Major push on EPR ‘convergence’ and levelling up from the centre

Local NHS leaders have been told that they must draw up plans to level-up and converge the electronic patient records (EPRs) in use across Integrated Care System (ICS) boundaries.

The new policy direction features in February provider digitisation guidance from NHS England and Improvement, which states EPRs are essential “to support the recovery and sustainability of the NHS and care”.

“Our primary focus is to achieve universal EPR coverage across all ICSs (i.e.to level up EPR provision),” states the joint letter from Tim Ferris, director of digital transformation at NHS England and Improvement (NHSEI), David Sloman, COO at NHSEI and Sonia Patel, system CIO, NHSEI.

“We are also encouraging ICSs to work towards the managed convergence of EPRs over time, to reduce the number of EPRs across acute care, community services, mental health, ambulance services, primary care, and social care,” the letter to NHS regional IT leads states.

“The primary benefits and drivers are to provide critical, real-time access to all health-related information for caregivers. It will also enable more simplified access for patients to their own data.”

The letter frames the move in part as ‘levelling up’ EPR provision across the NHS in line with the Long Term Plan commitment for providers to achieve a core level of digitisation by March 2025.

One source familiar with the guidance said that the letter was the clearest demonstration yet of NHSEI charting a new direction on nationally directed digital transformation, since disbanding NHSX and taking back control of strategy.

Sajid Javid, the Secretary of State for Health and Social Care, said in February that he wants 90% of NHS trusts to have an EPR in place by December 2023.

The guidance also says that NHS organisations should all achieve a baseline digital maturity – which the accompanying questionnaire indicates should be equivalent to HIMSS level 5, this will then be followed by convergence and then levelling up.

Regional leaders have been told to ensure that every ICS has a plan “to ensure coverage and convergence of EPRs” and to “broker necessary discussions across partner ICSs and providers”.

The letter goes on to tell them to ensure “strategic and clinical engagement to ensure clinical and operational readiness within each ICS”.

Regional leads are also told to help provide “financial support to help ICS’ and providers find affordable EPR financing solutions as part of their business case”.

To gain a baseline picture regional leads are asked to provide a detailed picture of the current position, local capabilities, and local EPR roadmaps. The questionnaire had to be completed by 25 February.

These plans should “cover the plans, and associated costs and constraints, that each ICS has to meet the core level of digitisation for NHS secondary care providers”, and “the strategy for the convergence of EPR provision within the ICS, demonstrating how the plans above support this strategy”.

NHSEI says that it will be linking plans to future investment and providing support to assist, including “agreeing a revised business case template and process to expedite investment approval”.

The guidance also reveals that work is underway to agree “a set of core requirements for an EPR and discussing these with EPR vendors in order to expedite implementation timeframes and secure better value for money”.

Sources had previously indicated that Ferris has strongly advocated policy of greater standardisation of EPRs across NHS hospitals, in part informed by his first-hand experience of how Massachusetts General Hospital had become more coherent as an organisation after standardising on an Epic EPR.