can still succeed in the NHS if changes are made. “By clearly restating its aims, providing timetables and indicating how they will be met, and ensuring local organisations take charge of deployment, NHS CFH can still ensure that NHS CRS is a success.”

The committee’s report, The Electronic Patient Record, can be found on this website.