EPR cost per patient per year (from the UK)

Public
1

This is profoundly interesting, and captures a significant chunk of the costs of an EPR (per patient per year) quite nicely:

Cost of EPRs per patient per year in the UK
Cost of EPRs per patient per year in the UK800×622 80.3 KB

Of note, it doesn’t account for staff time - both to run the thing and the time it takes to interact with it. From my own observations, any functional EPR seems to need a veritable army of clinical informaticians to run the sucker. This is probably at least similar across vendors though but would be an equally (if not more important) comparison too.

Of special note, bespoke EPRs are cheap. Perhaps this is the route we should go down in NZ?

from this LinkedIn post by Paul Brown

.

2 Likes
2

You mean like HealthOne?

3

These cases are even more ‘homegrown’ - by this I mean actually developed and supported in-house. An example is PICS at University Hospitals Birmingham. You can read a little more about this here (is the ‘Case study’):

https://nhsproviders.org/making-the-most-of-your-epr/where-to-start

Health One is a connector between primary care EPRs and other clinical (including secondary) info rather than an EPR itself. My knowledge of Health One’s origins are a little sketchy to be honest - it may well have at least started in-house. @martin.wilson, can you flesh out the story a little more?

Personally, I’d love to see us tackle our own home-grown EPR built on OpenEHR - and strongly believe that we could pull it off if we set our No 8 wire minds to it. Of course, this is presently utterly impossible with the ongoing evisceration of digital health in our public health system.

4

Hi Nathan,

The HealthOne (H1) story started as early as 1992 when I fully computerized my GP medical records. at the time on MT16 as I recall!!

The thought was around having (initially my) records available from home and then available to any Health Care Professional (HCP) caring for my patients in other settings (ED, OPD another GP 24HS etc.

the first bit was easy as we had Microsoft NT on the practice server and it had a safe dial-back system, but the latter turned into a lifetime work.

So began the eSCRV (electronic or emergency. Never did define the e. in Shared Care Record View) which morphed into HealthOne. Along the way assisted (financially) by David Meats and & Carolyn Gullery along with secondary care CMO Dr Nigel Millar.

H1 is on FHIR and has FHIR API’s.

Now most all south Islanders have their GP records available across the South Island in H1. with approx. 400,000 page views monthly it connects primary and secondary care. The GP daily record is still being rolled out but my entire GP record is safely shared across the SI which was my goal back in 1992.

When I recently transferred GP practices i realized just how bad GP3GP transfers were and was able to practice safely using H1 until the information was transferred.

Interestingly I still use the Classification lists, Labs, hospital letters etc from H1 in preference to my patient PMS because I know all the data is in H1 where as I only have a subset in my Indici records.

H1 is not a PMS but more like a read only PMS which is updated instantly via FHIR API’s from GP land.

The jewel in the H1 crown is its privacy framework which proactively monitors access and reports on anomalies which are followed up by the privacy team. There have been very very few inappropriate accesses but they have been appropriately dealt to via the NZMC and all that entails.

So, one wonders where we are going after the hibernation of HIRA. Should we be consider using H1 nationally? Certainly North Island HCP’s who have worked in the SI lament such an easy, safe, more efficient, more effective one click in patient context system when caring for their patients in the NI.

Any questions welcomed.

2 Likes
5

Thanks @NathanK, very interesting. I’d love to see an average customer satisfaction rating alongside each of those systems, as not only are some very expensive, I hear anecdotally that they are quite disappointing in features or flexibility.
There are vanishingly few PASes or EPRs which suit the NZ public health sector well, so the notion of a bespoke system has been on my mind for several years. We do have the expertise to design such a system, but it would be a big job.
I’ll be keen to hear from others on this topic.

1 Like
6

I am a bit biased but our southern anthropometrics program that was developed by lance elder and myself to replace paper growth records about 15 years ago is still running across the South Island and some places in the north. It is an all age repository for body measurement data. It has some deficiencies but is very clinician friendly and now has minimal or no support but keeps running! The cost of development was kept in house and when discussed nationally, is denigrated because of no ongoing support from an external company. So, as far as cost goes, I know where we stand!

7

A few years ago in the UK, I saw some research done by klasresearch.com on this very thing (health staff EHR satisfaction). As it wasn’t very flattering to the big EHR companies, I suspect that it isn’t publicly available - I certainly can’t find it now!

What I recall:

  1. There was zero correlation between the vendor of an EHR and the staff satisfaction with the EHR
    • for example, both the highest performing and lowest performing EHRs were from the same (expensive) vendor
  2. The raw cost of the EHR did not seem to be a significant factor
  3. How an EHR is implemented seems much more important than which EHR
  4. Health staff love a system which they have ownership of, which makes communication and tasks easier, and facilitates communication with patients.
1 Like
8

My limited experience with PASes in NZ agrees with all four of those EHR points.

I would add that an EHR which supports customisation - without breaking vendor support agreements - is a much more attractive proposition than one where you need to lobby the vendor and the entire international user base for any changes to be agreed upon.

Re. point 4, I’m often impressed at our staff’s willingness to don their rose tinted specs and see through some of the UI/design flaws of these systems. Things that I would be grumbling about regularly, they often seem content to tolerate indefinitely - and they even say so!
A pragmatic bunch, our healthcare colleagues.

1 Like