EPR Models: checklists or constraints?
I was reminded of the good old six level Electronic Patient Record (EPR) model that originally appeared in Information for Health back in 1999 through a posting on the E-Health Insider group on LinkedIn. For those of you who haven't seen it or have maybe forgotten it, here it is...
- Level 6 Advanced multi-media and telematics Level 5 plus: telemedicine, other multi-media applications (e.g. picture archiving and communications systems)
- Level 5 Speciality specific support Level 4 plus: special clinical modules, document imaging
- Level 4 Clinical knowledge and decision support Level 3 plus: interactive care pathway support, electronic access to knowledge bases, embedded guidelines, rules, electronic alerts, expert system support
- Level 3 Clinical activity support Level 2 plus: electronic clinical ordering, results reporting, prescribing, passive multi professional care pathways
- Level 2 Integrated clinical diagnosis and treatment support Level 1 plus: integrated master patient index, departmental systems
- Level 1 Clinical administrative data Patient administration and independent departmental systems
Unfortunately, it never really influenced NHS thinking outside of the IT department. Most Chief Executives hadn't heard of it and---dare I say--neither had some IT directors. To some extent this ignorance paved the way for the NHS National Programme for IT. Now the HIMMS EMR adoption model gains in popularity.
But I am not sure that these models are any good at all, other than as a communication tool. At a time when healthcare should be looking sideways to its partners and forwards to its customers, these models encourage introspection. Good IT Directors will implement a strategic plan appropriate to their organisation's starting point and to look outwards. At best these models are useful ticklists, at worst misleading anachronisms.