Doctors need to actively engage with EPR roll-out

Doctors must actively engage with the introduction of electronic patient records (EPRs) and help design bespoke systems for their specialties to ensure optimum success, according to a clinical lead for the roll-out of the EPR system in Northern Ireland.

Dr Johnny Cash, Consultant Gastroenterologist and Hepatologist, Regional Liver Unit, Royal Victoria Hospital, Belfast, told the Irish Society of Gastroenterology 2025 Winter Meeting about the experience of the NHS in Northern Ireland introducing its EPR over the past five years.

He said Northern Ireland was the first region in the world to have a unified EPR record for every citizen.

All citizens in the region have been able to access a single digital care record since May, following the roll-out of the encompass patient record system, built in partnership between the IT company Epic and the Northern Ireland health and social care services.

The My Care portal, via the My Care app or web page, was created to coincide with the move from paper patient records to EPRs across the entire Northern Ireland health system. The system, however, is not yet fully integrated with general practice.

Introducing an EPR system is a mammoth undertaking, and brings significant organisational, data sharing, and training challenges, but has substantial benefits for healthcare practitioners and patients, Dr Cash said.

These include instant access to relevant patient records and test results across different healthcare services, and the ability to comprehensively monitor diagnosis and treatment trends, and clinic data, while being further enhanced with the use of artificial intelligence applications. Dr Cash said EPR systems can also halve medication errors and improve patient flow.

The Northern Ireland system can link in to share data and expertise with hospitals in England with the same system.

‘Pop-ups’ and modules on EPR systems can be customisable to specific specialties, hence the need for clinical leads in each medical specialty to be involved in designing and refining EPRs for their areas, he said.

Training is a major part of the implementation process and key to the uptake and success of EPRs, noted Dr Cash, stressing that it must be comprehensive, continuous, and embedded early on.

“It is going to require leadership within each specialty to review the syllabus that is going to be offered to train [healthcare staff], to ensure it is fit for purpose for Ireland… it is very important that local voices are heard,” he told the Medical Independent (MI).

Dr Cash has already given insight from the Northern Ireland experience to healthcare leaders in the Republic, with much learning that could help inform the roll-out of the planned EPR here, he told MI.

When asked if the Republic should consider choosing the same EPR system as Northern Ireland to try to link services where appropriate and conduct all-Ireland research, Dr Cash agreed it would be beneficial. “Absolutely. We have already started that [working together on certain healthcare services like the all-island paediatric cardiology service], writing the data sharing agreements and legal stuff, and ensuring the services in Dublin have the right access to our records and vice versa.”

Data sharing and the legal issues around that are significant and time consuming so the work should be started in advance to prepare, he said.

Physician burnout risk is another key issue that must be acknowledged, due to the ‘always on’ nature of EPRs, especially on clinicians’ personal electronic devices, Dr Cash added.

“My strongest advice is to get involved – don’t let things be done onto you. Get involved and understand from the outset what the system can do for you. It is so powerful under the bonnet… but like a car you can pick and choose how to spec it out, and learn how to maintain it, and if you do that you will have a better product,” Dr Cash concluded.