This appeared in the UK last week.
Speculation of national Epic deal with NHS England
Could we see a national deal for the Epic electronic patient record? Jon Hoeksma speculates and explores what this could mean for the healthcare system.
Jon Hocksema – 7 October, 2021
Speculation about a national deal between NHS England and US electronic patient record (EPR) supplier Epic were fanned last week a decade on from the end of the NHS National Programme for IT.
Rumours have been circulating over the summer that Tim Ferris, the new head of digital transformation at NHS England, is a big advocate of the system and has told colleagues it should be used by many more trusts.
Highly regarded Ferris joined NHS England from Massachusetts General Hospital, which in 2016 deployed Epic in a programme reportedly costing almost a billion dollars.
Ian O’Neil, the current director of transformation at NHS England, indicated at an industry conference in London last week that there have been recent high-level meetings with Judy Faulkner, the founder of Epic, but declined to give details of the topics under discussion.
In response to subsequent questions from Digital Health News on whether negotiations on a national deal were underway with Epic, the NHSX press office sought to play a straight bat with a ‘move along, nothing to see here’ type statement:
“In response to your questions about supplier discussions, it is standard practice for NHS digital leadership to meet on a routine basis with technology vendors currently providing services to the NHS.”
As to what any meetings covered:
“Meetings cover a range of topics, all with the aim of ensuring that vendors are working towards the vision and priorities of the NHS, particularly within the context of strategies such as What Good Looks Like and Data Saves Lives (Reshaping Health and Social Care With Data).”
The idea of procuring a single national EPR system for all hospital trusts in England was the central pillar of the failed NHS National Programme for IT (NPfIT) that ran from 2003-2011.
In subsequent reports and investigations of the NPfIT the National Audit Office concluded that the top-down national approach had failed to recognise the very different local circumstances between hospitals and failed to secure the support and commitment of local clinicians.
So far this is all in the realms of rumour and speculation. There were also said to have been discussions with Epic in recent months on whether it could potentially offer its system as a platform for use across Integrated Care Systems (ICSs)
As the NHSX press statement says, it’s perfectly sensible for NHS agencies to have meetings with all its key software and technology suppliers. And it is to be hoped that other suppliers are enjoying similar discussions and access.
Just imagine a moment
But just suppose for a moment that some kind of national deal for making Epic more widely available were under discussion, and again this is only speculation, what might it look like and what might it cost?
The cost of an EPR varies hugely depending on supplier and local organisation and there is a distinct lack of transparency on pricing. An NHSX source last week told Digital Health News that new work was being planned to get better data on pricing.
What price an EPR?
Best estimates suggest that NHS hospital EPR deals typically weigh in somewhere between £20million – £100million over ten years.
Epic is at the very top end of that scale, in the realm of roughly £80-100million (call it £90million average) over ten years, with most of the money not going to the software vendor but in infrastructure and dedicated staffing to implement, install and run the software. The split is said to be roughly thirds.
But the costs can be far, far more, Cambridge University Hospitals back in 2014 had a £200m budget for its digitisation programme as the first Epic site in the NHS.
Guys and St Thomas’ NHS Foundation Trust’s Epic project is reportedly significantly in excess of £175million.
Manchester University Hospitals NHS FT has a budget of £181million, while Northern Ireland has a budget of £275million and Frimley Health NHS FT a budget of £108million.
These types of projects are the single largest investment most NHS hospital trusts will make other than the physical buildings.
There are currently 138 acute trusts in England and Epic is in use at five of them: Cambridge University Hospitals, University College London Hospitals, Great Ormond Street and Royal Devon. A number of further NHS trusts in the process of implementing the system.
So, say for the sake of argument, and suspending all competition and procurement rules, that there are about another 100 NHS acute trusts to be funded to get the system – what would be required?
So the 100 acute trusts paying an estimated £90million would come to a total of roughly £9billion. Let’s round it up to £10billion to allow for a little contingency and modest management consultancy fees.
Lots more on rationale and benefits here:
https://www.digitalhealth.net/2021/10/speculation-of-epic-deal-with-nhs-england/
In Australia there are a range of unique barriers.
