Electronic records are less efficient than paper, finds DH research lead

14 Dec 09

Professor Trisha Greenhalgh, professor of primary healthcare at University College London, led a review of hundreds of previous studies from all over the world, which found that large systems such as that being developed by Connecting for Health, are less efficient than locally-based systems and often less useful than paper records.

Professor Greenhalgh’s research will come as a particular body blow as she is heading up the ongoing UCL study commissioned by the DH into the effectiveness of the patient electronic care record rollout.

The study, which began in 2007, is published today and is the second major blow to the project in the past few months.

The Government has pledged to slash £5bn from its budget by 2012-13 by measures including cutting back the NHS IT Programme and Tories are already planning to contract a string of NHS IT systems out to private providers.

Despite this, the patient electronic care record rollout is about to embark on its next big phase in January, when millions of patients across London will be given three months to opt out, or have records automatically created.

But the study published today, in the US journal Milbank Quarterly, identifies what the researchers claim are ‘fundamental’ problems with the design of such systems, finding that:

• While secondary work like audit and billing may be made more efficient by electronic patient records, primary clinical work can be made less efficient;

• Paper, far from being technologically obsolete, can offer greater flexibility for many aspects of clinical work than the types of electronic record currently available;

• Smaller, more local EPR systems appear to be more efficient and effective than larger ones in many situations and settings;

• Seamless integration between different EPR systems is unlikely ever to happen.

Professor Greenhalgh said: ‘EPRs are often depicted as the cornerstone of a modern health service. According to many policy documents and political speeches, they will make healthcare better, safer, cheaper and more integrated. Implementing them will make lost records, duplication of effort, mistaken identity and drug administration errors a thing of the past.

‘Yet clinicians and managers the world over struggle to implement EPR systems. Depressingly, outside the world of the carefully-controlled trial, between 50 and 80 per cent of EPR projects fail – and the larger the project, the more likely it is to fail.

‘Our results suggest it is time for researchers and policymakers to move beyond simplistic, technology-push models and consider how to capture the messiness and unpredictability of the real world.’

An interim report in September from Professor Greenhalgh’s ongoing study for the DH already found next to no evidence the record had produced any improvement in care in the areas in which it had been rolled.

It found the record was likely to make a limited contribution to A&E care, was plagued by IT problems and often failed to work in out-of-hours care.