Expert sounds alarm bells over upcoming NHS data platform

Research warns not to make the same mistakes as other electronic patient record systems

A leading expert has warned that the value of the NHS's Federated Data Platform (FDP) will depend on usability testing if it is to improve patient safety and efficiency in the UK health service.

In late December, a month after the FDP was finally awarded to Palantir – the contract for which was heavily redacted – Helen Jones, senior safety investigator for the UK's Health Services Safety Investigations Body, pointed out the harms done by patient record systems in recent years.

In April last year, a $10 billion Oracle Cerner project in the US ground to an indefinite halt following repeated problems with the rollout of electronic patient records (EPR), some of which caused physical harm to patients.

The Department of Veterans Affairs announced that EPR deployments would be stopped while it focused on improving five sites that used the new EPR as part of a larger program reset. The department has since said it is renegotiating its contract with Oracle to hold it accountable for the deployment.

More recently in the UK, County Durham and Darlington NHS Foundation Trust admitted that as of October last year, 1,394 letters or documents were not sent from hospitals to family doctors for the year 2023/24. "Since November 2022 2,117 incidents have had this option selected; however, only three have been deemed to cause patient harm," the trust said in November in response to a Freedom of Information Act request.

Jones said the NHS's FDP would enable every NHS trust and integrated care system to connect and share information between them. "This type of digitised, connected system would enable services to be delivered more effectively and efficiently, with the patient front and centre," she said in a blog.

However, she warned that incidents involving EPR systems showed how patient safety should be a consideration too.

She pointed out that a number of investigations suggested a lack of interoperability between patient records and other IT systems across services. For example, a 43-year-old epileptic inmate suffered multiple seizures after his medication was not transferred with him to a new prison because essential information could not be automatically shared across the healthcare records and operational IT systems.

Cases show that failures in usability testing also led to safety problems in patient treatment. Jones cited a situation where a four-year-old child suffered harm after receiving 10 times the intended dose of an anticoagulant on five separate occasions due to an undetected prescription error recorded on a patient record system. "We found that the usability and functionality of the EPR had not been assessed through user-testing across a range of different settings during the design process," she said.

Jones also highlighted a lack of standardization in EPR software systems. "Testing and standards can help ensure that staff and patient interactions with the EPR system can be better understood to help identify the systems strengths and weaknesses and identify potential errors that could result in harm to patients," she said.

Health department quango NHS England says the FDP will provide software to link NHS trusts and regional systems and offer a consistent technical means of linking data that is already collected for patient care. Making the data available in a "federated" manner would help clinicians and healthcare planners access the information they need to do their job, "freeing up time spent on administrative tasks and enabling them to deliver the most appropriate care for patients."

However Jones warned that any EPR system needs to plan for interoperability or put in place processes to manage poor interoperability. Vendors should also understand human factors and user-centered design, and commit to testing with the staff who will actually use the system. ®

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