George Crooks: Having An Electronic Health Record Is Not Enough

October 4, 2018
Digital technology is part of our every day lives and is not regarded as being special. Many kitchens have microwave ovens, almost every home as at least one television and telephones, fixed line and mobile are not a luxury but a necessity! But when we move into the world of healthcare, digital technology takes on a different persona. It can be viewed with suspicion, it can generate hostility and can be regarded as unreliable and unwanted. This should not be unexpected, if you look back to the industrial revolution, this was exactly how mechanisation was viewed.  But if we are truly seeking to secure health and care services that are not only safe and effective but are sustainable into the medium and long term, we have to embrace change. Adoption does not happen just because it is the right thing to do and adoption at scale is like the Holy Grail, many want it but it is proving highly elusive! So what are the conditions that make it more favourable for technology solutions to be successful in health and care? Doctors and nurses are looking for solutions that are easy to use, fit in well with existing clinical processes, do not interfere with the interaction with the patient, make the job easier by reducing workload, support decision making and reduce clinical and personal risk. To do all of these things there requires to be significant time and effort spent on co-design. This is often less about the generic product but how the service wrap around is developed to support an informed redesign rather than dictating the working practices of staff. The EHR is a case in point, it aids data flow and communication. If well designed it can deliver many efficiencies, saving clinicians time and effort. It can reduce risk by supporting safe and effective prescribing and can assist clinical decision making by making available in one place all the necessary information from radiology to blood tests and present them in an easily accessible way. However, the EHR also opens a window on clinical practice that in the past was hidden behind the consulting room door or bed screens. The EHR exposes variation in clinical practice. We know well that increasing variation brings with it increased risk of harm to patients.
Technology enabled care will transform how we deliver significant parts of our health and care activities. 
We are also aware that increased variation can reduced clinical effectiveness, create waste, inefficiencies and drive up cost.  Simply having an electronic health record is not to have achieved the main prize.  It is what an organisation does with that digital tool that will benefit the patients, the clinical staff and ultimately the organisation. Optimisation of the electronic health record can be carried out in a way that engages and empowers clinicians, reduced variation and deliver quality improvement across a clinical service, directorate or institution. To move in this direction requires a significant managerial commitment and clinical input into planning and supporting the processes required to deliver success.  We also need to start thinking now about how we can safely and effectively use citizen generated data to better inform and aid clinical decision making, how that data can be trusted and how it can flow securely and seamlessly into the EHR. This is an opportunity worthy of serious consideration. However, in my opinion it is an effort well worthwhile making as in the long run there will only be winners. Technology enabled care will transform how we deliver significant parts of our health and care activities.  However, this agenda is NOT about replacing doctors, nurses or carers with pieces of technology.  We should NOT simply use a digital solution because it is available.  We need to use these technologies appropriately and redesign our services accordingly.  The most valuable resource any health or care system has is the people who deliver those services and technology can support them to ensure that when any of us needs to see a health or care professional we have ready access to that person.