Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study

Abstract

Background In the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs). Objective Our study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail. Methods Semi-structured interviews were conducted between November 2020 – October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes. Results Fifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging inter-organisational collaboration. Conclusion Tackling poor interoperability will require solutions both at the technical level and in the wider policy context. This will involve demanding interoperability functionalities from the outset in procurement contracts, fostering greater inter-organisation cooperation on implementation strategies, and encouraging systems vendors to prioritise interoperability in their products. Only by comprehensively addressing these challenges would the full potential promised by the use of fully interoperable EHRs be realised.

Adoption by clinicians of electronic order communications in NHS secondary care: a descriptive account

“…14 The UK has lagged behind the international community in developing and implementing CPOE, but CPOE usage is now increasing across the UK. [15][16][17][18] Our aim is to audit uptake of electronic orders over time for diagnostic, therapeutic and support services within the clinically led CPOE system known as the Prescribing, Information and Communication System (PICS) at University Hospitals Birmingham NHS Foundation Trust (UHB). To our knowledge, this is the first study looking at uptake of an ordering system hospital wide within the NHS.…”

“…Much of the literature comes from North America where orders are often connected with billing, which is not needed in the NHS setting 14. The UK has lagged behind the international community in developing and implementing CPOE, but CPOE usage is now increasing across the UK 15–18…”

eHealth implementation in Europe: a scoping review on legal, ethical, financial, and technological aspects

“…Foremost among identified barriers is the intricate challenge of inadequate data connectivity between disparate health systems, or even across disparate versions of a health system (45, 47,50,53,55,58,61,66,67,69,70). This requires harmonizing processes and data across heterogenous healthcare services and facilities (45, 53, 66).…”

“…This requires harmonizing processes and data across heterogenous healthcare services and facilities (45, 53, 66). A significant barrier is the lack of interoperability between technologies and electronic medical records (50,53,64,68), exacerbated by the current phase of EHR rollout (53). Integrating eHealth into healthcare professionals' work practices poses challenges (45, 53), including updating records management to accommodate expanded technology capabilities (45).…”

“…Inadequate data connectivity between IT-systems (including different versions of one system) (45, 47,50,53,55,58,61,66,67,69,70) Develop health technologies that seamlessly integrate with existing workflows and generate interpretable data for clinicians (40,58,67) Lack of integration between health technology and electronic medical records (50,53,64,68) Establish an eHealth infrastructure rather than standalone health technologies (60,67,68) Challenges integrating health technology with healthcare professional work practices (45, 53,67) Create regulatory environments that encourage integration across data sources without stifling innovation (40) Complexities in ensuring that health technology interoperability complies with legal system and protection legislation (67,68) Incorporate a connection between electronic patient files and health technologies (67) Non-transferable data across countries (70) Enable seamless information exchange among healthcare providers within and between healthcare facilities (45)…”