EHRs: who is setting records?

If all goes well over the next few years, most NHS trusts and boards across the UK will be implementing electronic health records (EHRs) as a replacement for the medical records paper chase that has been in place at most health organisations for decades. In England at least, however, bringing in EHRs will have been a tough job. The National Programme for IT's Care Records Service, which should already have provided a centrally-bought system for many NHS trusts, has not delivered this for more than a handful. "There are many reasons why the CRS is so far behind schedule: poor security standards, poor reliability, limited capacity and – most importantly – little customisation," says Kable's senior health analyst Victor Almeida. "Trusts were offered one vendor under the NPfIT scheme and – given the benefit promises made – very few chose to opt out of the initiative." Almeida points out that, as a result of the delays and the resulting political notoriety, the CRS is at risk of being scrapped or substantially rearranged in the next few months. This looks set to put the onus on trusts to choose an EHR provider. "It is almost inevitable that the pool of suppliers will be expanded," he says. "Most clinicians and patients are not against health records. They just want a solution which is both secure and reliable." Those suppliers already involved with the CRS could lose guaranteed customers, but would arguably be left in a strong position to compete, given the years of work they have already undertaken with the NHS, and the (few) reference sites this has generated. Cerner and iSoft are the chosen CRS providers to London and the North, Midlands and East regions of England respectively, although they are already selling to trusts outside these areas. Emis is in a slightly different position, but also has a very strong NHS presence: it is best known for supplying the majority of GP surgeries, and is now aiming to add larger NHS organisations to its customer list. Cerner US-based Cerner has been working with the NHS for more than two decades and its flagship EHR system, Cerner Millennium, has so far been installed across 16 trusts and 70 hospitals since being launched in 2004. It also supplied the software for NPfIT's Choose and Book appointment scheduling system, which processed more than 15m patient bookings during 2009. Its existing customers include Kingston Hospital - which went live just inside the government's November 2009 target date - and Homerton Hospital in London, while other sites, such as Newham University Hospital Trust and Wirral University Teaching Hospital NHS Foundation Trust are extending their use of its technology: in June, the latter said it will start using the software in A&E ( article ). Newham is planning to extend its Millennium installation to deliver integrated patient care pathways for its citizens. In partnership with its neighbour, Homerton University NHS Foundation Trust, Newham was the first NHS site to implement Cerner Millennium around five years ago, and plans are now in place to implement fully-electronic prescriptions and electronic workflow for all aspects of the two trust's patient care process. A version of Cerner Millennium modified by University of Pittsburgh Medical Centre has been bought by Newcastle-upon-Tyne NHS Foundation Trust Hospitals: the patient administration elements of the software suite went live across the trust on 7 November 2009. The trust is planning to extend Millennium's use to two primary care health centres which it runs in the city. In July 2010, the firm said that former NHS chief information officer Matthew Swindells was joining Cerner from his previous role at Tribal Group. Latest SmartHealthcare.com articles on Cerner iSoft The second major firm offering EHR systems to the NHS on a wide scale is Australian company iSoft Health, which has a customer base of more than 13,000 health organisations in more than 40 countries. Formerly known as IBA, it bought UK-based iSoft and took its name. This represents a new chapter for the organisation: four former executives of the old iSoft, none of whom now works for the company, appeared in court in January 2010 regarding financial irregularities dating from before the purchase. The firm is best known for its Lorenzo suite, which went live with v1.9 of this at University Hospitals of Morecambe Bay NHS Trust in June 2010 ( article ) following several delays, and with some problems reported by staff soon after its launch ( article ). In April of 2009, iSoft Health secured a £2.5m deal with Heatherwood and Wexham Park Hospitals NHS Foundation Trust for its i.Patient Manager patient administration system (Pas) technology, as well as a refresh of its i.Clinical Manager platform. The trust serves a population of more than 450,000 in six locations. What was notable about the deal was the fact that the trust negotiated directly with iSoft for a replacement Pas rather than waiting for this to be developed by the National Programme for IT. According to Adrian Stevens, iSoft's managing director, this contract was one of the first major deals in the NHS southern cluster, and is being serviced by Fujitsu – which formerly acted as the local service provider to the whole area, before abandoning this role in the National Programme. In November 2009, iSoft signed a similar deal with Sheffield Teaching Hospitals NHS Foundation Trust for a common Pas across the trusts' Northern and Central campuses. The Northern campus is seeing an upgrade of its current iSoft Pas, whilst the Central campus will move from McKesson TotalCare Pas to the iSoft platform. In August 2010, iSoft released e-prescribing and medication administration software (EPMA) in the UK ( article ), but at the end of the month the firm said that chief executive Gary Cohen was stepping aside from his post to help assist the board "in the evaluation of strategic options for the company". Chief operating officer Andrea Fiumicelli is serving as acting chief executive. Financial results released on the same day revealed a statutory loss of A$381m (£221m), which chairman Robert Moran blamed in part on delays to NPfIT, although the strength of the Australian dollar was also blamed. The firm received £5.8m from NHS Connecting for Health in 2009-10. Latest SmartHealthcare.com articles on iSoft Emis Emis – Egton Medical Information Systems – has also been central to implementing EHRs in the NHS, ever since it started operations in the 1980s when Dr Peter Sowerby and Dr David Stables wrote the software for their GP practice in Egton in North Yorkshire. Today, the company claims that more than half of GP practices across the UK use Emis software, with more than 30m patient records being handled by the technology. The company is planning a listing on the AIM stock market during 2010. In 2009-10 it was fifth biggest supplier to NHS Connecting for Health, which spent £27.5m with the company in that financial year. On 7 September 2010, Emis said it had received full roll-out approval for Emis Web, its new centrally-hosted cross-organisational healthcare system, and it will now start its controlled roll-out to existing GP users. According to the company, Emis Web is already being used by more than 1,000 early adopters across the UK, including GPs, community and secondary care clinicians in NHS Tower Hamlets, NHS Liverpool and NHS Cumbria primary care trusts. In Tower Hamlets, the firm says that 300 community staff are now using the system to access relevant data from the GP record and recording their consultations, leading to the trust making time and efficiency savings, as well as improving data capture and reporting. In June 2010, University Hospital Aintree said it had established access to 450,000 people's GP records in the area, in association with Emis, supplier System C and the local primary care trust ( article ). Meanwhile, July saw NHS Cumbria announcing that it will extend use of Emis Web to 100 district nurses in the South Lakeland area ( article ). Managing director Sean Riddell says that a unique feature of Emis Web v2 is an integral record interrogation tool which conducts instant, automated searches of the whole electronic patient record. This is meant to allow clinicians to pull together key information about a patient's care on a near on-demand basis. He adds that it is the biggest piece of software, requiring the most detailed testing, that his company has ever undertaken in the history of the company. Latest SmartHealthcare.com articles on Emis Second part on Alert, Agfa, Orion, CSE, InterSystems and TPP This article was last updated on 14 September 2010