UK EHR Landscape

I hadn’t posted much about the UK, and so I thought I’d post (with permission) this email I got from a regular commenter DKBerry about the UK EMR world. I find it fascinating that one EHR vendor owns 50% of the private EHR market in the UK. Polar opposite of our world, no? Now to his email:

Have you ever presented any information on the United Kingdom’s efforts?  Everyone thinks that the entirety of the UK healthcare system is run by NHS.  NHS operates the secondary care facilities … but the primary care practitioners are private … and are contracted by NHS.  Unlike the U.S. where there are 300+ EHR vendors in the U.K. there are only a handful.  Literally.  Egton Medical Information Systems (EMIS) has over 50% of the private GP market in the U.K.

Thought you might appreciate this … Don

From this article

“EMIS and INPS software users in the UK represent around 75% of GP practices and together hold approximately 46 million electronic patient health records.

The formation of Healthcare Gateway Limited allows real-time interoperability with GP systems and other healthcare professionals within the NHS. This has the potential to significantly increase efficiency in the NHS in addition to improving patient care.”

From the EMIS Wikipedia entry:

“EMIS chose not to be one of the major current GP computer providers initially included in the proposed National Programme for IT(NPfIT) due to issues surrounding the lack of system choice for GPs.[1]

The disenfranchisement of General Practitioners and the resultant political change which affected the NPFIT led to the creation of the GPSOC (General Practitioners System of Choice) programme which allowed individual GPs to choose their own system for storing electronic patient notes. As a result EMIS are now involved in the GPSOC programme.

As of 2009, of the 5000 practices using EMIS, 40% are now able to transfer notes electronically with the GP2GP electronic record transfer software to other GP practices using either EMIS or INPS Vision.[3] In 2009 EMIS is also to release its next generation system, EMIS Web, which (with other interoperability initiatives pioneered by EMIS) is intended – subject to patient consent – to allow patient data to move freely and safely not just between GPs but also elsewhere within the NHS (Accident & Emergency, Out of Hours, Hospitals, Community Nursing, etc.).”

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

3 Comments

  • I remember the recent item on EHR in Nigeria … and comment from one poster who wondered how other countries similar to the U.S. handled EHR deployment. So I’d been thinking about posting something on the U.K. and EMIS for awhile so sent my note backdoor to John.

    For those unfamiliar with U.K. healthcare system… we all know a little bit or more about NHS. NHS funds the national (England, Scotland, Wales, Northern Ireland) and then regional trusts. The regional trusts run the secondary care facilities and contract for primary care services with primary care “surgeries” at a per capita rate for all primary care services for a segment of the local population.

    Everyone has an assigned PCP. Where there is insufficient private capacity … NHS has established its own surgeries to augment. Some time ago in an effort to expand primary care services after hours NHS told its primary care practitioners they needed to service their patients 24/7. PCPs pushed back from that … creating a second PCP service initiative with Out of Hours surgeries covering for PCPs who didn’t want to work 24/7.

    Because of the requirement to service patients 24/7 and the fact that ED’s do not provide primary care services in the U.K. There was compelling reason for PCPs to adopt an EHR that their “After Hours” partner practice could then access and provide treatement as if it were their own patients.

    One of a few EHRs has been adopted by nearly every private PCP without any NHS incentive money. While very successful … implementation of an EMR system at NHS’s secondary care facilities has been a failure. Problems with the vendors has been a problem but much of the problem is due to the different management of the facilities even though they employ the same procedural standards. The VA model should work in the UK … but for some reason has not been at all successful.

    Others may have some points which differ from mine and would help paint the picture on how the UK compares to the US … and why the difference in the success.

    Interesting … I’d read a piece some time ago … but EMIS while it has product deployed in Canada, Austraila, and New Zealand … deliberately chose to not enter the U.S. EHR market.

  • Is there a capability to create a longitudinal view of the patient, one that goes across the primary and secondary care environments? What access, if any, does NHS have to the PCP patient care records; clinical, administrative and cost data?

  • Jodi… sorry for the delay responding.

    As I understand it … there is limited ongoing “longitudinal” view of a patient across both primary and secondary care. The NHS secondary care facilities may be provided a copy of the patient’s primary care records electrically or hard copy depending on the technical capacity of the NHS facility.

    NHS does not have an on line national electronic access down into a PCPs records of their patients.

    NHS is not like CMS with a national headquarters building … NHS is a system and while the facilities are funded from the UK parliament to the English, Scottish, Welsh, and N Ireland authorities… and then to the local primary care trusts.

    The regional primary care trusts contract with the physicians to provide coverage to each citizen at a negotiated capitation rate. Also contracted are the out of hours services also at a capitation rate. The trust is also the authority which funds the secondary care facilities. Interesting in the UK … primary care is king. PCP ‘surgeries’ are privately operated … and contracted by the trust. The specialists are employees of the NHS and the secondary care facilities. Typically pay sucks for the specialists compared to the primary care docs.

    Remember too … the broader deployment of EHR in the UK is at the primary care segment to enable contracted PCPs to be able to share records with the out of hours service providers.

    So to your original question … “is there a longitudinal view?” … not so much as there is a lateral view when you recognize the out of hours surgeries mostly provide urgent care primary care services or augment basic primary care services for those with conflicts unable to see their PCPs during clinic hours.

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