Problems with new Epic EHR contributed to U.K. hospitals' drop in care quality

The United Kingdom's Care Quality Commission has recommended that the Cambridge University Hospitals NHS Foundation Trust be put on "special measures" in large part because of problems the Trust has had in implementing its new Epic electronic health record system.

The report, published Sept. 22, related that the Commission inspected the Trust, which operates Addenbrooke's and the Rosie Hospitals, in April and May 2015, and found its performance rating "inadequate" overall, with five "elevated risks" and four risks on its "intelligent monitoring" system. Just five months prior, the Trust had only two "elevated risks" and one risk on "intelligent monitoring." The Epic EHR system was implemented in October 2014.

The inspection found, among other things:

  • Since the introduction of the EHR system, outcomes of patient care and treatment were not robustly collected or monitored
  • Epic was the "root cause" of the problems with data collection
  • The system created significant numbers of delayed discharges that impacted patients receiving end of life care
  • The system was time consuming to use and limited engagement with patients
  • The system did not produce accurate data
  • There were "serious" increases in time between referral for treatment and the provision of treatment after implementation
  • The system generated prescription errors
  • Some information seemed to disappear from patient records

Additionally, three staff members felt "bullied" after raising concerns about patient safety following implementation.

The report did note some efficiencies and benefits, such as the ease of accessing "do not attempt to resuscitate" orders and elimination of problems deciphering handwriting. It also noted that other problems, such as staffing shortfalls and communications issues, contributed to the decline in ratings.

A related article from BBC noted that the system cost £200m and illustrated one of the Trust's "mistakes."

EHR usability and functionality has long been an issue surrounding adoption, raising patient safety issues. It has been reported that vendors' commitment to usability varies significantly. Epic has been in the hot seat before, most recently for concerns that its conduct violates U.S. antitrust laws.

To learn more:
- read the report (.pdf)
- here's the BBC article