Electronic Patient Record

Background

The Electronic Patient Record (EPR) system is a business process-based software solution that brings together key clinical and administrative information involved in the care and management of patients.  

The Government of Jersey’s Digital Care Strategy includes a four-year programme to implement a new EPR system.  The stated aim of the EPR programme is to provide a single source of patient information available at the time and place where care is being delivered.    

 The November 2020 EPR Business Case states that the outcomes to be delivered by the EPR programme include:   

• a sustainable and continued improvement in the quality and safety of acute care within Jersey   
• improvements in acute care patient outcomes   
• reduction in unwarranted variation away from clinical pathways and protocols, with associated cost savings and improvements in care; and   
• to continue to build and contribute to a Jersey Care Record, a unified digital care record for Jersey patients across all aspects of care.   

The EPR programme has been designated as a Major Project under the Public Finances Manual.  A total of £16.2 million has been allocated to the Digital Care Strategy in various Government Plans including the Government Plan 2023-2026.  

The total estimated programme costs in the EPR November 2020 Business Case were £29.3 million between 2021 and 2031 including both capital and revenue expenditure.   

The EPR implementation was planned to take place in a series of releases between 2022 and 2024.  

At the time of the review Releases 1 and 2 had gone live, with the remaining three phases planned to be implemented with an estimated completion date of July of 2024, or possibly the autumn of 2024.  

Scope

The review has evaluated the design and operation of the EPR programme against the best practice framework developed by the UK National Audit Office.

In particular the review has evaluated whether:

• clear criteria for success have been articulated such that the programme has properly evaluated the options available to deliver the benefits identified
• the procurement approach has been appropriate and follows best practice
• strong governance, programme management and project management approaches and plans are in place, including robust assessment and management of programme and project risks
• robust organisational and digital strategies have been developed with a clear view of technological requirements specific to health
• the programme and project teams have a clear understanding of the operational realities, supported by operational experts committing time to help develop the strategy
• the complexity of legacy system issues is really understood including the challenges involved in data migration and systems configuration
• best practice is being followed in respect of information governance, security and data protection risks
• robust plans are in place in respect of operational readiness for the implementation of each phase of the programme, in line with the overarching agreed timetable
• there is sufficient challenge and review of existing operational and clinical business processes in preparation for EPR implementation; and
• systems users and other key stakeholders are being engaged with effectively with clear communications plans in place

In April 2023 I published my report Integrated Technology Solution – Follow Up which considered the operation of the ITS programme to November 2022.  The EPR programme is running concurrently with the ITS programme.  Some of the recommendations made in my April 2023 report are also relevant to the EPR implementation.

Conclusions

There is a large degree of similarity between the findings of this review and those of my previous reviews of the Integrated Technology Solution (October 2021 and April 2023) and Major and Strategic Projects, including Capital Projects (November 2023).

While good practice frameworks have been established for projects such as the EPR implementation, in order to drive value for money from significant investments there needs to be a much greater focus on effective stakeholder and user engagement as well as more effective discipline around the identification, monitoring and delivery of benefits.