Health Select Committee Inquiry into the Electronic Patient Record and its use
1.0 Findings of the RCN E-Health Survey 2007
1.1 The RCN E-Health Survey 2007 investigated nurses views on IT development and the Electronic Patient Record (EPR). The survey found that nurses overwhelmingly welcomed the EPR but as the RCN’s written evidence put forward, that there is a continued lack of clinical engagement, consultation and training in the development of the EPR. The RCN believes that nurses should fully engaged in the EPR in order for the NHS to meet its current and future healthcare challenges and continue to deliver improved patient care, access and quality.
1.2 The survey was conducted in June 2007 and is the fourth survey to be carried out with three previous surveys undertaken in February 2004, May 2005 and June 2006. The views of 2,635 nurses were surveyed from a wide range of specialties and grades from across the UK. It should be noted that this survey was carried out online and the respondents to the survey are by definition already familiar with IT and possibly more highly skilled than the nursing population as a whole.
2.0 Electronic Patient Record
2.1 An overwhelming majority 94% of respondents had heard of the EPR before taking part in this survey and two thirds of the respondents welcome the introduction of EPR. Of those who have never used EPRs 61% welcome its introduction.
2.2 Many respondents had received little information about IT developments in general in the NHS, with 17% having received none and 56% “a little”. Also, little information has been received from relevant agencies concerning EPR developments in the NHS. The main source of information for respondents about EPR is their respective Trust or Organisation, the media and colleagues.
2.3 Overall, 42% of respondents believe that the NHS can deliver an EPR for all patients in the foreseeable future, while 28% are uncertain and 30% do not believe this is achievable in the near future. Those who are already using EPRs are more positive than those that have not used EPRs, although of those who are already using EPRs 26% do not believe that the NHS can deliver an EPR in the foreseeable future and 20% are uncertain.
2.4 Nearly all respondents 92% feel that it is very important/fairly important to have consultation about the EPR with individual practising nurses. However, only 11% have had “a great deal” or “quite a lot” of consultation. As one might expect, those respondents already using EPRs had received more consultation than those who had never used EPRs. Overall, 66% have not been consulted about EPRs.
2.5 Opinions as to whether respondents feel ready for the introduction of EPR vary considerably, with 46% in agreement, 43% disagreeing and 12% uncertain.
2.6 Half of the respondents thought that EPRs would improve patient safety, with the rest uncertain (29%) or unconvinced (21%). Opinion was divided exactly on whether the EPR will save nursing time, even among those already using EPRs.
2.7 31% of respondents felt that EPRs threaten patients’ confidentiality while 43% disagreed with this. However, 39% felt that the EPR will be more secure than the current paper-based system, although there was a high level of uncertainty about this with 32% being unsure.
2.8 Overall 43% of nurses felt that EPRs would improve patient care, but 24% disagreed. Those who were already using electronic records were more positive towards the EPR improving clinical care.
3.0 IT skills and use of technology
3.1 The study shows that an overwhelming majority 91% of respondents have access to a computer both at home and at work. Almost all respondents use their computer to get information from the Internet.
3.2 The majority of respondents state that they share the computer they use in their immediate clinical setting, with only 30% having sole access to one. Only 1% of respondents felt they did not need a computer and 68% felt their access to a computer at work was adequate for their needs.
3.3 55% of respondents indicate that they have received no IT training within working time in the last six months and 23% have received either half a day or a whole day. Extra training is widely desired among the respondents to consolidate their existing IT skills before being able to use EPR, with only 20% of respondents feeling that they did not need extra training. A respondent commented that:
“Due to the inability to get off the ward for training (staffing levels) it is difficult to get off the ward to get to computer sessions.”
3.4 Overall, IT support when there are problems with computers at work is considered to be good.
4.0 Summary and Conclusions
4.1 The introduction of the Electronic Patient Record (EPR) seems to be welcomed by the majority of nurses, even by those who have no experience of it. Only a minority of nurses are currently using EPRs. Those that are using EPRs are generally more favourable towards it than those who have not. However, there appears also to be a note of caution from those already using the EPR. For example 30% do not feel that the security of the EPR will be better than the current paper-based systems, 29% feel that the EPR threatens patient confidentiality, and 42% disagree that the EPR will save nursing time.
4.2 Consultation, training and information about IT developments in the NHS appear to have changed little from last year and little from previous surveys. The EPR is viewed as beneficial by the majority of nurses with the following comment by a respondent a typical example:
“I believe that EPR will be beneficial, but I do feel that so far resources in training and equipment have been very poor. The NHS has set specific timescales to our trust and our trust cannot fulfil this due to inadequate training and hardware facilities. In my area alone we have four terminals for 38 staff and only six individuals have been able to access official training in EPR.”
4.3 Whilst the experience is generally positive of those nurses that are already using EPR, a significant proportion of current users indicate reservations about the benefit to patient care. Notably, the perceived effect of the EPR on clinical care continues a downward trend with now only 42% of respondents believing it will improve clinical care compared to 70% in 2004.
4.4 Many respondents have received little information and had little consultation about IT or EPR developments and a huge majority feel that consultation with them is important. Furthermore, consultation on IT developments does not appear to have changed with 62% not having been consulted in 2006, 66% in 2007 and 63% in 2004. This is a key issue of concern for the RCN as the ability of nurses to use EPR effectively is dependent upon engagement with this clinical group.
4.5 The survey highlights a high degree of uncertainty about the EPR which suggest a lack of knowledge for instance:
• 26% do not know if they welcome the introduction of an EPR
• 28% do not know if the NHS can deliver a in the foreseeable future
• 29% do not know if they will improve patient safety
• 32% do not know if EPRs will be more secure than the paper-based records systems currently in use
• 26% do not know if EPRs will threaten patient confidentiality
• 34% do not know if EPRs will improve patient care.
4.9 Nurses responding to this survey believe that their IT skill level is quite high - although as already mentioned the respondents to this online survey are by definition already familiar with IT. However, the respondents recognise that they need further training, although the majority have not received any in the last six months. IT training given to nurses appears to be at the same level as 2006.
4.10 In conclusion the RCN welcomes the EPR as a positive development but there remain concerns about the lack of engagement, consultation and training with the clinical team in order to use the technology effectively for the benefit of patient care.
Contact: Alison Cairns
Head of Government & Parliamentary Relations
RCN, 20 Cavendish Square, London, W1G 0RN
RCN July 2007