The Electronic Patient Record (EPR)

Since the 1980s computers have increasingly become a part of our daily lives. Initially this was at work, but gradually they have become part of our home lives too. Now we don't even think about the computers that surround us: from mobile phones to the washing machine, in our cars, mobile music players, alarm clocks... what doesn't have a computer chip inside it these days?

So it was natural we should look to computers to help manage the enormous task of keeping our health records safely and accurately. The RCN plays an active role in advising on EPR systems at a national and local level. 

What is the EPR?

What would you want from an electronic patient record? Let's start with the basics:

Finding information

You want to get information about your patient, what care they have had in the past, where, by whom, etc. Electronic records have a lot to offer here, by giving you access to records from other parts of the service, letting you search for specific information, and much quicker than having to flick through paper notes. And you can read them.

Updating the record

You want to enter data about your own contribution to care. You want it to communicate this to others who need to know.

That's the least you would expect from a record system, but we could ask for more. 

How might the EPR actually improve care?

Encouraging best practice

We can ensure our documentation is based on the latest and best practice standards.

Warning and prompting

Where something might be dangerous, the EPR system should warn us, for example an allergy or drug interaction. It could prompt us to take action, for example if something is overdue, or a referral to a specialist.

Helping us make decisions

The EPR can include links to evidence, educational resources or specific decision-support tools.

An EPR system that included all this, and was easy to use, would make a positive difference to patient care. It would be the hub for all the communication that goes on around a patient's care.

Please go to the eHealth Case Studies page for examples.

How far have we come?

While health care providers, information technology companies and governments are making progress with all the above, it has been slower than the optimistic predictions for electronic patient records back in the 1980s.

Progress has been patchy while the technology has developed at breakneck speed offering us more powerful and cheaper computers and other hardware, but our ability to use it has lagged behind.

What are the problems?

It might sound strange, but when you use a computer to do something, it makes you think about what you are doing, why and how you are doing it. If a paper form doesn't have space for something, you just write in the margin. If it's important you can write in red pen, you can write what you like or even draw pictures.

On a computer, you might have to choose from a list or tick a box. If you can type, it will be in a box. Of course, having the data in a more structured and predictable format makes it easier to process.

So, with paper systems, people can work around problems, whereas on the computer you may be confronted by them.

For the nursing workforce, there are also problems getting access to computers where and when you need to use them. Issues of confidentiality and security, training needs, organisational politics and scarce resources have to be addressed too - the EPR is not just as simple as putting computers into wards.

Change and the future

Underlying all this is the fact that health care is changing rapidly, and patients are increasingly expecting to be part of our 'system'. People attend health care not just with a collection of issues, symptoms or needs for care, but with a printout from a web site and the expectation that you'll know all about new approaches to care.

The EPR of the future must support the nurse-patient relationship, with shared decision-making, and patient access to their personal record and health information.

Designing and delivering effective EPR systems is quite a challenge, but it's also an opportunity: supporting better practice, new ways of working, better information on outcomes, and demonstrating the contribution which the nursing team make to health care.

Useful links

The RCN is in agreement with a vision statement from the Royal College of Physicians which emphasises the importance of focusing the development of electronic patient records on supporting the care of the individual patient.

The case and the vision for patient-focussed records can be accessed from the Royal College of Physician's health informatics webpage.

The Royal College of General Practitioners' (RCGP) health informatics group webpage contains guidance documents on patient access to their electronic records.

The RCN is contributing to the RCGP led Shared Record Professional Guidance (SRPG) project. This will develop a set of professionally-led guidelines that considers the governance, medico-legal and patient safety consequences of Shared Electronic Patient Record (SEPR) systems in primary care.