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Speculation of epic national deal with NHS England

Could we see a national agreement for the Epic electronic patient record? Jon Hoeksma is speculating and exploring what this could mean for the healthcare system.

Speculation over a nationwide deal between NHS England and U.S. electronic medical records (EPR) provider Epic was fueled last week, ten years after the NHS ‘nationwide computing program ended.

Rumors have circulated over the summer that Tim Ferris, NHS England’s new digital transformation manager, is a big advocate for the system and has told his colleagues that it should be used by many other trusts.

Highly regarded, Ferris joined NHS England from Massachusetts General Hospital, which in 2016 deployed Epic in a program that reportedly cost nearly $ 1 billion.

Ian O’Neil, the current director of transformation at NHS England, told an industry conference in London last week that there had recently been high-level meetings with Judy Faulkner, the founder from Epic, but declined to provide details on the topics under discussion.

In response to subsequent questions from Digital Health News about whether national deal negotiations were underway with Epic, the NHSX press office sought to play a forehand with a ‘come on, nothing at all’ statement. see here ” :

“In response to your questions about discussions with providers, it is standard practice for the NHS digital leadership to meet regularly with technology providers who currently provide services to the NHS. “

As for what the meetings covered:

“The meetings cover a range of topics, all with the aim of ensuring that providers are working towards the vision and priorities of the NHS, especially in the context of strategies such as What Good Looks Like and Data Saves Lives (Reshaping Health and Social Care With Data). “

The idea of ​​procuring a single national EPR system for all hospital trusts in England was the central pillar of the failure of the NHS National Program for IT (NPfIT) which ran from 2003 to 2011.

In subsequent NPfIT reports and surveys, the National Audit Office concluded that the national top-down approach failed to recognize the very different local circumstances between hospitals and failed to gain the support and commitment of clinicians. local.

So far, this is all in the realm of rumor and speculation. There have also reportedly been discussions with Epic in recent months as to whether it could potentially offer its system as a platform for use in Integrated Systems of Care (ICS).

As the NHSX press release says, it makes perfect sense for NHS agencies to have meetings with all of its major software and technology vendors. And hopefully other vendors benefit from similar discussions and access.

Just imagine for a moment

But let’s just assume for a moment that some sort of national deal to make Epic more widely available is under discussion, and again this is just speculation, what could that look like and how much could it cost?

The cost of an EPR varies enormously depending on the supplier and the local organization, and there is a glaring lack of price transparency. An NHSX source told Digital Health News last week that new work was planned to get better price data.

How much does an EPR cost?

Best estimates suggest that NHS hospital EPR deals typically weigh between £ 20m and £ 100m over ten years.

Epic sits at the very top of that scale, in the range of £ 80million to £ 100million (average call it £ 90million) over ten years, with most of the money not going to the software provider but to the infrastructure and dedicated personnel to implement. , install and run the software. It is said that the division is about the thirds.

But the costs can be much higher, Cambridge University Hospitals had a budget of £ 200million in 2014 for their digitization program as the epic first NHS site.

The Guys and St Thomas NHS Foundation Trust’s Epic project is reportedly well in excess of £ 175million.

Manchester NHS FT University Hospitals have a budget of £ 181million, while Northern Ireland has a budget of £ 275million and Frimley Health NHS FT has a budget of £ 108million.

These types of projects are the single largest investment most NHS hospital trusts will make, aside from physical buildings.

There are currently 138 acute care trusts in England and Epic is used in five of them: Cambridge University Hospitals, University College London Hospitals, Great Ormond Street and Royal Devon. A number of other NHS trusts in the process of implementing the system.

So let’s say for the sake of argument and suspending all competition and procurement rules, that there are about 100 more acute NHS trusts to fund to get the system – what would it take?

So the 100 acute trusts paying out around £ 90million would add up to around £ 9bn. Let’s round up to £ 10bn for a bit of contingency and modest management consulting fees.

And everyone ?

Of course, this does not cover all mental health trusts, community trusts, ambulance trusts, combined health and care trusts, or other specialist providers. And that doesn’t cover social care, but Epic generally doesn’t cover those areas, so put them aside for the sake of this speculative “what if” scenario.

Let’s also ignore the fact that there is currently barely enough implementation capacity to handle current sites.

What would be the benefits of a nationally unique acute RPE?

If we instead imagined all of this happening, what would be the benefit to the NHS and the patients it serves?

Well, for starters, almost everyone in the acute industry would use the same system and not have to retrain every time they moved to a different organization. Everyone would learn to use the same system and get the most out of it.

For inpatients, close integration between prescriptions and test results and integrated clinical decision support tools would be beneficial. Electronic medication management would be universal and part of the basic RPE with significant benefits for patient safety.

One of Epic’s greatest pride is that they have never bought another company and that the whole system has been developed in-house. So that would mean that there would be no more messy interfacing of different systems to create your own set of EPR capabilities.

The digitization of patient records and clinical workflows also opens up a whole new ability to perform large-scale predictive analytics, better conduct research and clinical trials, and identify patients at risk.

One of the big financial benefits that US hospitals see after implementing Epic is better coding of procedures resulting in increased billing, which does not apply directly to the NHS.

The world beyond the hospital parking lot

But all of these benefits would only apply within hospital boundaries, and even within a single provider organization, an EPR isn’t everything. It has to interface and connect with many other systems.

Go to the exit of the hospital car park [if you have fuel] and the familiar complex and messy heterogeneity would remain unchanged.

Enter the world of community, mental health, primary care and it becomes much more complex and requires a lot of plumbing and interoperability between the different systems. Digitizing suppliers is an important but sufficient part of a complex puzzle.

And that, more than anything else, would seem to be the most telling argument for any nationwide purchase of a hospital EPR to enable the digitization of acute care providers, regardless of the quality of the solution. And there is no doubt that Epic is very good.

In the age of integrated health and care; SCIs; complex patient journeys spanning multiple organizations; to equip patients with the tools and information to co-manage their own health; it would appear that it is fundamentally backward to focus solely on digitizing one sector, no matter how small, with one type of system.

A decade after the end of NPfIT, does the NHS really need a PFI-like program for the acute digitization of providers that could lock it in higher costs and patterns of care for decades to come? ?

* Fun fact – Massachusetts General is also where the MUMPS (MMassachusetts General Hospital Utility MultimatePprogramming System) still used by Epic and other healthcare software vendors was invented in 1966.


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