Any doctor will tell you that, the more complex the case, the more likely that diagnosis will involve some measure of detective work. Practically speaking, that means delving into the patient’s medical history to find the crucial piece of evidence pointing to this or that ailment – a simple enough exercise if the relevant records are easily available. Until recently, this wasn’t the case at Health and Social Care Northern Ireland (HSCNI), with patient histories scattered among disparate digital systems or buried in endless reams of paper files.
Predictably, this led to diagnostic delays, frustrating doctors and patients alike. “It was always very difficult to get information that was up-to-date and accurate,” says Neil Martin, the director of strategic planning, performance and ICT at the Northern Trust, one of HSCNI’s regional branches. Some technical relief was afforded by the introduction of the Northern Ireland electronic care record (NIECR) in 2013, which sucked up information from multiple systems to provide a more unified view of patient data. Even then, says Martin, the system didn’t provide the granular detail on patients most clinicians needed to liberate them from the tyranny of paper files.
The solution, as it turned out, was an electronic health record named ‘Epic.’ Created by a homonymous medical software firm based in Wisconsin, the EHR allowed medical organisations to unite all relevant clinical patient data into a single transferrable document. ‘encompass,’ the name given to the sequential rollout of Epic across HSCNI, would – in theory – allow clinicians to go about gumshoeing with minimal delay. With the introduction of Epic, says Martin, medical professionals could now “see their patient’s entire clinical history at their fingertips.”
Bringing end-users up to speed with this newly digitised workflow was no easy task. The rollout first necessitated a significant data migration project – 850,000 records in one HSCNI branch over a single weekend, Martin recalls – as legacy systems were cleansed and their data, from active referrals to waiting lists, uploaded to Epic’s EHR. Deploying Epic at scale also meant the rollout of thousands of new handheld ‘Rover’ devices, not to mention portable laptop stations that could access the system via cloud applications to every department across the Six Counties.
Martin’s 20-strong project management team then had to acclimatise 12,000 fellow staff members to this new workflow without disrupting their ability to treat patients. To do so, they had to “make encompass everybody’s project,” explains Martin, training one in four members of staff to become ‘super-users’ of Epic so that anyone else who ran into trouble using the new system could have a helping hand at a moment’s notice. To make the transition even smoother, the local IT team was also supplemented by staff from Epic Systems, who arrived at go-live to aid with any troubleshooting issues.
Epic’s introduction certainly had some teething pains. A common complaint among clinicians using the system worldwide has been the complexity of its workflow, which “required too many clicks,” according to Shannon Germain Farraher, a senior analyst at Forrester. One junior doctor who was present for the launch of Epic to the Southeastern Trust in late 2023 told Tech Monitor that, while her productivity did take a short-term hit thanks to the transition, she adapted fairly quickly to the new system. Now working at a trust still reliant on paper-based records, she says, “I do miss Epic.”
Over time, argues Martin, Epic will become more intuitive for individual end-users if they harness the platform’s customisable dashboards and shortcuts. “There are a lot of people struggling to deliver the same productivity as before because they’re still understanding all the different clicks,” says Martin. “But we’re taking baby steps and there’s a lot of growing to be done.”
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