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The EPR and market access for medtech

The Electronic Patient Record (EPR) is a critical enabler for community healthcare and healthcare IT alike. Jeremy Thorp of NHS Connecting for Health explains how the EPR moves the healthcare goalposts – and how medtech innovation can hit the back of the net.

The effective integration of medical technologies into the community-based treatment and monitoring of patients is essential for their role in 21st-century healthcare. The Electronic Patient Record (EPR) enables clinical information in various forms to be integrated into a profile of the patient’s medical history that can be accessed at any location. The EPR promises to do for healthcare in general what PACS (Picture Archiving and Communication Systems) has already done for hospital-based imaging. And like PACS, the EPR is a major opportunity for the medtech industry to work with the NHS in transforming patient care. NHS Connecting for Health is looking to roll out the EPR over the next few years. Jeremy Thorp, Director of Business Requirements, Technology Office, NHS CfH, talked to On Target about what the EPR means for medtech companies and the healthcare model. In broad terms, what does the Electronic Patient Record mean for the healthcare model in the UK? Historically, the way patient records have been maintained is within each organisation: the GP surgery, the hospital and so on all had their own separate records. If a patient was referred to a hospital, the hospital wouldn’t know much about the patient and would have to repeat certain questions and tests. The EPR is designed around the patient and follows the patient: it is available wherever the patient goes. The way the NHS is changing at the moment, with a growing emphasis on being able to treat the patient at home or in the community rather than in hospital, lends itself to the application of these technologies. Without the EPR, in fact, you couldn’t transform the way services are provided for patients. You’d still have a situation where the patient was discharged from hospital and no-one outside knew their treatment history. The EPR (or Care Record Service) allows multiple copies to be made available wherever they are needed. For example, an out of hours service at a GP surgery cannot access paper records, but could access the EPR. We’re moving towards a situation where patients have more choice about where to be treated, so it’s more important than before that we have the means to make this information available. More effective data capture, via the EPR, improves the analysis of health needs and treatment effectiveness to support disease prevention. An example is the care of patients at risk of readmission. Having full information about the patient’s past treatment enables you to assess the risk of complications or further difficulties, and so to suggest in certain cases that the patient is monitored by community staff. So you’re managing down the risk of patients who might become ill, and doing so affordably in the community – rather than waiting for the patient to have a heart attack and go into hospital, where the situation is hugely more expensive, complex and potentially dangerous. What does the EPR mean for the medtech industry? How will it affect the prospects for take-up and use of innovative medical technologies in the UK? The EPR consists of many different types of information: text, images, measurements and so on. Ten years ago we’d have thought it was mostly about typing in records; but now many different forms of data from different types of equipment can be integrated into the record. PACS demonstrates the value of digital imaging, and having a visual patient record adds a new dimension: a picture is worth a thousand words. This means there are opportunities for suppliers to contribute new ideas that can be integrated into the EPR. Companies are already linking all kinds of equipment together to build a more comprehensive picture of the patient’s health and treatment, which is reaping clinical dividends. It’s both a challenge and an opportunity for the medtech industry: it implies a greater need for linkage and integration as information is shared. An important example of this trend is the Continua Alliance, an alliance of healthcare IT companies who are realising that they need to work together to start creating and developing standards, particularly in relation to device interoperability, with an emphasis on remote monitoring and homecare. Our contacts with Continua are at various levels, including formal contacts through standards work. One of my roles is Chairman of the UK Health International Standards Committee, and a number of medtech companies are involved with that work. We also have pilot projects, funded by the DH, to develop telehealth and telecare services with industry partners – instead of engaging with individual companies, we can link with the Continua Alliance to the benefit of all its members. How can the medtech industry help the NHS to implement the EPR and realise its potential for improving healthcare provision? Industry is an important partner is helping to implement the EPR. The recent implementation of PACS was a superb example of medtech working in partnership with the NHS. The industry already had examples of digital imaging in the UK and worldwide. The situation brought out the best in the suppliers, who came forth and said: Yes, we understand this, we’ve done it before, we can help you roll this out. The result was a huge success. PACS was implemented across the entire country within three years, due in no small part to the efforts of the suppliers involved. With PACS, the technology had reached a level of maturity such that it was just a matter of implementing it. Some other technologies at the moment haven’t quite reached that level of maturity. So with some home monitoring equipment, I think people are still trying to work out the most effective systems and establish the cost-benefit ratios. We can identify from a health perspective what approach we want, but it would be great for industry to come along and point to maturing technologies in other countries or industry sectors that we can use for health. I’m not sure industry feels that up to now, there’s been the opportunity to make those kinds of suggestions. Does the EPR mean that the medtech industry can look forward to a more unified and integrated market? Or will new technology accelerate the diversification of the market across different types of customer, end user and healthcare model? The requirements for EPR increasingly revolve around the integration of multiple technologies and disparate information sources. Companies will need to be adaptable and prepared to work with other vendors. Increasingly, agreement of standards and conformance to international protocols will be critical success factors for those seeking to deliver. Everyone realises that it’s increasingly difficult to have one big company that does everything: we’re all reliant on multiple copies, interoperable devices and so on. Companies need to ask “How do I play in a bigger pool?” and “How do I work alongside others?” A few years ago, when a lot of new technologies were proprietary, it was quite difficult for new entries to break in. But if there are published standards and international approaches, it’s much easier for new entries to come along: you’ve got a plug-in situation. In terms of trying to encourage innovation, that gives us a much more diverse platform where people know what they need to do in order to connect their devices to other systems. We believe the EPR is of huge benefit to patients, and therefore to the NHS and society as a whole. We’ve been working on this for a long time, and we’re reliant on suppliers to support and promote what we’re doing.  

There are opportunities for suppliers to contribute new ideas that can be integrated into the EPR. Companies are already linking all kinds of equipment together to build a more comprehensive picture of the patient’s health and treatment, which is reaping clinical dividends.

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