IDCR, EMRAM and Meaningful Use in the NHS: 'Paper Independence' is a realistic goal

Acronyms and jargon were in the ascendant as NHS England unveiled its roadmap for the future of electronic patient records. The new Integrated Digital Care Record (IDCR) provides a framework for NHS Trusts to procure technology that enables electronic patient records to be used across all care settings – including social care – and be accessible to patients. IDCR provides a maturity index that illustrates an organisation’s progress toward a fully integrated care record. 

One of the first questions that sprang to mind was whether this was needed at all. Since HIMSS Europe adapted its established EMRAM (Electronic Medical Record Adoption Model) to the European setting, surely that provides a clear measure by which an organisation can state that “Yes, we have an electronic medical record. We are paper-free.” There are a number of differences between the HIMSS model and the IDCR.

• IDCR addresses all care settings. Whilst the IDCR seeks to provide an integrated record for all care settings, the EMRAM focuses its attention on acute. In this respect, EMRAM is more suited to England, especially as it seeks to include social care into its model.
• EMRAM provides a route map. The EMRAM model provides a defined route of incremental steps toward achieving a paper-free medical record. In order to achieve Stage 7, a hospital must have achieved stages 1-6 in order - stage 4 cannot be completed before stage 3, etc. The IDCR model uses an aggregated scoring system to provide organisations with an overall view of their progress toward an integrated digital care record. On the surface this offers more flexibility, but sometimes when you want to get from A to B, you want a direct route, and a plethora of choices will only delay the moment when you finally set off. 
• IDCR acknowledges the role of document management. The HIMSS EMRAM focuses on clinical systems without acknowledging that 25-50% of patient information lives outside of these systems. The requirement for electronic document management is implied but never made explicit. In order for clinicians to achieve a genuine single view of the patient, they need integrated access to this information. Electronic document management (EDM) provides this, and the IDCR explicitly identifies EDM as a key technology. 
• The IDCR initiative also marks a step along the journey to the adoption of US-style Meaningful Use standards. NHS England have stated that there is not time to develop a Meaningful Use standard for the NHS, but that there is a desire to build partnerships with vendors to identify and promote best practices. Eventually this could turn into an English Meaningful Use model, with Trusts being encouraged (whether it be pushed or coaxed) to adopt “accredited” technologies. 

Paper will not be totally eliminated from the NHS by 2018. However, by encouraging good practice through Meaningful Use, and by working toward a defined integrated digital care record, organisations can make it unnecessary for any of their business processes to require paper documents. The achievement of “Paper Independence” is a realistic goal.