First there is a pretty dominant provider in the form of Cerner in at least 3 States.
Second the other States have or are getting new systems implemented.
Third the States themselves are possibly a barrier.
Fourth there is Medicare Billing which is quite complex and has tested many system vendors.
Fifth it would be pretty expensive!
The key positive is that it has been implemented here (RCH) and is clearly a very, very good system!
What do others think?
David.
Sadly, I think the public health sector in Australia is far too fragmented and fundamentally broken for a universal solution. Medicare's run at a federal level, and many of the states receive funding for health from the federal government.
ReplyDeleteBut even just in NSW, the state's own systems are not uniformly deployed, even among the public hospitals (let alone the private hospitals/practices). The state public health system is broken down into LHDs (Local Health Districts, today's term for regional health organisations that have over the last 20 years grown, shrunk, changed, split, merged, split again, etc - there's no long-term stability at all), and those LHDs largely all do their own thing - significant effort and cost are then involved in merging the results from those LHDs into a state system (for billing, maintenance of a common health record/etc).
Some systems are mandated - a state-wide medical records data warehouse for instance, and LHDs receive funding to manage project to integrate with those systems - but some groups take the state money and then ignore their responsibilities because they're spending a fortune running their own bespoke systems and are stone motherless broke with no control of their spending. Corruption is rife (tenders for unnecessary systems awarded to former employees without going through proper tender processes), IT is run by such a mix of competency (there are some great staff, there are some absolute shockers - nurses [who've largely forgotten about patient care principles] who once accidently touched a PC at home in the early 1990s are now IT management - up to the CIO level - given the pathetic pay rates at that level though, this isn't surprising, frankly). I'm surprised we haven't lost more patients due to complete screwups due to a mix of complexity, incompetence and "NMFP" thinking.
Until some fundamental issues with governance of health (the LHDs simply need to be pulled into line, and if government want competence in senior leadership positions, they need to pay for it - paying a "CIO" $160k is a joke), there's just no way that a central solution can be implemented without just making things even more complicated than they already are.
re "Sadly, I think the public health sector in Australia is far too fragmented and fundamentally broken for a universal solution."
ReplyDeleteThen there's the public/private divide with people moving between them at will.
The advice is to fix the system first, then fix the IT.
You cannot do it the other way round. If you try to fix the IT first, all you do is make it harder to fix the system later.
Yes, however in order to 'fix' the system as the first and highest priority you need to deploy the power of IT as a tool, as a catalyst, as a driver. It is not feasible to attempt to 'fix' the system absent IT. Without the 'help' of IT the political, cultural, professional, and deeply ingrained procedural force at play will block any attempt to 'fix' the system no matter how hard you try.
ReplyDeleteAs a minimum you need to know how you are going to fix the system and and how you will transition. That allows you to plan what IT you will need and how you are going to implement it.
ReplyDeleteIf you deploy the IT first, without knowing what IT you will need, you are making life hard.
You may have to change both the system and the IT at once, but the first thing to do is to know where you are going.
Using IT to dictate (i.e. drive) changes to the system sounds backwards to me. It certainly hasn't worked so far. Just look at the number of medical record systems implemented since 2012.
I completely agree Bernard that … “you need to know how you are going to fix the system and how you will transition. That allows you to plan what IT you will need and how you are going to implement it.”
ReplyDeleteI certainly was not suggesting deploying IT first without knowing what IT you will need” – absolutely not. I fear you may have misinterpreted my comment. Nor was I proposing … “Using IT to dictate (i.e. drive) changes to the system”.
It’s quite reasonable to suggest … “the public health sector in Australia is far too fragmented and fundamentally broken for a universal solution”. However, the nub of the discussion lies in the phrase “fix the system”. That drags the conversation back to the most basic of questions, viz:
1. What is wrong with the system and why is that so?
2. What is right with the system and why is that so?
That is the beginning of the ‘journey’ and somewhere along the way it will become necessary … “to deploy the power of IT as a tool, as a catalyst, as a driver to ‘assist / help’ in ‘fixing’ the system.