The Future of Electronic Patient Records

From the Frontline – a new semi-regular series of blogs featuring independent thought leadership and comment from a range of leaders that span the healthcare industry.

The way healthcare organisations implement and utilise Electronic Patient Records (EPR) is at a critical tipping point. The next wave of technology is poised to take over and become dominant. This will be a game changer for the sector and disrupt the market like never before. The shift will be like the move from VHS, CDs and DVDs to streaming, and we all know what happened to Blockbuster and Netflix, and HMV and Spotify. What opportunities will this open up for healthcare… and what are the risks? 

Electronic patient records are becoming increasingly important in healthcare systems around the world. The development of these solutions has followed the typical life cycle for new technology, moving from invention, through early adoption with the need for customisations, to productisation from a handful of dominant providers. There is now little difference in the functionality of solutions from major providers and they are all based on 20+ year old legacy technology.

Time and again we’ve seen that as an area of technology matures, comprehensive proprietary solutions from major vendors exist in their own separate universes unable to talk to each other. Customers must buy into a supplier’s vision of the world. It is in the vendors’ interest to keep things this way as when they win a client, that organisation is likely to have to stay with them for a long time. It is hard for customers to integrate innovative applications which emerge from other vendors – just as consumers aligning themselves with the Apple world face difficulties if they try to introduce an Android phone because it has a better camera, or link in Alexa smart speakers as they make voice-driven shopping from Amazon easier.

A new epoch for patient information

The speed of the IT life cycle is ever faster. Many health and social care organisations are still to fully implement and get the most from their chosen EPR, yet we are on the brink of a major shift in IT. We are entering a disruption phase which will see innovators emerge offering new best of breed applications hosted in the cloud and covering specific areas of functionality, developed on, and with, the latest technologies.

As the NHS comes to terms with the move to more collaborative ways of working between health and social care organisations, to better serve the needs of specific geographies through Integrated Care Systems (ICS), different types and sizes of providers must work together more seamlessly. It is likely that they will have a range of EPRs or not yet use one. The temptation is for all organisations to be pushed towards what the dominant or most advanced player is using. Yet the new phase we are entering should mean that disparate organisations will be able to use the EPR best suited to their needs while maintaining the ability to collaborate and share common patient information easily.

Cloud-native (as opposed to cloud hosted) EPR systems offer several advantages over traditional on-premises systems, including increased scalability, accessibility, and cost-effectiveness. Critically, a really key advantage of cloud native systems is flexibility and speed of development. Yes, many of the smaller systems are not as mature and functionally rich as the dominant players. But they won’t remain this way. A modern cloud native architecture means that the potential to out-innovate the dominant suppliers (working on legacy technology) is very real and is happening. It is like IBM not worrying about a pretty small online book store renting out its server space. Amazon used this to their advantage.

Standardisation of patient data models fuels innovation

What has held back innovation and collaboration are the proprietary information models used by different major vendors. What is needed is a standard information model for the storage of clinical data. This will allow different best of breed EPR modules to work together and also share standard information with other types of systems used by healthcare organisations. Integration of EPRs with other healthcare technologies, such as telehealth platforms, wearables, and artificial intelligence (AI) systems will be much simpler. This integration will enable more personalised and efficient care, as well as improved patient outcomes.

Emerging standards for open health records should provide the key to making this interoperability possible. For example, openEHR is a not for profit organisation that publishes technical standards along with domain‑developed clinical models to define content. The development of common standards and protocols for patient data will enable different systems and organisations to better collaborate. Each one can implement emerging innovative EPR applications which best suit their specific requirements.

Digital identity is required to support the possibilities of AI

The needs and workloads of clinicians must be at the forefront of the design of the overarching solutions architecture. Using solutions from multiple vendors will not work if staff have to repeatedly log in and out of different systems needing multiple user IDs and passwords. These interoperable systems will only be workable together with strong, fast user authentication utilising single sign on (SSO) and digital identity. Such tools will also help deliver improved approaches to data governance and security.

Earlier I noted that the speed of IT development is increasing in its velocity. As we discuss one fundamental change, another is already becoming a reality. With the emergence of Artificial Intelligence (AI) solutions such as ChatGPT and Bard from Google, the debate on the possibilities and pitfalls AI brings is making it into the headlines. Such solutions cannot only generate content but also develop software code driven by non-technical user questions and needs. With the explosion of AI, low code/no code software will mean applications can be developed much more quickly and be more tailored to specific needs leading to even more best of breed options.

Technology innovations will keep on coming. It is our job to be open, understand them and harness the possibilities. We need to keep in mind that our principal architectural concept should be the development of lifelong, patient‑centric, shared health records; future‑proofed data; and support for evolving clinical processes and workflows which are able to cross organisational boundaries. We are on the brink of very exciting times.