Optimising EPR usability: Reducing risk, burden and variability in NHS digital systems

We know from the RCP’s 2023 census that the single thing that would most improve the working lives of consultant physicians is working IT systems. A survey I conducted last year looking at digital health, showed that the clinical digital systems we use are less than half as usable as the digital tools we use in our everyday lives. 

I’ve just changed jobs to a hospital that uses the same electronic patient record (EPR) provider as my previous trust but with a very different implementation strategy. Thinking about the way in which organisations choose to implement and optimise digital systems has made me realise the added risk and increased burden on staff.

Which way round does your trust’s EPR display the chronology of results? Are the newest results on the right (which makes sense to my brain) or the left? It’s different between the two trusts I’ve moved between. I’ve heard of another EPR where the laboratory results are in one direction and the observations in another. The lack of standardisation, even within a single EPR, increases the risk that I will miss essential information and increases the cognitive burden of caring for patients. On paper, it was easy to standardise the NEWS chart, but in different digital systems the same information is displayed in multiple ways. Many of them are much worse at making it obvious to clinicians that the patient is deteriorating. 

In my previous trust, I could use voice recognition software to dictate my outpatient letter and note directly into the EPR. In the new trust, I have to type a clinical note into the EPR and dictate a letter in a different system to create a letter that is then edited by a secretary to send back to me to approve. I then edit it again and either ask the secretary to make corrections or make them myself. Previously, I could select test results and drop them into the letter but now I need to ask my secretary to do that. One process in one digital system is now five or six in at least two systems for two people and takes me more than a week rather than being instantaneous. 

Work from the Arch Collective and Klas Research demonstrates that all EPRs see a widespread in user experience from organisation to organisation. The consistent finding is that systems are easier to use and therefore safer if users can:

·       personalise their EPR experience with shortcuts to make repeated tasks faster

·       share ownership for EPR governance and be listened to when they identify problems in workflows, and be involved in designing new processes

·       be expert users of their EPR solution because they were trained well before they started, and ongoing training and at-the-shoulder support is available.

NHS England is partnering with Ethical Healthcare Consulting and Klas Research to survey all staff on how usable the EPR is in their organisations. In 2021, the previous survey received over 10,000 responses – the largest usability survey ever undertaken, even if it included only a small percentage of staff. It showed that relative to other global systems, the NHS is poor at training, infrastructure (the hardware that we use to access systems) and clinical engagement. All these elements are key to system usability. Benchmarking your organisation and its EPR against other organisations using the same EPR means that we can learn what makes systems work better in the NHS and provides data to challenge your hospital to do better. 

This will only work if enough of us complete the survey. Please fill it in and encourage as many of your colleagues as possible to do the same. Data is power. If we can show the extent of the problem, then we can challenge the NHS to do better.