One of the biggest barriers to the widespread adoption of an Electronic Patient Record (EPR) is its usability - or lack thereof - which is no surprise considering the ease of its predecessor: paper. 

Clinicians don't want clunky technology to slow them down. Productivity suffers, for example, finding clinical information in a patient's record requires a lot of mouse clicks and glances at a confusing screen layout. Every extra minute taken to review a patient chart means less time spent actually treating the patient.

So why bother with an EPR at all given the myriad problems – do the benefits really outweigh these problems? It is pretty clear to me, most governments and hospitals, that the future will be paperless and the only real question is, how fast vendors and healthcare organisations can transition from the current environment to one where the full benefits of an EPR are realised. There are a large number of EPR vendors, however the market is dominated by five who take about 80% - from KLASresearch.com

Advantages of an EPR for the Patient - the benefits of having an EPR should include:

• Improved diagnosis and treatment resulting in better outcomes
• Significantly fewer errors – eliminating handwriting problems for example
• Faster care and decision making responses from clinicians – notes always available when needed

Advantages of having an EPR for the Hospital:

• The ability to quickly access and share patient data from one department to another
• Eliminating the storage and space requirements needed for paper
• The ability to increase the number of patients treated due to increased productivity
• Workflow efficiencies and cost reduction
• Move the hospital up the CDMI/HIMSS technology adoption levels and give it a competitive advantage

While it is pretty obvious that a usable EPR will deliver improvements in patient safety and care, why is it that this aspect of healthcare technology has been so slow to arrive, and lags so far behind other areas of our lives – banking, travel etc?

In general it is such a large investment and the current experience doesn’t give huge confidence that the investment will be returned. These are some of the barriers that prevent hospitals from moving down the EPR path more quickly:

• Costs: The cost of an EPR solution from one of the big vendors can run into millions and be a major barrier. There are also many examples of healthcare organisations that have invested in these big EPRs, and have ended up years later still awaiting full implementation. Epic EHR systems are some of the most expensive on the market. In the US, Duke University Health System reportedly paid $700 million for its Epic system; Kaiser Permanente, $4 billion.
• Change Management: When users are unfamiliar with the technology and how a new system works they often spend more time on it. Or, if they are uncomfortable using it, it will take them longer to carry out routine procedures. All this lost time could be potentially spent on patient care. When clinicians haven’t been fully involved in the development there can be resistance which can also prevent hospitals and patients benefiting.
• Integration: Since electronic patient records are still a relatively new technology, there is no real standardisation of requirements and they all have to integrate with multiple systems – this can be a challenge resulting in delays to roll-out, errors and duplication of efforts.

The user-friendliness of EPR’s does hinge in large measures, on vendors working closely with clinicians to ensure they understand the workflows and processes at that particular organisation – not all hospitals are the same. Software suppliers can't just drop off a shiny new EPR at the front door and let users figure out what to do with it. The quality of training makes a difference. So does sharing best practices gleaned from existing customers with new ones.

If capturing data was as easy as using paper this would be a big step in the right direction. This is where Vitro from Sláinte Healthcare scores above some of the bigger EPR vendors. By taking a paper chart/process and creating an intelligent digital version of it, which integrates with other Hospital Information Systems clinicians can rapidly see the benefits of an EPR. In addition, because the digital version of the chart looks identical to the paper version and has the same qualities without the downsides of paper there is low resistance to change and high adoption rates. 

Vitro also allows for an incremental approach to implementing an EHR, rather than a big bang across a whole site which has a higher rate of failure.

So rather than simply purchasing an EPR from a large vendor and expecting all the problems to be resolved in one fell swoop, healthcare organisations should ensure that the vendor has understood how they work in all areas of the hospital, is willing to take a step-by-step approach and can demonstrate rapid implementation and value for money. What is the point in investing millions in a system that takes years to implement, doesn’t have the full buy-in from hospital staff and is so unusable that they prefer to stick to the old reliable – paper!

If they can achieve all this then it will definitely be worth the effort and go a long way to delivering improved patient outcomes.

Canice McKee - Business Development Manager Ireland & UK, Sláinte Healthcare

Canice is responsible for growing Slainte Healthcare’s business within the UK and Ireland. During a successful 6 years at Lincor Solutions Canice won many contracts for their bedside computing solution in hospitals across UK, Ireland and the Middle East, developing an understanding of how technology can improve patient outcomes. Canice’s background prior to becoming involved in Healthcare was in the Mobile Communications market, where he held senior global marketing positions with Nokia and sales and marketing roles with BT and Orange. Canice is a Business graduate and is a Member of the Institute of Marketing

LinkedIn: http://ie.linkedin.com/in/cmckee