Measuring the Scale of Hospital Health Record System Fragmentation in England

Abstract

Many patients experience a fragmented health care journey that involves transitions of care between different hospitals. Ineffective sharing of health data between hospitals can impair the delivery of safe, high‐quality care. This study aimed to identify the unmet need for interhospital data sharing by quantifying the movement of patients between acute hospital trusts and health record systems in the NHS in England.This retrospective observational review examined Hospital Episode Statistics (HES), a national hospital administrative dataset relating to patient encounters with the NHS in England. Outcome measures included the frequency of patient encounters with multiple hospital trusts and the frequency of consecutive encounters with hospitals using different health record systems.All adult patients with inpatient, emergency department, or outpatient encounters at acute hospitals in the NHS in England during the 12‐month period from April 2017 to April 2018 were included.21,286,873 patients were involved in 121,351,837 encounters at 152 included NHS trusts over the one‐year period. There was limited regional alignment of electronic health record (EHR) systems in the 117 (77.0%) hospital trusts that were using EHR systems. 15,736,863 (73.9%) patients had two or more encounters with the included trusts and 3,931,255 (25.0%) of those attended two or more trusts. Over half (53.6%) of these patients had encounters shared between just 20 pairs of hospitals. Only two of these pairs of trusts used the same EHR system. On 11,017,767 (9.1%) occasions, patients presented to a hospital using a different EHR, or paper record system, to their previous hospital attendance.This study found that nearly four million patients accessed care at two or more different NHS hospital trusts over the one‐year study period, highlighting the demand for effective interhospital data sharing. Most of the pairs of hospital trusts that commonly share patients do not use the same health record systems. The fragmented distribution of health record systems that exists in the NHS in England represents a significant barrier to interhospital data sharing and interoperability.To make informed and safe decisions for patients negotiating increasingly complex health care systems, clinicians need the right information about the right patient in the right place at the right time. The findings from this study provide guidance for policy makers, clinicians, service managers, researchers, software providers, and patients to better understand and improve how data may be shared between hospitals. The methods used in this research could be applied to health care systems in other settings to guide the procurement and coordination of EHR systems to promote interoperability and effective data sharing.National Institute for Health Research (UK).